Grange Park Surgery

Updated 12 September 2016

Grange Park Surgery is a member of Airedale Wharfedale and Craven Clinical Commissioning Group (CCG). Personal Medical Services (PMS) are provided under a contract with NHS England. The practice is registered with the Care Quality Commission (CQC) to provide the following regulated activities: maternity and midwifery services, family planning, diagnostic and screening procedures and treatment of disease, disorder or injury. They also offer a range of enhanced services, which include:

• Childhood vaccination and immunisations
• The provision of influenza and pneumococcal immunisations
• Facilitating timely diagnosis and support for patient with dementia
• Extended hours access
• Improving online access

Grange Park Surgery is located in Burley in Wharfedale, which is commuter village in a semi-rural location in West Yorkshire.

The practice is situated in purpose built premises, which was built in 1986. There are facilities for people with disabilities and all patients areas are on the ground floor. There are car parking facilities on site with designated disabled parking.

The practice has a patient list size of 6642 which is made up of predominantly white British, with an almost 50:50 ratio of male and female patients. The practice serves a population in the 10% least deprived in the country.

There are four GP partners, and four associate GPs, five female and three male, who were supported by two practice nurses and a health care assistant; all female. There is a practice manager and a team of administration and reception staff. The practice also has the support of a practice employed pharmacy technician.

The practice was open 8am to 6pm Monday and Tuesday, 7.00am to 18.00 Wednesday and Friday, and 7.00.30am to 6.00pm Thursday. When the practice is closed out-of-hours services are provided by Local Care Direct, which can be accessed via the surgery telephone number or by calling the NHS 111 service.

The practice has good working relationships with local health, social and third sector services to support provision of care for its patients. (The third sector includes a very diverse range of organisations including voluntary, community, tenants’ and residents’ groups.)

We were informed of the challenges the practice had undergone over the past year, when there had been a change of practice manager and a major rebuild and refurbishment of the surgery.

Due to the demographics of the practice and its population, in addition to hospitals within Airedale, they are also required to liaise with Leeds Hospitals, Bradford Hospitals; which are based in other CCG areas.

Updated 12 September 2016

Letter from the Chief Inspector of General Practice

We carried out an announced comprehensive inspection at Grange Park Surgery on 11 July 2016. Overall the practice is rated as good for providing safe, effective, caring, responsive and well-led care for all of the population groups it serves.

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

• The ethos and culture of the practice was to provide high levels of care a good quality service.
• Patients told us they were treated with compassion, dignity and respect and were involved in care and decisions about their treatment.
• Patients’ needs were assessed and care was planned and delivered following best practice guidance. A recognised tool was used to identify patients who were considered to be at risk of frailty.

• The practice had good facilities and was well equipped to treat and meet the needs of patients. Information regarding the services provided by the practice and how to make a complaint was readily available for patients.
• Patients we spoke with were positive about access to the service. They said they found it generally easy to make an appointment, there was continuity of care and urgent appointments were available on the same day as requested.
• The practice had a good understanding 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.)
• The partners promoted a culture of openness and honesty and there was a comprehensive ‘being open’ policy in place, which was reflected in their approach to safety. All staff were encouraged and supported to record any incidents. There was evidence of good investigation, learning and sharing mechanisms in place.
• Risks to patients were assessed and well managed. There were safe and effective governance arrangements in place.
• There were comprehensive safeguarding systems in place.
• The practice sought patient views how improvements could be made to the service, through the use of patient surveys, the NHS Friends and Family Test and the patient participation group.
• There was a clear leadership structure, staff were aware of their roles and responsibilities and told us the GPs and manager were accessible and supportive.
• The GP partners were forward thinking, aware of future challenges to the practice and were open to innovative practice.

We saw an area of outstanding practice:

• The practice supported the return to practice of two GPs who had previously left the profession. There were no other support mechanisms to support the individuals. They were able to demonstrate the success of redeveloping competencies and supported the GPs to secure employment in the area.

Professor Steve Field (CBE FRCP FFPH FRCGP) 

Chief Inspector of General Practice

Updated 12 September 2016

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

• The GPs had lead roles in the management of long term conditions and were supported by the nursing staff. Annual reviews were undertaken to check patients’ health care and treatment needs were being met. Holistic reviews were undertaken with patients who had several co-morbidities, which avoided the need for multiple appointments.

• The practice maintained a register of patients who were a high risk of an unplanned hospital admission. Care plans and support were in place for these patients.

• 96% of patients with diabetes had an influenza immunisation the preceding 1 August to 31 March period of01/04/2014 to 31/03/2015 (CCG average 87%, national average 90%).
• 83% of patients diagnosed with asthma had received an asthma review in the last 12 months (CCG average 77% and national averages of 75%).
• 94% of patients diagnosed with chronic obstructive pulmonary disease (COPD) had received a review in the last 12 months (CCG and national average 90%).
• The practice identified those patients who had complex needs and life limiting conditions and ensured they were on the palliative care register.

Updated 12 September 2016

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

• The practice worked with midwives, health visitors and school nurses to support the needs of this population group.
• There was a ‘did not attend’ (DNA) process in place to follow up any children and young people who failed to attend a hospital appointment or immunisations at the practice.
• Patients and staff told us children and young people were treated in an age-appropriate way and were recognised as individuals.
• Appointments were available outside of school hours and the premises were suitable for children and babies. All children who required an urgent appointment were seen on the same day as requested.
• Immunisation uptake rates were better than or comparable to the CCG rates for all standard childhood immunisations.
• Sexual health and cervical screening services were provided at the practice.
• 83% of eligible patients had received cervical screening (CCG average 77% and national average 82%).
• Appointments were available with both male and female GPs.

Updated 12 September 2016

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

• The practice provided proactive, responsive and person-centred care to meet the needs of the older people in its population. All elderly patients had a named GP and were referred to a geriatric consultant as necessary.
• The practice worked closely with other health and social care professionals, such as the district nursing and local neighbourhood teams, to ensure housebound patients received the care and support they needed.
• The practice participated in Airedale Wharfedale and Craven (CCG) initiatives to reduce the rate of elderly patients’ acute admission to hospital, such as supporting a local nursing home.
• Patients who were considered to be at risk of frailty were identified and support offered as appropriate.
• Care plans were in place for those patients who were considered to have a high risk of an unplanned hospital admission and patients were reviewed as needed.
• Health checks were offered for all patients over the age of 75 who had not seen a clinician in the previous 12 months.
• Patients were signposted to other local services for access to additional support.
• The practice provided weekly attendance of a GP, community matron and a pharmacy technician at a large local nursing home to perform medication reviews and promote good therapeutic practice.

Updated 12 September 2016

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

• The needs of these patients 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 provided extended hours appointments one evening per week, telephone consultations, online booking of appointments and ordering of prescriptions.
• The practice offered a range of health promotion and screening that reflected the needs for this age group. This included screening for early detection of chronic obstructive pulmonary disease (a disease of the lungs) for patients aged 40 and above who were known to be smokers or ex-smokers.
• Health checks were offered to patients aged between 40 and 74 who had not seen a GP in the last three years.
• Students were offered public health recommended vaccinations prior to attending university.
• Travel health advice and vaccination were available.
• There was an in-house minor surgery clinic and phlebotomist to avoid the need for some patients having to access secondary care.
• The practice provided extended hours commuter clinics three mornings per week.

Updated 12 September 2016

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

• The practice regularly worked with multidisciplinary teams in the case management of people in this population group, for example the local mental health team.
• Patients and/or their carer were given information on how to access various support groups and voluntary organisations.
• 86% of patients diagnosed with dementia had received a face to face review of their care in the preceding 12 months (CCG average 89%, national average 84%).
• 92% of patients who had a complex mental health problem, such as schizophrenia, bipolar affective disorder and other psychoses, who had a recording of their alcohol consumption in their record in the preceding 12 months (CCG average 92% and national average of 90%).
• Staff had a good understanding of how to support patients with mental health needs or dementia.

Updated 12 September 2016

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

• Staff knew how to recognise signs of abuse in children, young people and adults whose circumstances may make them vulnerable. They 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 could evidence the number of children who were on a child protection plan (this is a plan which identifies how health and social care professionals will help to keep a child safe).
• Patients who had a learning disability received an annual review of their health needs and a care plan was put in place. Carers of these patients were also encouraged to attend, were offered a health review and signposted to other services as needed.
• We saw there was information available on how patients could access various local support groups and voluntary organisations.