Dr Underwood and Partners

Updated 23 June 2016

Dr Underwood and Partners is located in the centre of Beverley and is close to local bus routes. There is parking, including disabled parking available at the practice. The practice is in a purpose built health centre and shares the building with various community health services. Consulting and treatment rooms are available on the ground and first floors; there is lift access to the first floor.

The practice provides services under a General Medical Services (GMS) contract with the NHS North Yorkshire and Humber Area Team to the practice population of 12300, covering patients of all ages. The practice is a ‘dispensing practice’ and is able to dispense medicines for patients who live more than one mile from the nearest pharmacy.

The proportion of the practice population in the 65 years and over age group and the under 18 age group are similar to the England average. The practice scored nine 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.

The practice has seven GP partners, three are full time and four are part time. There are two male and five female GPs. There are three practice nurses and three health care assistants, all female and all work part time. There is a practice manager, an assistant practice manager, a finance manager and a team of administrators, secretaries and receptionists/phlebotomists. There is a pharmacist and three prescribing clerks.

The practice is open between 8am to 6pm Monday to Friday. Appointments are available from 8am to 11.00am and 1pm to 5.35pm Monday to Friday. There is extended opening on a Monday until 8pm and on a Saturday morning from 8.30am to 11am for pre-booked appointments only. Information about the opening times is available on the website and in the patient information leaflet.

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 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 teaching practice for first year medical students from the Hull York Medical School.

Updated 23 June 2016

Letter from the Chief Inspector of General Practice

We carried out an announced comprehensive inspection at Dr Underwood and Partners on 14 April 2016. 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 the skills, knowledge and experience to deliver effective care and treatment.
• 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.
• Patients said they were able to get same day appointments and pre bookable appointments were available.
• 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. 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.

However there were areas of practice where the provider needs to make improvements.

Importantly the provider should:

• Ensure that controlled drugs registers are completed in accordance with the misuse of drugs regulations 2001.

• Ensure all staff are up to date with mandatory training.

• Ensure the practice has a written strategy and supporting business plan which outlines their vision and plans for the future.

Professor Steve Field (CBE FRCP FFPH FRCGP) 

Chief Inspector of General Practice

Updated 23 June 2016

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

• 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 2014/2015 showed that outcomes for patients with long term conditions were good. 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 was 90.4%. This was 2.1% above the local CCG and England average.

• The Practice had a GP with a Special Interest in Diabetes and Endocrinology and all diabetic patients were seen by the diabetic specialist GP when they were newly diagnosed.

• Longer appointments and home visits were available when needed.

• Patients with LTCs had a named GP and a structured annual review to check that their health and medicines needs were being met. For those people with the most complex needs, the named GPs worked with relevant health and care professionals to deliver a multidisciplinary package of care.

Updated 23 June 2016

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 or who failed to attend hospital appointments.

• Immunisation rates were high for all standard childhood immunisations. For example, rates for all immunisations given to children aged 12 months, 24 months and five years were 95% or above.

• 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 84.5%. This was comparable to the local CCG average and 2.8% above the England average.

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

• There was a nominated receptionist who following delivery of a baby made telephone contact with the family to ask whether a visit or appointment to the new mother or baby would be appreciated.

• We saw good 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.

• Practice staff spent two Sundays every September at a local residential college of further education to enable students to register with the practice. The college provided a minibus to bring students to the practice each day and the practice made a number of appointments available to coincide with the college transport time. Students could also have appointments at other times as and when required.

Updated 23 June 2016

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. Patients over the age of 75 had a named GP.

• The practice had assessed the older patients most at risk of unplanned admissions and had developed care plans which were reviewed every three months.

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

• Nationally reported data for 2014/2015 showed that outcomes were good for conditions commonly found in older people. For example, performance for heart failure indicators was 100%; this was 1.9% above the local CCG average and 2.1% above the England average.

Updated 23 June 2016

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 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.

• Telephone consultations were available every day with a call back appointment arranged at a time to suit the patient, for example during their lunch break.

• Late evening and Saturday morning appointments were available with the GPs

Updated 23 June 2016

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 84% of people diagnosed with dementia had had their care reviewed in a face to face meeting in the preceding 12 months. This was the same as the local CCG and England average.

• Nationally reported data from 2014/2015 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 92.2%. This was 1.3% above the local CCG average and 3.9% above the England average.

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

• 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.

• 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.

• One of the GPs was a member of the national Mental Capacity Forum.

• Staff had a good understanding of how to support people with mental health needs and dementia. Nursing and non clinical staff had completed dementia training to become ‘dementia friends’. (A dementia friend is someone who learns more about what it is like to live with dementia and turns that understanding into action).

• Staff were trained to recognise patients with memory problems and arranged telephone reminders for appointments when needed.

Updated 23 June 2016

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

• The practice held registers of patients living in vulnerable circumstances which included those with a learning disability.

• The practice offered longer appointments for people with a learning disability.

• Nursing staff used easy read leaflets, pictures and CDs to assist patients with learning disabilities to understand their treatment.

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

• The practice 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.

• One of the GPs was the local Safeguarding Adults Lead and provided regular education and updates for staff, as well as advice in the event of any difficult issues arising from capacity questions.

• Telephone interpretation services were available and information leaflets in different languages were provided when required.