Elliott Chappell Health Centre Also known as St Andrews Surgery

Updated 5 January 2018

The St Andrews Surgery, Hessle Road, Hull, HU3 4BB is situated to the west of the city of Hull within the Elliot Chappell Health Centre. There is one other branch site located at the Newington Health Centre to the west of the city of Hull. We visited this branch as part of our inspection visit. The practice provides services under a Personal Medical Services (PMS) contract with NHS England, Hull Area Team. The practice list size of 9,800 is predominantly white British background and 7% are non English speaking patients. The practice is a training practice.

The practice has three full time GP partners one of who is male and two are female, two advanced nurse practitioners (one with prescribing duties) and two practice nurses. There are two health care assistants, a phlebotomist, a practice manager, an assistant practice manager and a team of secretarial, administration and reception staff.

The main practice and Newington Health Centre branch is open between 8am and 6.30pm Monday to Friday. GP appointment times are from 9am to 12.30pm and 2.30pm to 6pm on a Monday, Tuesday, Thursday and Friday and 9am to 11.30am and 1.30pm to 5pm on a Wednesday. An on-call GP provides telephone appointments from 9am to 6.30pm. Nursing and Health Care Assistant appointments are available from 8am to 6.30pm Tuesday, Wednesday and Thursday and from 8am to 5pm Monday and Friday. The practice offers alternative Saturday morning clinics from 8.30am to 1.30pm.

The proportion of the practice population in the 01-04 years age group is higher than the England average. The practice population in the 20-29 years age group is also higher than the England average. The practice scored one 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 greater need for health services. The overall practice deprivation score is worse than the England average, the practice is 49.4 and the England average is 21.8.

The practice, along with all other practices in the Hull CCG area have a contractual agreement for NHS 111 service to provide Out of Hours (OOHs) services from 6:30pm to 8am. This has been agreed with the NHS England area team. 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 website can be accessed at www.standrewssurgery-hull.nhs.uk

Updated 5 January 2018

Letter from the Chief Inspector of General Practice

This practice is rated as Good overall. (Previous inspection January 2017 – Requires Improvement)

The key questions are rated as:

Are services safe? – Good

Are services effective? – Good

Are services caring? – Good

Are services responsive? – Good

Are services well-led? - Good

As part of our inspection process, we also look at the quality of care for specific population groups. The population groups are rated as:

Older People – Good

People with long-term conditions – Good

Families, children and young people – Good

Working age people (including those recently retired and students – Good

People whose circumstances may make them vulnerable – Good

People experiencing poor mental health (including people with dementia) - Good

We carried out an announced comprehensive follow-up inspection at St Andrews Surgery on 14 November 2017. At our previous inspection on 10 January 2017 the overall rating for the practice was requires improvement. The full comprehensive report from the January 2017 inspection can be found by selecting the ‘all reports’ link for St Andrew Surgery on our website at www.cqc.org.uk. We conducted a further comprehensive follow-up inspection visit on 14 November 2017 and found improvements had been made. The report on the November 2017 inspection can be found by selecting the ‘all reports’ link for St Andrew Surgery on our website at www.cqc.org.uk.

At this inspection we found:

• The practice had clear systems to manage risk so that safety incidents were less likely to happen. When incidents did happen, the practice learned from them and improved their processes.

• The practice routinely reviewed the effectiveness and appropriateness of the care it provided. It ensured that care and treatment was delivered according to evidence- based guidelines.

• Staff involved and treated patients with compassion, kindness, dignity and respect.

• Patients found the appointment system easy to use and reported that they were able to access care when they needed it.

• There was a strong focus on continuous learning and improvement at all levels of the organisation.

• The practice implemented service developments using input from clinicians to understand their impact on the quality of care.

• The practice had implemented a new on-line electronic system for patients to allow them to log into the practice system from their own home and self-assess their current condition which consulted with a GP.

The areas where the provider should make improvements are:

• Consider the lead person identified for infection and prevention control receives appropriate training for the role.

• Consider that nursing staff have completed on-going competency assessment and supervisions.

• Consider implementing additional systems to ensure all staff are aware of what actions are taken, by whom and by when to enable learning from significant events.

• Consider a system for refrigerator temperature checks is regularly maintained.

Consider implementing systems to ensure patient access to appointments is improved.

Professor Steve Field (CBE FRCP FFPH FRCGP) 

Chief Inspector of General Practice

Updated 24 March 2017

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 2015/2016 showed that outcomes for patients with long term conditions were worse. For example, performance for chronic obstructive pulmonary disease (COPD) related indicators was 77%, compared to the CCG average of 81% and the national average of 95%.

• Longer appointments and home visits were available when needed.

• Patients 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 GP worked with relevant health and care professionals to deliver a multidisciplinary package of care.

Updated 24 March 2017

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. Immunisation rates were relatively high for all standard childhood immunisations.

• Nationally reported data from 2015/2016 showed patients diagnosed with asthma, on the register, who had had an asthma review in the last 12 months was 54%, which was significantly worse than both the local CCG average of 76% and the national average of 76%.

• Patients told us that children and young people were treated in an age-appropriate way and were recognised as individuals. We did not see evidence to confirm this.

• Nationally reported data from 2015/2016 showed the practice’s uptake for the cervical screening programme was 90%, which was worse than the local CCG average 97% and similar to the national average of 97%.

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

Updated 24 March 2017

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

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

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

Updated 24 March 2017

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 offered online services as well as a full range of health promotion and screening that reflected the needs for this age group.

Updated 24 March 2017

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

• 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 39%. This was significantly worse than both the local CCG average of 84% and the national average of 89%.

• Nationally reported data from 2015/2016 showed 52% of people diagnosed with dementia had their care reviewed in a face to face meeting in the last 12 months. This was significantly worse than both the local CCG average of 82% and the national average of 84%..

• 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 told patients experiencing poor mental health about how to access various support groups and voluntary organisations.

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

Updated 24 March 2017

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

• The practice held a register of patients living in vulnerable circumstances and those with a learning disability.

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

• The practice regularly worked with other health care professionals in the case management of vulnerable patients.

• The practice informed 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.