The Park Surgery

Updated 31 May 2017

The Park Surgery, Eastgate Road, Driffield YO25 6EB is located near the centre of the market town of Driffield and is close to local bus routes. There is a car park available at 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 lift access to the first floor. There is one branch site, Nafferton Surgery, 22a High Street, Nafferton YO25 4JR which is located in the village of Nafferton, two 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 15300, covering patients of all ages. The practice covers a large rural area of 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. There is a dispensary at both surgeries. The practice dispenses medicines for approximately 48% of its patients.

The proportion of the practice population in the 65 years and over age group is slightly above the local CCG and England average and in the under 18 age group is slightly below the local CCG and England average. The practice scored eight 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 eight GP partners and a salaried GP, two full time and seven part time. There are five female and four male GPs. There are three nurse practitioners, six practice nurses and four health care assistants (HCAs). All the nurses and HCAs work part time. All the nurses are female and there are three female and one male HCA. There is a practice manager, a finance officer/personal assistant and a team of administrators, secretaries and receptionists. There is one pharmacist and five dispensers.

The Park Surgery is open between 8am to 6pm Monday to Friday. GP appointments are available from 8.30am to 11.10am and 3.30pm to 6pm Monday to Friday. There are ‘sit and wait’ clinics at the Park Surgery from 8.30am to 10.30am Monday to Friday for patients who have new, urgent or acute issues that need dealing with quickly.

The Nafferton surgery is open between 8am and 12.30pm and 1.30pm to 6pm on a Monday. From 8am to 12.30pm and 1.30pm to 5pm on Tuesday, Thursday and Friday and from 8am to 12pm on Wednesday. GP appointments are available from 8.30am to 11.10am Monday to Friday and from 2.30pm to 5.30pm Monday and 2pm to 4.30pm Tuesday, Thursday and Friday.

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 6pm. 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 training practice for GP Registrars; doctors who are training to become GPs. The practice is also a teaching practice for year four and five medical students and Foundation Doctors (FY2). FY2 is a grade of medical practitioner in the United Kingdom undertaking the Foundation Programme – a two-year, general postgraduate medical training programme which forms the bridge between medical school and specialist/general practice training. The practice is a training site for student nurses.

The practice was inspected on 19 August 2016 and following this inspection we took enforcement action in relation to the safe management of medicines and good governance.

Updated 31 May 2017

Letter from the Chief Inspector of General Practice

We carried out an announced comprehensive inspection at The Park Surgery on 19 August 2016. The overall rating for the practice was requires improvement. The full comprehensive report on the 19 August 2016 inspection can be found by selecting the ‘all reports’ link for The Park Surgery on our website at www.cqc.org.uk.

This inspection was undertaken following actions by the provider and was an announced comprehensive follow up inspection on 25 April 2017. We visited the main surgery in Driffield and the branch surgery at Nafferton during the inspection. Overall the practice is now rated as good

Our key findings were as follows:

• There was an open and transparent approach to safety and an effective system in place for reporting and recording significant events.
• The practice had clearly defined and embedded systems to minimise risks to patient safety.
• Staff were aware of current evidence based guidance. Staff had been trained to provide them with skills and knowledge to deliver effective care and treatment.
• Results from the national GP patient survey showed patients were treated with compassion, dignity and respect and were involved in their care and decisions about their treatment.
• Information about services and how to complain was available. Improvements were made to the quality of care as a result of complaints and concerns.
• Patients we spoke with said they found it easy to make an appointment with a named GP and there was continuity of care, with urgent appointments available the same day. However some patients told us it could be difficult to get through on the phone and to make appointments in advance.
• 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 the requirements of the Duty of Candour. Examples we reviewed showed the practice complied with these requirements.

The areas where the provider should make improvements are:

• Review procedures to ensure fridge temperatures are recorded daily in line with national guidance.

• Implement a standard operating procedure for dispensers for when there is no GP on site at the branch surgery.

• Embed documented checks of competency for dispensary staff.

Professor Steve Field (CBE FRCP FFPH FRCGP) 

Chief Inspector of General Practice

Updated 31 May 2017

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

• Nursing staff had lead roles in long-term 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 good. For example, the percentage of patients with diabetes, on the register, whose last measured total cholesterol (measured within the preceding 12 months) was 5mmol/l or less was 79%. This was comparable to the local CCG average of 81% and England average of 80%.

• The practice followed up on patients with long-term conditions discharged from hospital and ensured that their care plans were updated to reflect any additional needs.

• There were emergency processes for patients with long-term conditions who experienced a sudden deterioration in health.

• Longer appointments and home visits were available when needed.

• Patients with LTCs had a named GP and there was a system to recall patients for 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.

• The practice hosted retinal screening clinics for patients with diabetes.

Updated 31 May 2017

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

• From the sample of documented examples we reviewed we found there were systems 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 accident and emergency attendances.

• Immunisation rates were relatively high for all standard childhood immunisations. Data from 2015/2016 for childhood immunisation rates showed for children aged two the practice was achieving above the national expected coverage of 90% for vaccinations for the four indicators. For children aged five years immunisation rates were similar to or above the local CCG and national average.

• Patients told us, on the day of inspection, that children and young people were treated in an age-appropriate way and were recognised as individuals.

• Sit and wait clinics were held every morning and appointments were available outside of school hours.

• The premises were suitable for children and babies.

• The practice worked with midwives, health visitors and school nurses to support this population group. For example, in the provision of ante-natal, post-natal and child health surveillance clinics.

• The practice had emergency processes for acutely ill children and young people and for acute pregnancy complications.

Updated 31 May 2017

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

• Staff were able to recognise the signs of abuse in older patients and knew how to escalate any concerns.

• The practice offered proactive, personalised care to meet the needs of the older patients in its population.

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

• The practice identified at an early stage older patients who may need palliative care as they were approaching the end of life. It involved older patients in planning and making decisions about their care, including their end of life care.

• The practice followed up on older patients discharged from hospital and ensured that their care plans were updated to reflect any extra needs.

• Where older patients had complex needs, the practice shared summary care records with local care services. We saw records summaries were shared with the out of hours service.

• Older patients were provided with health promotional advice and support to help them to maintain their health and independence for as long as possible.

• The practice was delivering ‘A Care Home Scheme’. This ensured patients living in care homes had structured annual reviews which included a review of medication by a pharmacist, review of clinical care and advanced care planning with the GPs and nurses.

• Minor surgery and ear irrigation was provided on site thus reducing the need for patients to travel to hospital which could be a journey of 20 miles.

Updated 31 May 2017

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

• The needs of these populations 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.

• Signposting was available to local pharmacists for treatment of minor illnesses that could be accessed at weekends. Also to mental health support services to enable patients to access them at times convenient to them.

Updated 31 May 2017

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

• The practice carried out advanced care planning for patients living with mental health needs, including dementia.

• Nationally reported data from 2015/2016 showed 80% 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 2015/2016 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 100%. This was above the local CCG average of 88% and the England average of 89%.

• The practice specifically considered the physical health needs of patients with poor mental health and dementia.

• The practice had a system for monitoring repeat prescribing for patients receiving medicines for mental health needs.

• 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 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 practice nurses was trained to administer long acting medication for patients experiencing mental health problems. This reduced the need for patients to travel to hospitals in Hull for this treatment.

• The practice had information available for patients experiencing poor mental health about how they could access various support groups and voluntary organisations.

• 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).

• Staff interviewed had a good understanding of how to support patients with mental health needs and dementia.

Updated 31 May 2017

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.

• End of life care was delivered in a coordinated way which took into account the needs of those whose circumstances may make them vulnerable.

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

• The practice had information available for vulnerable patients about how to access various support groups and voluntary organisations.

• Staff interviewed knew how to recognise signs of abuse in children, young people and . 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.

• Staff had completed training in the identification of potential exploitation and female genital mutilation.

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