Dr Akester and Partners

Updated 31 May 2017

Dr Akester and Partners, The Holroyd Surgery, Main Street, Kirkby Malzeard, Ripon, HG4 3SE and the branch practice at Masham Surgery, Market Place, Masham, Ripon, HG4 4DZ serve the immediate area and surrounding villages. Both locations were visited as part of the inspection. The practice provides services through a General Medical services (GMS) contract.

The practice is a dispensing practice and dispenses medicines to 95% of their patients. The registered list size is approximately 5,500 and predominantly White British background. The practice is ranked in the eighth least deprived decile (one being the most deprived and 10 being the least deprived).

The practice is run by five GP partners (three female and two male) and a practice manager.

The practice employs four practice nurses and two health care assistants. There is an office manager/dispensary lead supported by 13 administration/dispensing staff.

Both surgeries are open 8.30am to 6pm Monday to Friday and clinics are held throughout the day. Appointments are available until 7pm on Monday and Thursday and emergency appointments are available on a Saturday morning. Out of hours care is provided by North Yorkshire Ambulance Service.

During the inspection we saw that previous ratings were on display at the provider and also on the practice website.

Updated 31 May 2017

Letter from the Chief Inspector of General Practice

We carried out an announced comprehensive inspection at Dr Akester and Partners on 17 November 2016. The overall rating for the practice was good. However, a breach of the legal requirements was found which resulted in the practice being rated as requires improvement for providing safe services. The full comprehensive report on the November 2016 inspection can be found by selecting the ‘all reports’ link for Dr Akester and Partners on our website at www.cqc.org.uk.

This inspection was an announced focused inspection and took place on 16 May 2017 to confirm that the practice had carried out their plan to meet the legal requirements in relation to the breach of regulation that we identified in our previous inspection on 17 November 2016. This report covers our findings in relation to those requirements.

The practice has made the required improvements to meet the legal requirements in the key question of safe and is rated as good.

Our key findings were as follows:

• The practice had ensured that sufficient arrangements were in place for the safe management of medicines, including the recording and dispensing of controlled drugs.

Professor Steve Field CBE FRCP FFPH FRCGP

Chief Inspector of General Practice

Updated 25 January 2017

The practice is rated as good for the care of people with long-term conditions.

• GPs and nursing staff had lead roles in chronic disease management and patients at risk of hospital admission were identified as a priority.

• Performance for the ten diabetes related indicators was higher than the England average in all areas. For example the percentage of patients with diabetes, on the register, whose last measured total cholesterol (measured within the preceding 12 months) was 5 mmol/l or less (01/04/2015 to 31/03/2016) was 91.6% compared to the national average of 80.3%. Longer appointments and home visits were available when needed.

• All these patients had a named GP and a structured annual review to check their health and medicines needs were being met. For those patients with the most complex needs, the named GP worked with relevant health and care professionals to deliver a multidisciplinary package of care.

Updated 25 January 2017

The practice is rated as good for the care of families, children and young people.

• There were systems in place to identify and follow up children living in disadvantaged circumstances and who were at risk, for example, children and young people who had a high number of A&E attendances.

• Patients told us that children and young people were treated in an age-appropriate way and were recognised as individuals, and we saw evidence to confirm this.

• Childhood immunisation rates for the vaccinations given were high when compared to the England average for under two year olds and for five year olds. For example childhood immunisation rates for the vaccinations given to under two year olds ranged from 91% to 100% compared to the England average of73% to 96% and five year olds from 85% to 96% compared to the CCG average of81% to 95%.

• The practice’s uptake for the cervical screening programme was 81%, which was equal to the England average of 81%.

• Open access ‘sit and wait’ surgeries provided patients with access to a GP daily; outside of school hours.

• A full range of sexual health screening and contraceptive services were officered via the same day access service.

• We saw positive examples of joint working with midwives, health visitors and healthy child team.

Updated 25 January 2017

The practice is rated as good for the care of older people.

• The practice offered proactive, personalised care to meet the needs of the older people in its population. For example the practice was proactive in identifying and responding to older patients who experienced social isolation. They worked closely with volunteer groups such as The Red Cross.

• The practice was responsive to the needs of older people, and offered home visits, telephone consultations and urgent access appointments for those with enhanced needs.

• Outcomes for patients in this age range were good.

Updated 25 January 2017

The practice is rated as good for the care of working-age people (including those recently retired and students).

• The needs of the working age population, those recently retired and students had been identified and the practice had adjusted the services it offered to ensure these were accessible, flexible and offered continuity of care. For example access to online appointment and prescription ordering.

• Open access ‘sit and wait’ surgeries including two evening surgeries and weekend access provided patients with access to a GP daily outside of working hours.

• The practice was proactive in offering online services as well as a full range of health promotion and screening that reflects the needs for this age group.

Updated 25 January 2017

The practice is rated as good for the care of people experiencing poor mental health (including people with dementia).

• Performance for the six mental health related indicators was higher than the England average in all areas.For example the percentage of patients with schizophrenia, bipolar affective disorder and other psychoses who had had a comprehensive, agreed care plan documented in their record, in the preceding 12 months (01/04/2015 to 31/03/2016) was 90% compared to the national average of 89%.

• The practice regularly worked with multi-disciplinary teams in the case management of patients experiencing poor mental health, including those with dementia.

• The practice carried out advance care planning for patients with dementia.

• The practice had told patients experiencing poor mental health about how to access various support groups and voluntary organisations.

• The practice had a system in place to follow up patients who had attended accident and emergency where they may have been experiencing poor mental health.

Staff had a good understanding of how to support patients with mental health needs and dementia.

Updated 25 January 2017

The practice is rated as good for the care of people whose circumstances may make them vulnerable.

• The practice demonstrated a proactive and responsive approach to understanding the needs of vulnerable patients and to deliver care in a way that met their needs. For example, the practice had well established shared care arrangements for patients who had drug and alcohol dependence. The practice was able to demonstrate the significant benefit this service had had for these patients.

• The practice was proactive in identifying and responding to patients who were carers or who experienced social isolation. They worked closely with volunteer groups. For example The Red Cross. The practice was able to demonstrate the positive impact this work had had for 2.4% of their population.

• The practice held a register of patients living in vulnerable circumstances including housebound patients, carers and those with a learning disability.

• The practice offered longer appointments for patients assessed as needing them.

• The practice offered 11 ‘open surgery – sit and wait’ surgeries per week across both sites including two evening surgeries and one weekend surgery every week. Pre-booked face to face and telephone appointments was also used which meant patients within this group could see a GP at any time.

• There were longer appointments available for patients with a learning disability.

• Home visits were available for older patients and patients who had clinical needs which resulted in difficulty attending the practice.

• The practice offered a range of services aimed at providing care closer to the patient’s home.

• Staff knew how to recognise signs of abuse in vulnerable adults and children. Staff were aware of their responsibilities regarding information sharing, documentation of safeguarding concerns and how to contact relevant agencies in normal working hours and out of hours.