Moss Healthcare Harrogate

Updated 18 August 2016

Dr Moss and Partners provides a Personal Medical Service (PMS) to their practice population of over 19,854 patients. Their main surgery is in Harrogate Town Centre. They have two branch surgeries one in Killinghall Village and one at the Jennyfields Health Centre which is located at the edge of a large housing conurbation. They are also contracted to provide other enhanced services for example: extended hours access and minor surgery.

There are eight GP partners. Two female and six male. There are four salaried GPs, two female and two male. There is one GP retainer, female, who has returned to the profession after a period of absence. This is a teaching and training practice. There are currently registrars delivering care and treatment in the practice. These are qualified doctors who wish to train as GPs. Student doctors from Leeds University Medical School are taught at this practice. Patients are informed when the students are in the practice. Patients are given a choice whether or not the student will be present at their consultation.

There is one nurse manager, seven practice nurses and two health care assistants all female. There is one business manager who is supported by practice and reception managers and teams of receptionists, medical secretaries and prescription clerks to help maintain the effectiveness of the group practice.

All of the surgeries (Kings Road, Jennyfield Health Centre and Killinghall Medical Centre) are open from 8am-6pm Monday to Friday. There is extended hours opening at Kings Road Surgery each Saturday morning from 8am-12 midday. Killinghall Medical Centre is open from 7am each Wednesday. These (extended hours) are for pre-bookable appointments. Harrogate and District Foundation Trust provides GP OOH services from 6.30pm until 8am Monday-Friday, and each weekend from 6pm on Friday until 8am on Monday; this is a Harrogate and Rural District CCG contract. The practice contracts with Primecare to provide a call handling service between 6pm and 6.30pm Monday to Friday.

Updated 18 August 2016

Letter from the Chief Inspector of General Practice

We carried out an announced comprehensive inspection at Dr Moss and Partners on 19 July 2016. Overall the practice is rated as good. We only visited the main surgery on Kings Road in Harrogate on this occasion.

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 been trained to provide them with 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 found it easy to make an appointment with a named GP and there was continuity of care, with urgent appointments available the same day.
• 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.

Professor Steve Field (CBE FRCP FFPH FRCGP) 

Chief Inspector of General Practice

Updated 18 August 2016

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

• Nursing staff supported chronic disease management and patients at risk of hospital admission were identified as a priority. The practice had identified 4% of their practice population who were at risk of unplanned hospital admissions. These patients had care plans in place.

• The percentage of patients with diabetes, on the register, in whom the last IFCC-HbA1c was 64 mmol/mol or less in the preceding 12 months (01/04/2014 to 31/03/2015), was 78% which was lower than the CCG average of 82% and higher than the national average of 77%.

• The percentage of patients with diabetes, on the register, in whom the last blood pressure reading (measured in the preceding 12 months) was 140/80 mmHg or less (01/04/2014 to 31/03/2015) was 70% which was lower than the CCG average of 78%and the national average of 78%.

• The percentage of patients with diabetes, on the register, who had had influenza immunisation in the preceding 1 August to 31 March (01/04/2014 to 31/03/2015) was 89% compared to the CCG average of 95% and the national average of 94%.

• 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 care professionals to deliver a multidisciplinary package of care.

Updated 18 August 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. Immunisation rates were relatively high for all standard childhood immunisations.

• 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.

• The percentage of women aged 25-64 whose notes recorded that a cervical screening test had been performed in the preceding 5 years (01/04/2014 to 31/03/2015) was 81% which was lower than the CCG average of 83% and in-line with the national average of 81%.

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

• We saw positive examples of joint working with midwives, health visitors and school nurses. Monthly multi-disciplinary meetings were held to discuss those patients with particular needs.

Updated 18 August 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 aged 70 and above represented 10% of the practice’s patient population. All patients over the age of 75 had an accountable GP.

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

• There were care plans for patients over the age of 75 and those at high risk of hospital admission.

• A CCG pilot had recently started this included having representatives from Dementia Forward in attendance each week at the Kings Road surgery. They were working closely with the practice and the Carers' resource that would also be in attendance each week to support carers and patients. This was to be provided at Jennyfields Health Centre branch surgery as there was car parking available on site.

Updated 18 August 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.

• This included a range of appointment lengths, times, and formats with early morning extended hours from 7am each Wednesday at the Killinghall Branch Surgery and weekly Saturday morning clinics at the main surgery on Kings Road from 8am until 12midday, in addition to telephone appointments.

• The practice was proactive in offering online services as well as a full range of health promotion and screening that reflected the needs of this age group.

Updated 18 August 2016

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

• 83% 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 CCG average of 86% and also lower than the national average of 84%.

• The practice had recently started a CCG pilot where a member of Dementia Forward attended the practice each Tuesday afternoon for patients and /or their carer to access advice and support.

• The percentage of patients with schizophrenia, bipolar affective disorder and other psychoses who had a comprehensive, agreed care plan documented in the record, in the preceding 12 months (01/04/2014 to 31/03/2015) was 81% which was lower than the CCG average of 90% and lower than the national average of 88%.

• The practice regularly worked with multi-disciplinary teams in the case management of patients experiencing poor mental health, including those with dementia.

• The practice carried out advance care planning for patients with dementia.

• The practice had told patients experiencing poor mental health 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.

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

Updated 18 August 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 and those with a learning disability.

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

• The practice had strong links with the local Harrogate Homeless Project and Women’s Refuge.

• The practice had been approached by the CCG to register refugees’ families and to support them with their transition to a new environment. This was facilitated by the practice who co-ordinated interpreters and the hospital staff to screen for specific infectious diseases, in case treatment was required. The practice had previous experience of registering and supporting refugees from previous crises for example in Kosovo.

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

• 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.