The Old Fire Station Surgery

Updated 22 June 2016

Dr Mixer and Partners (also known as the Old Fire Station) is located in the centre of Beverley and is close to local bus routes. There is a small amount of parking available at the practice and a number of pay and display car parks close by. The practice is in an adapted building and consulting and treatment rooms are available on the ground floor. There is one branch site on Samman Road in Beverley; this was not 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 10227, covering patients of all ages.

The proportion of the practice population in the 65 years and over age group is slightly above the England average. The practice population in the under 18 age group is slightly below 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 four GP partners, two salaried GPs and a GP Registrar, all full time. There is also a full time junior doctor who was in training at the practice. There are five male and three female doctors. There are three practice nurses, a dermatology specialist nurse, one health care assistant and a phlebotomist; all female and all work part time. There are two practice managers, an office supervisor and a team of administration, reception and secretarial staff.

The Old Fire Station site is open between 8am to 6pm Monday to Friday. Appointments are available from 9am to 11.30am and 2pm to 5.30pm Monday to Friday. There is extended opening one evening a week from 7pm to 9.15pm and on a Saturday morning from 8am to 1pm for pre-booked appointments only. The Samman Road surgery is open from 8.30am to 10.30am and operates a sit and wait service. Information about the opening times for both sites 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 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 and a teaching practice for third, fourth and fifth year medical students from the Hull York Medical School. One of the GPs was awarded Tutor of the Year in 2014 and 2015 by the Hull, York Medical School.

Updated 22 June 2016

Letter from the Chief Inspector of General Practice

We carried out an announced comprehensive inspection at Dr Mixer and Partners on 1 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.

We saw an area of outstanding practice.

• The practice provided a specialist led dermatology clinic which was operated jointly by a Dermatology Consultant and a GP with a special interest in dermatology. This incorporated minor surgery. When necessary the practice also assessed patients for cryotherapy and phototherapy treatment and patch testing. The practice employed a specialist dermatology nurse who contributed to these services. The service was available to the practices’ own patients and patients from other practices in the local area.

• The practice had also invested in a phototherapy unit which was used to treat chronic skin problems for the practice’s own patients and for other patients in the local area. This service had been running since 2011 and an audit conducted in 2013 showed very positive results. There had been a reduction of 307 patients who had not needed a referral to hospital for their treatment. The audit also measured the clinical improvement in 54 patient’s skin problem and their quality of life; in all but two patients there was improvement in both these areas. Feedback from patients was also very positive with patients describing the service as excellent. They also commented on the convenience of not having to travel to hospital for treatment and being able to access early morning appointments before they started work.

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

Importantly the provider should:

• Ensure staff have access to procedures for the management of controlled drugs.

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

Professor Steve Field (CBE FRCP FFPH FRCGP) 

Chief Inspector of General Practice

Updated 22 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 90.9%. This was 2.6% above the local CCG and England average.

• 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 22 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 relatively high for all standard childhood immunisations. For example, rates for all but one immunisation given to children aged 12 months, 24 months and five years were 92% 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 80.1%. This was 4.8% below the local CCG average and 1.7% below the England average.

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

• There was a ‘one stop shop’ approach which offered a post natal check appointment for the mother that was followed by an appointment with the nurse for the baby to have their first immunisations.

• 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.

• There was specific information on the practice website about support available for young carers.

Updated 22 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.

• They were responsive to the needs of older people, and offered home visits and urgent appointments for those with enhanced needs. The practice had developed a risk tool to assess the patients most at risk and had carried out a clinical assessment of wellbeing, a review of medication and an assessment of future care needs for these older patients.

• 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 22 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 and early morning appointments for blood tests.

Updated 22 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 83% of people diagnosed with dementia had had their care reviewed in a face to face meeting in the preceding 12 months. This was 1% below 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 76.2%. This was 14.7% below the local CCG average and 12.1% below 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 Deprivation of Liberty assessor and Mental Health Act assessor. This enabled them to support patients who did not have capacity or were experiencing mental health crises.

Updated 22 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 and pictures 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.