Archived: York Street Health Practice

This practice is rated as Good overall. This was the first inspection of this service under the current provider.

The key questions at this inspection are rated as:

Are services safe? – Good

Are services effective? – Good

Are services caring? – Good

Are services responsive? – Good

Are services well-led? – Good

As part of our inspection programme, we carried out an announced comprehensive inspection at York Street Health Practice on 26 September 2018.

At this inspection we found:

• The practice had systems in place to manage risk so that safety incidents were less likely to happen.
• There were systems for reviewing and investigating when things went wrong. The practice learned and shared lessons, identified themes and took action to improve safety in the practice. There was shared learning across the provider’s locations.
• There were comprehensive safeguarding processes in place. Patients who were most at risk were easily identifiable and staff were supported to keep safe.
• There was evidence of good record keeping showing how patients were supported, the care and treatment provided, and what liaison with other services had taken place.
• There was an effective electronic system in place to support staff to identify sepsis.
• Staff were trained in conflict resolution. We saw that the team had developed a range of skills and strategies to assist patients who may be distressed or agitated.
• The practice identified patients who were a carer for another person and support was provided at an individual level. In addition, the practice also identified those patients who had a support worker and liaised with them accordingly.
• The practice had a register of extremely high-risk patients. These patients would be seen opportunistically and "fitted in" without necessarily having an appointment. This list was reviewed in the monthly multidisciplinary meetings. All patients were seen as needed; irrespective of whether they were on the register.
• Outreach work was undertaken with asylum seekers and the homeless to support them to register with the practice.
• Collaborative working was undertaken with another agency to support sex workers to access healthcare.
• The practice had undertaken an analysis of patient deaths to identify if any lessons could be learned. As a result, they had improved the use of the end of life template to record a patients’ wishes and their next of kin.
• There was governance at a local and provider level to support safe and effective management of the practice.
• There was a focus on continuous learning and improvement.

We saw areas of outstanding practice:

• There was evidence to show the practice were one of the lowest prescribers of opioids within the local CCG. Clinicians had worked with patients to support them in reducing their reliance on opioid medication, which had resulted in an overall 40% reduction in prescribing these medicines within a 12-month period.
• The provider operated a ‘street medicine bus’, which was used within Leeds city centre two evenings per week. Staff provided advice, support and signposting for people who accessed the bus. We were given examples where patients had received clinical interventions and urgent referrals to secondary care services.

The areas where the provider should make improvements are:

• Check that all appropriate equipment is calibrated or removed from use until calibration has been completed.
• Review and improve the storage and the accessibility for staff of policies, procedures or any documents/records needed to support safe and effective service delivery.
• Review and improve how prescriptions are recorded when coming into the practice to include serial numbers, in line with their standard operating procedures.

Professor Steve Field CBE FRCP FFPH FRCGPChief Inspector of General Practice

Please refer to the detailed report and the evidence table for further information.