The Old School Medical Practice

Updated 26 August 2016

The Old School Medical practice is a semi-rural dispensing practice and they provide General Medical Services to their practice population.They have two locations. All patients can be seen at any of the locations. We visited both locations on 19 January 2016.The practice population is 7,400. The practice population lives in a less deprived area than average for England.

This is a teaching practice for medical students who are studying at Hull & York Medical School (HYMS).

There are five GP Partners and one Practice Manager, plus one salaried GP and an Advanced Nurse Practitioner. There are two Practice Nurses and two Health Care Assistants (HCAs). They are supported by dispensary assistants, secretaries, administration and reception teams.

The Copmanthorpe surgery is open every week day between 8am and 6pm. They have extended opening hours every Monday evening until 8pm.

The Bishopthorpe surgery is open every week day between 8am and 12midday and from 3pm to 6pm. This surgery is closed every Tuesday from 12 midday.

The practice website and leaflet offer information for patients when the surgery is closed. They are directed to the Out of Hours Service provided by Northern Doctors Urgent Care.

We previously inspected The Old School Medical Practice on 19 January 2016. Following this inspection, the practice was given a rating of good. The practice was rated as requires improvement for providing safe care. This was because the staff had not been provided with appropriate policies and guidance to carry out their roles in a safe and effective manner. Governance systems and processes were not implemented and so monitoring and assessing the whole service in relation to risk and improvements was not evidenced. The infection prevention and control (IPC) policy was in draft and had therefore not been implemented nor was there an up to date IPC audit for both premises. In addition there were areas where the provider should make further improvements.  These included embedding good record keeping in all aspects of dispensing medicines. Comprehensive standard operating procedures (SOPs) which were regularly reviewed required implementation in line with national guidance for dispensing practices. All staff who chaperoned patients required an up to date Disclosure and Barring Service (DBS) check. The dispensary staff's competencies required formal assessment.

A copy of the report detailing our findings can be found at w.cqc.org.uk/

Updated 26 August 2016

Letter from the Chief Inspector of General Practice

We carried out a focused desktop inspection of Old School Medical Practice on 16 August 2016 to assess whether the practice had made the improvements in providing safe care and services.

We had previously carried out an announced comprehensive inspection of Old School Medical Practice on 19 January 2016, when we rated the practice as good overall. The practice was rated as requires improvement  for providing safe care. This was because the staff had not been provided with appropriate policies and guidance to carry out their roles in a safe and effective manner. Governance systems and processes were not implemented and so monitoring and assessing the whole service in relation to risk and improvements was not evidenced. The infection prevention and control (IPC) policy was in draft and had therefore not been implemented nor was there an up to date IPC audit for both premises. In addition there were areas where the provider should make further improvements.  These included embedding good record keeping in all aspects of dispensing medicines. Comprehensive standard operating procedures (SOPs) which were regularly reviewed required implementation in line with national guidance for dispensing practices. All staff who chaperoned patients required an up to date Disclosure and Barring Service (DBS) check. The dispensary staff's competencies required formal assessment.

We asked the provider to send a report of the changes they had made to comply with the regulations; they were not meeting on the 19 January 2016. In addition we asked for an update of changes made within the dispensary and for verification of up to date DBS checks.

The practice was able to demonstrate that they were meeting the standards and had implemented all changes recommended within the dispensary. We were also provided with up to date DBS disclosures for the appropriate staff.

This report should be read in conjunction with the full inspection report dated 18 March 2016.

Our key findings across the area we inspected was as follows:

There are clearly defined and embedded systems, processes and practices to keep patients safe and safeguarded from abuse.

Staff had received up to date training in systems, processes and practices.

Risks to patients were assessed and well managed.

Professor Steve Field (CBE FRCP FFPH FRCGP) 

Chief Inspector of General Practice

Updated 18 March 2016

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

• Clinical staff had lead roles in chronic disease management and patients at risk of hospital admission were identified as a priority.

• The Advanced Nurse Practitioner had taken the lead role to optimise diabetes care, as this was an area where improvement was needed. They were liaising with the community diabetic team to arrange joint monthly clinics; to help improve the health status of this group of patients.

• Longer appointments and home visits were available when needed.

• All these patients had a named GP and a structured annual review to check their health and medicines needs were being met. For those patients with the most complex needs, the named GP worked with relevant health and social care professionals to deliver a multidisciplinary package of care.

Updated 18 March 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.

• 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.

• All very young patients in this age group were either seen or their parents telephoned by a GP the same day if required.

• Appointments were available outside of school hours (between 4-5.30pm) and the premises were suitable for children and babies.

• One of the GPs had a Post Graduate Certificate in understanding and treating Allergies such as infants with feeding problems and those with allergies. This avoided the need for onward specialist referrals in many cases.

• We saw positive examples of joint working with midwives and health visitors.

Updated 18 March 2016

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

• The practice offered proactive, personalised care to meet the needs of this population group .

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

• The practice held a register of patients who were at risk of unplanned emergency admission to hospital. The Advanced Nurse Practitioner visited these patients to offer support and to co-ordinate their care.

Updated 18 March 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 they 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.

• The practice hosted various services with direct and targeted benefits to their patient population.

Updated 18 March 2016

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

• 76% of patients diagnosed with dementia had, had their care reviewed in a face to face meeting in the last 12 months, which was lower than 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 carried out advance care planning for patients with dementia.

• All patients who did not attend (DNA) a mental health related appointment were contacted.

• 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.

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

• The practice had told patients experiencing poor mental health how to access various support groups and voluntary organisations, some of which were hosted within the practice.

Updated 18 March 2016

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 including those with a learning disability.

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

• The practice informed vulnerable patients 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.