Staithes Surgery

Updated 27 January 2017

Dr Croft & Dr Rigby Seaton Crescent, Staithes, Saltburn By The Sea, Cleveland, is situated in village of Staithes on the North Yorkshire coast. The practice is housed in a purpose built medical centre and owned by the partners. There is parking with some of the patients living within walking distance and there is limited access to public transport. The practice covers a rural and coastal area of 17 miles. There are 2768 patients on the practice list. The practice scored four on the deprivation measurement scale, the deprivation scale goes from one to ten, with one being the most deprived. People living in more deprived areas tend to have a greater need for health services.

There are two GP partners both male and one salaried GP female. There is one practice nurse and one heath care assistant (HCA) and an attached community based practice nurse hosted by the practice who works across three practices. There is a practice manager, departmental leads and administrative staff. The practice manager works across two other practices. The practice is a dispensing practice and there is a dispensing manager and dispensing staff.

The practice also benefits from CCG funded roles. A primary community practice nurse is shared between The Staithes Surgery and two other local practices as part of the nursing workforce project. They also receive pharmacist support for half a day once a month and additional support from a prescribing pharmacist who works between The Staithes Surgery and two other local practices.

The practice is open from 8am to 6pm, Monday to Friday. The practice provides extended hours one evening per week until 7.30pm. Appointments can be booked by walking into the practice, by the telephone and on line. Patients requiring a GP outside of normal working hours are advised to contact the GP out of hour’s emergency service which is manned by Primecare. The practice holds a General Medical Service (GMS) contract.

Updated 27 January 2017

Letter from the Chief Inspector of General Practice

We carried out an announced comprehensive inspection at Dr Croft & Dr Rigby also known as Staithes practice 14 November 2016. Overall the practice is rated as good.

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

• Staff understood and fulfilled their responsibilities to raise concerns and report incidents and near misses. All opportunities for learning from internal and external incidents were maximised.

• There was an open and transparent approach to safety and an effective system in place for reporting and recording significant events. The practice promoted a no blame culture and encouraged staff to raise concerns and possible risks.

• Patients said they were treated with compassion, dignity and respect and they were involved in their care and decisions about their treatment.

• Information about services and how to complain was available and easy to understand. Improvements were made to the quality of care as a result of complaints and concerns. When a complaint related to any aspect of clinical work it was raised as a significant event.

• Patients said they found it easy to make an appointment with a named GP and there was continuity of care, with urgent appointments available the same day and pre bookable appointments available.

• Feedback from patients about their care was consistently positive.

• The practice had good facilities and was well equipped to treat patients and meet their needs. However, the size of the building was limited and the practice was planning to increase the practice in the future to provide two additional clinical rooms.

• There was a clear leadership structure in place. The practice proactively sought feedback from staff and patients, which it acted on. The provider was aware of and complied with the requirements of the duty of candour. (The duty of candour is a set of specific legal requirements that providers of services must follow when things go wrong with care and treatment).

There were areas of outstanding practice:

• The practice responded to local support services such as the coast guard, life boat and agricultural service providing support often beyond their contractual hours of work.

Professor Steve Field (CBE FRCP FFPH FRCGP) 

Chief Inspector of General Practice

Updated 27 January 2017

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

• Nursing staff had lead roles in chronic disease management and patients at risk of hospital admission were identified as a priority. There was a joint approach in managing these patients with community and district nurses.

• Patients with chronic obstructive airways disease (COPD), asthma and diabetes were managed by nurse led clinics and GPs. The practice recalled patients with diabetes every six months rather than 12 months. One of the GPs had undergone further diabetes training. Nationally reported data for 2014/2015 showed that outcomes for patients with long term conditions were good. For example, the percentage of patients with diabetes, on the register, whose last measured total cholesterol (measured within the preceding 12 months) was 5mmol/l or less was 87% compared to the CCG of to the national average of 83% and the CCG average of 80%.

• 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 medicine needs were being met.

• The practice promoted self-management for some long term conditions and referred patients for ongoing support where required. Patient’s also utilised personal care plans to manage their own conditions and understood when they should ask for help. The practice actively screened for diabetes and had pre diabetes register in the practice to ensure early diagnosis of high risk patients. One of the GPs visited all their house bound patients in October to administer their Flu vaccine and to also undertake their annual review.

Updated 27 January 2017

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

• The practice used the National Society for the Prevention of Cruelty to Children (NSPCC ) audit tool 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. It is practice policy to document the name of any adult attending with a child if not recognised as being the parent.

• 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.

• Nationally reported data from 2014/2015 showed the practice’s uptake for the cervical screening programme was 84% compared to the local CCG average of 83% and national average of 81%.

• Appointments were available outside of school hours and the premises were suitable for children and babies. The staff informed the GP of any request for a same day appointment or visit for a child so that they could be triaged quickly. As the GPs collect their own patients from the waiting room they were able to quickly identify any acutely ill child in the waiting area.

• We saw positive examples of joint working with multidisciplinary teams, midwifes health visitors and school nurses. The health visitors attend the practice weekly and have time timetabled on a weekly basis to discuss families and children with the safeguarding lead.

• The practice provided access to contraception and screening for sexually transmitted diseases (STDs).

• The practice offered six week post-delivery checks for mothers and babies.

Updated 27 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.

• All patients over 75 had a named GP.

• The practice was responsive to the needs of older people, and offered home and urgent appointments for those with enhanced needs. The practice responds to all requests for home visits resulting in a large number of home visits.

• The practice had developed a new community nurse pilot post to identify and support the most vulnerable older people. The nurse was employed for a fixed term across three local practices.

• The practice had identified and reviewed the care of those patients at highest risk of admission to hospital. Those patients who had an unplanned admission or presented at Accident and Emergency (A&E) had their care plan reviewed. Care plans were reviewed and discussed.

• The GPs reviewed 111 contacts and planned follow up care as necessary.

Updated 27 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. The practice had appointments available on a Saturday morning and telephone consultations were available.
• The practice was proactive in offering online services as well as a full range of health promotion and screening that reflected the needs for this age group.
• The practice had a large number of off shore workers who were given email contacts and adequate supplies of medication to support them during their time away.

Updated 27 January 2017

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

• Nationally reported data from 2014/2015 showed 100% of patients diagnosed with dementia had had their care reviewed in a face to face meeting in the previous 12 months, compared to the local CCG average of 86% and the national average of 84%.

• Nationally reported data showed the percentage of patients with schizophrenia, bipolar affective disorder and other psychoses who had a comprehensive care plan documented in their record in the preceding 12 months was 92%, which was 1% below the CCG average and 4% above the national average.

• The practice undertook regular patient reviews in their own home or in the surgery. Those patients who did not attended were followed up with an invitation letter or with a phone call.

• The practice regularly worked with multi-disciplinary teams in the case management of patients experiencing poor mental health, including those with dementia. The practice were able to refer patients to the memory clinic and there was a memory café held in the nearby practice.

• The practice carried out advanced 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. Patients suffering acute mental health issues were seen on the same day and had access to the crisis team locally.

• 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.

• Patients on medicines requiring regular monitoring and where the practice shared their care with mental health services were monitored regularly.

Updated 27 January 2017

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

• The practice held a register of patients living in vulnerable circumstances and provided a supportive and non-judgemental approach. Examples of these patient groups were people with drug and alcohol problems and those living with a learning disability. There were same day appointments available for those in crisis. One GP partner was trained in the management of opiate addiction.

• The practice offered longer appointments for patients with a learning disability. Annual reviews for this group were monitored by the practice, 68% of patients on the register had received an annual review.

• The practice had a named GP for learning disabilities. The practice regularly worked with other health care professionals in the case management of vulnerable patients. 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.

• The practice held regular Gold Standards Framework (GSF) palliative care meetings to discuss and agree care plans. It involved the practice working together as a team and with other professionals in hospitals, hospices and specialist teams to provide the highest standard of care possible for patients and their families. The practice provided end of life care to patients outside of the out of hours service and families in the last days of their life and were given the GPs mobile numbers.