Esk Valley Medical Practice

Updated 23 January 2017

The Danby Surgery, Briar Hill, Danby, Whitby, YO21 2PA is a rural practice situated in Danby mainly serving this area and the Upper Esk Valley. The registered list size is approximately 2,300 and predominantly white British background. The practice is ranked in the sixth least deprived decile (one being the most deprived and 10 being the least deprived). The practice age profile differs from the national average with the highest age range above the national average being 45 to 79 years and the lowest being zero to nine years and 25 to 39 years. The practice is a dispensing practice and dispenses to approximately 96% of their patients.

The practice is managed by two GP partners (one male and one female). The practice employs one practice nurse, three health care assistants and a counsellor who works one day a week. There is a dispensary manager, eight dispensary/reception staff, one senior administrator, one secretary, one administrator and a practice manager who manages this and another two practices. The practice also benefits from CCG funded roles. A community practice nurse is shared between The Danby Surgery and two other local practices as part of the nursing workforce project. They also receive pharmacist support from the CCG for half a day once a month and additional support from a prescribing pharmacist one day every three weeks who works between The Danby Surgery and two other local practices.

The practice is a teaching practice. The practice, at the time of our inspection, has a GP registrar. This means the GP registrar is currently on a three year GP registration course.

The practice is open between 8am and 6.30pm daily except for Thursday when the practice closes at 12pm. During this time calls are managed by a nearby practice, Egton Surgery. Extended hours are offered every Tuesday from 7.30am to 8am and 6.30pm to 7.15 pm when patients can see a GP. During this time a health care assistant works alongside the GP.

The practice has opted out of providing out-of-hours services to its own patients. Out of hours patients are directed to Harrogate District Foundation Trust (the contracted out-of-hours provider) via the NHS 111 service.

The practice holds a General Medical Services (GMS) contract to provide GP services which is commissioned by NHS England.

Updated 23 January 2017

Letter from the Chief Inspector of General Practice

We carried out an announced comprehensive inspection at The Danby Surgery on 13 and 14 October 2016. Overall the practice is rated as good.

Our key findings across all the areas we inspected were as follows:

• There was an open and transparent approach to safety and an effective system in place for reporting and recording significant events.
• Risks to patients were assessed and well managed.
• Staff assessed patients’ needs and delivered care in line with current evidence based guidance. Staff had been trained to provide them with the skills, knowledge and experience to deliver effective care and treatment.
• Feedback from patients about their care and treatment was consistently positive. Data from the national GP patient survey showed patients rated the practice higher than others for all aspects of care.
• Staff were motivated and inspired to offer kind and compassionate care and worked to overcome obstacles to achieving this.
• The practice worked closely with other organisations and with the local community in planning how services were provided to ensure that they met patients’ needs.
• The practice implemented suggestions for improvements and made changes to the way it delivered services as a consequence of feedback from patients and from the patient participation group (PPG).
• The practice had good facilities and was well equipped to treat patients and meet their needs.
• The practice actively reviewed complaints and made improvements as a result.
• High standards were promoted and owned by all practice staff, and teams worked together across all roles.
• Governance and performance management arrangements were proactively reviewed and reflected best practice.
• The staff demonstrated a strong collaboration, commitment and a common focus on improving quality of care and people’s experiences.
• The patient participation group was active.
• There was a strong focus on continuous learning and improvement at all levels within the practice.

We saw three areas of outstanding practice including:

• The practice provided a weekly GP clinic at a local residential care service for people with a learning disability. At the time of our inspection the practice had 93 adults on their learning disability register (4% of the practice population), 89 of whom lived at this service. Appointments for people with a learning disability were between 15 and 30 minutes long dependent on individual need.
• The practice was proactive in engaging with the local community. Several members of staff attended local community events where they spoke about a range of initiatives. For example the senior administrator had attended and spoke about the benefits and availability of flu vaccines which resulted in an increased uptake. The community practice nurse had attended and spoken about falls and how to reduce them. This had resulted in a number of patients being identified who would benefit from a personalised care plan as part of the admissions avoidance project.

• To support independence and the safe use of medicines for many elderly patients who often lived alone, the practice dispensed medication into blister-packs (medication dosing systems). This included electronic dosing systems for patients with complex medication and special needs so they could maintain their independence whilst taking medication safely. Depending on their needs, patients received a medication administration chart or a large-print list of medication with information on their purpose and dosing.

However there was one area of practice where the provider should make improvements:

• Review the current procedures in relation to near misses to cover all aspects of the dispensing process.

Professor Steve Field (CBE FRCP FFPH FRCGP) 

Chief Inspector of General Practice

Updated 23 January 2017

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

• Clinical staff had lead roles in chronic disease management and patients at risk of hospital admission were identified as a priority.
• Performance for the five diabetes related indicators was in all but one area higher than the national average. For example the percentage of patients on the diabetes register, with a record of a foot examination and risk classification within the preceding 12 months (01/04/2014 to 31/03/2015) was 96% compared to the national average of 88%.
• 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.
• Patients were signposted or referred to support services. For example the practice had an agreement with a nearby practice that they could signpost their patients to ‘Living well with long-term conditions’ courses held at nearby Sleights Surgery.

Updated 23 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. Immunisation rates were relatively high for all standard childhood immunisations.
• 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 comparable for under two year olds and slightly lower than the England averages for five year olds. For example, childhood immunisation rates for the vaccinations given to under two year olds ranged from 75% to 95% compared to the England average which was 73% to 95% and five year olds which was 75% to 92% compared to the England average which was 81% to 95%.
• The practice’s uptake for the cervical screening programme was 82%, which was equal to the national average of 82%.
• Appointments were available outside of school hours and the premises were suitable for children and babies.
• We saw positive examples of joint working with midwives, health visitors and school nurses.
• The practice provided a full range of contraceptive services, including provision of implants to other local practices. IUD intrauterine device (IUD) or intrauterine system (IUS) services were provided by a nearby surgery or Teesside Sexual health service.

Updated 23 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.
• The practice was responsive to the needs of older people. For example, to support independence and the safe use of medicines for many elderly patients who often lived alone, the practice dispensed medication into blister-packs (medication dosing systems). This included electronic dosing systems for patients with complex medication and special needs so they could maintain their independence whilst taking medication safely.
• Home visits and urgent appointments were offered for those with enhanced needs.

Updated 23 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 extended opening hours were offered every Tuesday from 7.30am to 8am and 6.30pm to 7.15 pm when patients could see a GP. During this time a health care assistant worked alongside the GP.
• 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 23 January 2017

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

• Performance for the three mental health related QOF indicators was higher than the national average. 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 (01/04/2014 to 31/03/2015) was 93% compared to the national average of 88%.
• The percentage of patients diagnosed with dementia whose care had been reviewed in a face-to-face review in the preceding 12 months (01/04/2014 to 31/03/2015) was 95% compared to the national average of 84%.
• The practice employed a counsellor who worked at the practice one day a week improving access to one to one counselling, including bereavement counselling and Eye Movement Desensitization and Reprocessing (EMDR).
• 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 23 January 2017

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

• The practice held a register of patients living in vulnerable circumstances including housebound and those with a learning disability.
• The practice provided a weekly GP clinic at a local residential care service for people with a learning disability. At the time of our inspection the practice had 93 adults on their learning disability register (4% of the practice population), 89 of whom lived at this service. Appointments were between 15 and 30 minutes long and patients could attend at the practice or be seen by the GP at the residential care service.

• In response to the special needs of many patients with learning disabilities, the lead GP regularly provided training to carers and patients in the administration of emergency medication for epilepsy, adrenal crisis and hypoglycaemia. Due to the large number of carers involved in supporting the various patients with learning disabilities, carers were able to make direct contact with GP’s via e-mail. The lead GP had regular peer review meetings with local consultant colleagues in order to ensure best care for the complex needs of these patients.

• The practice employed a health care assistant to offer phlebotomy and, in response to an increasing prevalence in obesity, to offer weight management for the patients with learning disabilities in an easily accessible way. The health care assistant at the practice undertook special training to provide this.

• The practice had a Carers Champion and visits at the practice from both Carers Resource and the Alzheimer’s society.

• The practice regularly worked with other health care professionals in the case management of vulnerable patients. For example as part of the CCG Nursing Workforce Project, patients who were identified as elderly or frail and unable to attend the Practice would receive a home visit by the practice’s community practice nurse.
• The practice informed vulnerable patients about how to access various support groups and voluntary organisations.
• 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.