Archived: Field House Surgery

Updated 24 January 2017

Field House Surgery, 18 Victoria Road, Bridlington YO15 2AT occupies an adapted property that is a listed building. It is close to the town centre, the train station and local bus routes. Parking is available outside the practice and there is disabled access. It provides services under a General Medical Services (GMS) contract with the NHS North Yorkshire and Humber Area Team to the practice population of 7558, covering patients of all ages. There is a branch site in Flamborough however due to the shortage of GPs in the practice this is currently closed.

The proportion of the practice population in the 65 years and over age group is above the local CCG and England average. The practice population in the under 18 age group is slightly below the local CCG and England average. The practice scored two on the deprivation measurement scale, the deprivation scale goes from one to ten, with one being the most deprived. The overall practice deprivation score is higher than the local CCG and England average. People living in more deprived areas tend to have a greater need for health services.

The practice has undergone significant change during the past two and a half years with the loss of its GP partner, salaried GPs and members of the nursing team. The Provider One Medicare Ltd has been delivering the service at Fieldhouse Surgery since October 2014. One Medicare Ltd has, and continues to advertise for salaried GPs but has been unsuccessful in appointing any permanent GPs at the time of the inspection. This is reflective of the current difficulties being experienced in recruiting GPs to the local area. Since early 2015 GP provision has been provided by locums. There are two locum GPs working at the practice. Additional GP cover is provided remotely from the Provider’s hub in Leeds and occasionally from other sites. This cover includes telephone triage, booked telephone appointments and reviews of pathology results and clinical tasks.

There are two Advanced Nurse Practitioners, one was had been working at the practice for one week and the other was due to leave the following week. There was also a locum Emergency Care Practitioner who was doing regular sessions at the practice. There are three practice nurses; one was new and undergoing induction and two health care assistants, one of whom was leaving the following week. There is a Business Manager and an office manager who both work full time. The practice has a team of secretarial, administration and reception staff. There was pharmacist support from the provider’s hub site in Leeds and a second pharmacist who worked at the practice two days a week.

The practice is open between 8am to 6pm Monday to Friday. Appointments are available from 8.30am to 10.30am on a Monday and Friday and from 08.30 to 11.00am Tuesday, Wednesday and Thursday through the walk in clinics. Appointments are available from 3pm to 5pm daily. Between 10.30am and 3pm the phone is answered and any urgent requests are dealt with. The branch surgery at Flamborough which is located five miles from Bridlington is currently closed, this has been agreed with NHS England. If patients are unable to travel to Bridlington the practice undertakes home visits.

The practice, along with all other practices in the East Riding of Yorkshire CCG area have a contractual agreement for the Out of Hours provider to provide OOHs services from 6.00pm. This has been agreed with the NHS England area team.

The practice has opted out of providing out of hours services (OOHs) for their patients. When the practice is closed patients use the NHS 111 service to contact the OOHs provider. Information for patients requiring urgent medical attention out of hours is available in the waiting area, in the practice information leaflet and on the practice website.

The Practice is a member of Brid Inc Ltd, and is working in partnership with other local practices, social services and community services to improve the health and wellbeing of the local population. Uniting healthcare is a key aim of Brid Inc Ltd by bringing together the key individuals who create the health and social care services.Using strategies that have worked in other areas, Brid Inc Ltd’s wish is to provide Bridlington with solutions to the unique healthcare needs in their area.

Updated 24 January 2017

Letter from the Chief Inspector of General Practice

We carried out an announced comprehensive inspection of Field House Surgery on 6 January 2016. After the comprehensive inspection, the practice wrote to us to say what they would do to meet legal requirements in relation to Regulation 12 of the Health and Social Care Act 2008 (Regulated Activities) Regulations 2014: Safe care and treatment, Regulation 17 of the Health and Social Care Act 2008 (Regulated Activities) Regulations 2014: Good Governance and Regulation 18 of the Health and Social Care Act 2008 (Regulated Activities) Regulations 2014: Staffing.

On 21 September 2016 we undertook a unannounced follow up inspection to check that they had followed their plan and to confirm that they now met legal requirements. You can read the report from our last comprehensive inspection, by selecting the 'all reports' link for Field House Surgery on our website at www.cqc.org.uk.

At this inspection we found that the practice had satisfied the requirements of the notices in relation to Regulation 12 of the Health and Social Care Act 2008 (Regulated Activities) Regulations 2014: Safe care and treatment, Regulation 17 of the Health and Social Care Act 2008 (Regulated Activities) Regulations 2014: Good Governance. However there continued to be issues in relation to Regulation 18 of the Health and Social Care Act 2008 (Regulated Activities) Regulations 2014: Staffing.

Specifically we found that:

• There were systems in place for reporting and recording significant events and staff understood and fulfilled their responsibilities to raise concerns, and to report incidents and near misses.
• Risks to patients were assessed and managed, including those relating to the management of medicines. However there continued to be issues in relation to the deployment of sufficient staff.
• Staff assessed patients’ needs and delivered care. However there was limited documented evidence that a formal process was in place to review and assess clinical guidance when it was issued. Staff had the skills, knowledge and experience to deliver effective care and treatment.
• The majority of patients said they were treated with compassion, dignity and respect.
• Patient feedback showed that patients did not always feel satisfied with how they could access care and treatment.
• Patients reported that access to a named GP and continuity of care was not always available, although urgent appointments were usually available the same day.
• Information about services and how to complain was available and easy to understand.
• The practice had good facilities and was well equipped to treat patients and meet their needs.
• There was a clear leadership structure and staff felt supported by management in the practice. However staff said they did not always feel supported by the management team at the provider’s head office.
• 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 practice had a number of policies and procedures to govern activity and systems to monitor quality improvement.

However there was an area of practice where the provider must make improvements;

• Ensure that appropriate levels of staffing are maintained at all times.

There were areas of practice where the provider should make improvements;

• Follow their policy and national guidance to track blank prescriptions forms through the practice.

• Prioritise attendance at relevant infection prevention and control (IPC) training for the health care assistant IPC lead.

• Implement a system to ensure patients’ treatment was reviewed and updated if necessary following the issuing of updated clinical guidelines.

• Implement a process so patient records are summarised in a timely manner.

• Develop a home visit protocol.

The overall rating awarded to the practice following our full comprehensive inspection on 6 January 2016 remains unchanged. The practice will be re-inspected in relation to their rating in the future.

Professor Steve Field (CBE FRCP FFPH FRCGP) 

Chief Inspector of General Practice

Updated 24 January 2017

The practice is rated as requires improvement for the care of people with long-term conditions. The provider was rated as requires improvement for safe, effective, responsive and well-led. The issues identified as requiring improvement overall affected all patients including this population group. There were, however, examples of good practice.

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

• Nationally reported data for 2015/2016 showed that outcomes for patients with long term conditions were below the local CCG and England average. For example, the percentage of patients his was comparable to the local CCG average of 89% and the national average of 90%.

• Longer appointments and home visits were available when needed.

• Patients with long term conditions did not have a named GP due to the use of locums in the practice. They had a structured annual review to check that their health and medicines needs were being met. For those people with the most complex needs, staff worked with relevant health and care professionals to deliver a multidisciplinary package of care.

Updated 24 January 2017

The practice is rated as requires improvement for the care of families, children and young people. The provider was rated as requires improvement for safe, effective, responsive and well-led. The issues identified as requiring improvement overall affected all patients including this population group. There were, however, examples of good practice.

• 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.

• Nationally reported data from 2015/2016 showed immunisation rates were comparable to the local CCG and England national average for the standard childhood immunisations. For example, data from 2015/2016 showed rates for 17 of the 18 immunisations given to children aged 12 months, 24 months and five years in the practice ranged from 72% to 99%. This was comparable the local CCG rates of 74% to 98% and the England national rates of 73% to 95%.

• Nationally reported data from 2015/2016 showed the percentage of patients with asthma, who had had an asthma review in the preceding 12 months that included an assessment of asthma control, was 48%. This was below the local CCG average of 76% and the England average of 75%.

• 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 2015/2016 showed the practice’s uptake for the cervical screening programme was 88%; this was comparable to the local CCG average of 85% and the England average of 81%.

• Appointments were available outside of school hours and the premises were suitable for children and babies.

• We saw examples of joint working with midwives, health visitors and school nurses. The practice monitored any non-attendance of babies and children at vaccination clinics and worked with the health visiting service to follow up any concerns.

Updated 24 January 2017

The practice is rated as requires improvement for the care of older people. The provider was rated as requires improvement for safe, effective, responsive and well-led. The issues identified as requiring improvement overall affected all patients including this population group. There were, however, examples of good practice.

• The practice offered personalised care to meet the needs of the older people in its population. Patients over the age of 75 did not have a named GP due to the use of locums in the practice.

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

• Nationally reported data for 2015/2016 showed that outcomes were lower than the local CCG and England average for conditions commonly found in older people. For example, performance for heart failure related indicators was 70%, compared to the local CCG average of 97% and the England average of 95%.

Updated 24 January 2017

The practice is rated as requires improvement for the care of working-age people (including those recently retired and students). The provider was rated as requires improvement for safe, effective, responsive and well-led. The issues identified as requiring improvement overall affected all patients including this population group. There were, however, examples of good practice.

• 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 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.

Updated 24 January 2017

The practice is rated as requires improvement for the care of people experiencing poor mental health (including people with dementia). The provider was rated as requires improvement for safe, effective, responsive and well-led. The issues identified as requiring improvement overall affected all patients including this population group. There were, however, examples of good practice.

• Nationally reported data from 2015/2016 showed the percentage of patients diagnosed with dementia who had had their care reviewed in a face to face meeting in the preceding 12 months was 53%; this was below the local CCG average and England average of 84%.

• Nationally reported data from 2015/2016 showed the percentage of patients diagnosed with schizophrenia, bipolar affective disorder and other psychoses who had a record of blood pressure check in the preceding 12 months was 53%; this was below the local CCG average of 91% and the England average of 89%.

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

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

• Staff understood how to support people with mental health needs and dementia.

Updated 24 January 2017

The practice is rated as requires improvement for the care of people whose circumstances may make them vulnerable. The provider was rated as requires improvement for safe, effective, responsive and well-led. The issues identified as requiring improvement overall affected all patients including this population group. There were, however, examples of good practice.

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

• It offered longer appointments for people with a learning disability.

• The practice regularly worked with multi-disciplinary teams in the case management of vulnerable people.

• It had told 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.