The Medical Centre - Driffield

Updated 31 May 2017

The Medical Centre – Driffield, Cranwell Road, Driffield YO25 6UH is located in the centre of the market town of Driffield and is close to local bus routes. There is a car park available next to the practice. The practice is in a purpose built building with disabled access and consulting and treatment rooms available on the ground and first floors; there is no lift access to the first floor. The administration staff are based in a separate building which is a five minute walk from the practice. There is one branch site, Wetwang Surgery, 48 Southfield Road, Wetwang YO25 9XX which is located in the village of Wetwang which is approximately six miles from Driffield. There is disabled access and all consulting and treatment rooms are on the ground floor. This site was also visited during the inspection.

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 10290, covering patients of all ages. The practice covers a large rural area of approximately 400 square miles. 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 practice dispenses medicines for approximately half its patients.

The proportion of the practice population in the 65 years and over age group and the under 18 age group is similar to the England average. The practice scored seven 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 five GP partners and a salaried GP, all are part time. There are two female and four male GPs. There are two nurse prescribers, four practice nurses and three health care assistants. Two work full time and seven work part time, all are female. There is a practice manager and a team of administrators, secretaries and receptionists. There are eight dispensers and a trainee dispenser.

The Medical Centre – Driffield is open between 8am to 6pm Monday to Friday. Appointments are available from 8am to 5.30pm Monday to Friday. The Wetwang surgery is open between 8.15am and 12pm Monday to Friday and 3.30pm and 6pm Monday, Tuesday and Friday. Appointments are available from 8.15am to 11.30am Monday to Friday and from 3.30pm and 5.30pm Monday, Tuesday and Friday. Information about the opening times is available on the website and in the patient information leaflet – Booking Appointments.

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.

Updated 31 May 2017

Letter from the Chief Inspector of General Practice

We carried out an announced comprehensive inspection at The Medical Centre - Driffield on 16 June 2016. The overall rating for the practice was good and the rating for the safe domain was requires improvement. The full comprehensive report on the June 2016 inspection can be found by selecting the ‘all reports’ link for The Medical Centre - Driffield on our website at www.cqc.org.uk.

This inspection was an announced focused inspection carried out on 10 May 2017 to confirm that the practice had carried out their plan to meet the legal requirements in relation to the breaches in regulations that we identified in our previous inspection on 21 June 2016. This report covers our findings in relation to those requirements and also additional improvements made since our last inspection.

Overall the practice was now rated as good.

Our key findings were as follows:

• The arrangements for managing medicines, including emergency medicines and vaccines, in the practice minimised risks to patient safety (including obtaining, prescribing, recording, handling, storing, security and disposal).

We asked the practice to send us information to confirm that they had addressed other areas identified at the inspection in June 2016 that should improve. These included:

• A new schedule of meetings had been introduced to ensure that learning from incidents was shared with the whole practice team.

• A process was in place to monitor that all staff were up to date with mandatory refresher training.

• A business development plan was in place which set out the practice plans for the future.

• There was a rolling programme of review of policies and procedures and all policies had an annual review date added, as well as an issue date and version control.

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 (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 94% compared to the local CCG and England average of 88%.

• 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 12 September 2016

• 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 comparable to or higher than the local CCG area for all standard childhood immunisations. For example, rates for all immunisations given to children aged 12 months, 24 months and five years in the practice ranged from 93% to 100% compared to 94% to 98% for the local CCG area.

• 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 81% compared to the local CCG average of 85% and the England average of 82%.

• The practice held regular ‘Women’s Health’ clinics where patients could get advice and treatment, for example with regard to; hormone replacement therapy, contraception and pelvic pain.

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

• 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.

Updated 12 September 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.

• The practice was delivering ‘A Care Home Scheme’. Patients living in care homes had structured annual reviews (and three monthly interim reviews), which included a review of medication, clinical care and advanced care planning with the GPs, community nurses and care home managers.

• 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 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 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.

Updated 12 September 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 81% of people diagnosed with dementia had had their care reviewed in a face to face meeting in the preceding 12 months. This was comparable to the local CCG and England average of 84%.

• 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 98%. This was above the local CCG average of 91% and the England average of 88%.

• 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. Staff had completed dementia friends training (a dementia friend is someone who learns more about what it is like to live with dementia and turns that understanding into action).

• 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.

Updated 12 September 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 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.

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