Nidderdale Group Practice

Updated 3 March 2017

Nidderdale Group Practice, Feastfield Medical Centre, Pateley Bridge, Harrogate HG3 5AT is located in the market town of Pateley Bridge and serves surrounding villages. There are two branch sites: The Grange Medical Centre, Dacre Banks, Harrogate HD3 4DX and Spring Gables Surgery, Birstwith, Harrogate HG3 3AJ. All three sites were visited during the inspection. There is car parking available including disabled parking at all three sites. All sites are in a purpose built building with disabled access and consulting and treatment rooms on the ground floor.

The practice provides services under a General Medical Services (GMS) contract with the NHS North Yorkshire and Humber Area Team. The registered practice population is approximately 10523, 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 practice dispenses medicines for 77% of its patients from all three sites.

The proportion of the practice population in the 65 years and over age groups is similar to the local CCG and England average. In the under 18 age group the proportion of the practice population is similar to the local CCG and England average. The practice scores 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 five GP partners and four salaried GPs, one full time and eight part time. There are six female and three male GPs. There are three GP registrars, all full time, two male and one female. There are two nurse practitioners, four practice nurses and four health care assistants, all part time and all female. There is a practice manager, a reception manager, dispensing manager and a team of administrators, secretaries, receptionists, dispensers and cleaners.

The three sites are open between 8am and 6pm Monday to Friday. GP appointments at Feastfield and The Grange Medical Centre are available from 9am to 11am and 4pm to 6pm Monday to Friday. Appointments at Spring Gables surgery are available between 8am to 10.30am and 4pm to 6pm Monday to Friday.

Extended opening hours are available between 7am and 8am on Fridays at Spring Gables and between 8am and 1pm on Saturdays once a month at The Grange.

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 NHS Harrogate and Rural District 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.

The practice is a training practice for GP Registrars; doctors who are training to become GPs.

Updated 3 March 2017

Letter from the Chief Inspector of General Practice

We carried out an announced comprehensive inspection at Nidderdale Group Practice on 4 November 2016. We visited the main surgery Feastfield Medical Centre and the branch sites, Spring Gables Surgery and the Grange Medical Centre during the inspection. 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 had implemented GP succession planning. One partner had retired in 2016 and one was due to retire in 2017. Two salaried GPs had been employed before the partners retired to ensure continuity of care for patients.

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

Importantly the provider should:

• Monitor that chaperones record their attendance in patient records.

• Review the frequency of controlled drugs checks in line with the practice Standard Operating Procedure.

• Implement a process for checking and recording expiry dates for medicines at the Grange and Spring Gables sites in accordance with current guidance.

• Review the management of blank prescription forms at all sites.

• Review actions plan templates so they include all required information.

Professor Steve Field (CBE FRCP FFPH FRCGP) 

Chief Inspector of General Practice

Updated 3 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 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 80%, compared to the local CCG average of 81% and England average of 80%.

• 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 3 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 or who failed to attend hospital appointments.

• Immunisation rates for 2015/2016 were comparable to or slightly below the local CCG and England average for all standard childhood immunisations. For example, immunisations given to children aged 12 months, 24 months and five years in the practice ranged from 83% to 93% compared to 91% to 96% for the local CCG area and 73% to 95% for England.

• 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.

• Chlamydia testing kits were available in the patient toilets.

• Nationally reported data from 2015/2016 showed the practice’s uptake for the cervical screening programme was 83%, compared to the local CCG average of 83% and the England average of 81%.

• Joint appointments were available so new mums and babies could have their eight week check and immunisations together.

• 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 3 March 2017

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.

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

• The practice worked closely with a local voluntary driving service to enable their less mobile patients to attend the practice to see the practice nurses and /or GPs.

• Nationally reported data for 2015/2016 showed that outcomes were good for conditions commonly found in older people. For example, performance for heart failure indicators was 100%, compared to the local CCG average of 100% and England average of 98%.

Updated 3 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 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.

• Early morning appointments with GPs, nurse practitioner and practice nurses were available on Fridays at Spring Gables and on Saturday mornings once a month at the The Grange. Early morning appointments were available on Fridays twice a month with nurses for contraception advice and cervical smears.

• Family planning clinics, minor surgery and joint injections were provided at the practice so patients did not have to attend hospital to access these services.

Updated 3 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 85% of people diagnosed with dementia had had their care reviewed in a face to face meeting in the preceding 12 months, compared to the local CCG average of 85% and England 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 carried out advanced care planning for patients with dementia.

• Staff had completed dementia training to increase their understanding of what it is like to live with dementia and turn that understanding into action.

• When required receptionists telephoned patients who were living with dementia to remind them about their appointments.

• 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 97%, compared to the local CCG average of 92% and the England average of 89%.

• 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 3 March 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.

• 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.

• Staff had completed training in the identification of potential exploitation and female genital mutilation and how to identify patients that may be a risk of radicalisation.

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

• The practice referred and sign posted people who needed support for alcohol or drug problems to local counselling services.