Snaith and Rawcliffe Medical Group

Updated 26 January 2017

The Marshes (also known as The Snaith & Rawcliffe Medical Group), The Marshes, Butt Lane Snaith Goole Humberside DN14 9DY is located in the village of Snaith. There is car parking available at the practice. The practice is in a purpose built building with disabled access and consulting and treatment rooms available on the ground and first floors; there is lift access to the first floor. There is one branch site, The Surgery, Station Road, Rawcliffe, Goole, DN14 8QR which is located in the village of Rawcliffe, 3.5 miles from Snaith. There is disabled access and all consulting and treatment rooms are on the ground floor. This site was also visited during the inspection.

The practice provides services under a Personal Medical Services (PMS) contract with the NHS North Yorkshire and Humber Area Team to the practice population of 10151, covering patients of all ages. The practice covers a large rural area of approximately 80 square miles. 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 60% of its patients.

The proportion of the practice population in the 65 years and over age group and the under 18 age group is similar to the local CG and 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 five GP partners and three salaried GPs, one is full time and five are part time. There are four female and four male GPs. There is one nurse practitioner, four practice nurses and two health care assistants. One works full time and six work part time, all are female. There is a practice manager, an assistant practice manager and a team of administrators, secretaries and receptionists. There are eight dispensers.

The Marshes Surgery in Snaith is open between 7.40am and 8.30pm on Monday, 8am to 6pm Tuesday and Thursday and 7.40am to 6pm Wednesday and Friday. Appointments are available from 7.45am to 11am and 1pm to 8.30pm on Monday, 8.10am to 11am and 1pm to 6pm on Tuesday and Thursday and 7.45am to 11am and 1pm to 6pm on Wednesday and Friday.

The Surgery, Station Road in Rawcliffe is open between 8.30am and 11am Monday to Thursday and 8.30am to 12pm on Friday. Appointments are available from 8am to 11am Monday to Friday.

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 East Riding of Yorkshire 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 teaching practice for medical students from the Hull York Medical School. The practice is also a training practice for GP registrars and student nurses. One of the GPs had been nominated for an Educational Supervisor award and two GP’s had been nominated for an excellence in teaching award from the Hull York Medical School.

Updated 26 January 2017

Letter from the Chief Inspector of General Practice

We carried out an announced comprehensive inspection at The Marshes (also known as The Snaith & Rawcliffe Medical Group) on the 3 & 4 August 2016. We visited the main surgery in Snaith and the branch surgery at Rawcliffe 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.
• The practice had a very active Patient Liaison Group which worked with the practice to make improvements.

We saw several areas of outstanding practice:

• 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. There were 126 patients registered to use the service and 426 journeys had been made to the practice in the past 12 months which saved more than one home visit per day.
• The practice had introduced a service where patients had been taught to administer their own injections for long acting contraception. If patients were interested in self-administering the nurse demonstrated how to give the injection. The patient was also given an information sheet and video for them to take home and review. At the next visit if the patient wanted to self-administer the nurse assessed the patient was safe to give their own injection. The nurse had supported 22 of the 72 patients using long action contraception to change to the self-administered method in the previous 12 months so they then only had to attend the practice once a year instead of four.

• The practice had a very active Patient Liaison Group PLG which worked with the practice to make improvements, for example; one of the PLG members had worked with a GP to review the number of attendances at the branch site and used the information to inform a decision about opening hours and PLG members were included on interview panels when the practice recruited new staff. At the suggestion of a PLG member the practice had held a ‘Family Fun Day’ in May 2015 for members of the public. Practice staff diagnosed two patients with diabetes and seven patients with hypertension from opportunistically checking them whilst they visited the family fun day.

• The practice was involved in the ‘Productive General Practice’ programme, which encouraged staff to openly review the service and determine where they could improve. One area that staff had identified for improvement was to increase their collection of smoking data. A question was added to the appointment self- check in screen to collect smoking data. From April to November 2014, 2593 patients had had their smoking status recorded and 597 were given smoking cessation advice. From April 2015 to November 2015, 4653 patients had their smoking status recorded and 713 were given smoking cessation advice.

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

Importantly the provider should:

• Implement a near-miss record for the dispensary to identify trends and patterns in errors.

• Improve the arrangements in the dispensary for recording when balance checks for medicines have been carried out.

Professor Steve Field (CBE FRCP FFPH FRCGP) 

Chief Inspector of General Practice

Updated 26 January 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 on the diabetes register, with a record of a foot examination and risk classification within the preceding 12 months was 87%. This was comparable to the local CCG average of 90% and England average of 89%.

• The practice had a register of patients who were at high risk of diabetes, 700 patients had been identified as being at risk.

• 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 patients with the most complex needs, the named GPs worked with relevant health and care professionals to deliver a multidisciplinary package of care.

• Practice nurses visited patients at home to do long term conditions reviews and administer flu vaccinations during the flu season.

Updated 26 January 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 were comparable to the local CCG and England national average for 17 of the 18 standard childhood immunisations. For example, data from 2015/2016 showed rates for immunisations given to children aged 12 months, 24 months and five years in the practice ranged from 72% to 98% compared to 74% to 98% for the local CCG and 73% to 95% for the England national average.

• Children and young people were treated in an age-appropriate way and were recognised as individuals.

• Nationally reported data from 2015/2016 showed the practice’s uptake for the cervical screening programme was 84%. This was comparable to the local CCG average of 85% and the England average of 81%.

• The practice offered a range of sexual health services where patients could get advice and treatment, for example contraception. Information and testing kits for sexually transmitted diseases were available in the practice.

• 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 lead GP for safeguarding along with another GP met with the health visitor once a month to discuss any patients who were identified as at risk. 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 26 January 2017

The practice is rated as outstanding 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 did a ‘safety net’ search every moth for patients over 85 who had not been seen at the practice for more than a year. The patients ‘usual’ doctor contacted them and invited them for a consultation. In the past 12 months 12 patients that hadn’t been seen were contacted and five of these patients then made an appointment and came in to be seen.

• The practice had assessed the older patients most at risk of unplanned admissions and had developed care plans which were regularly reviewed.

• The practice was delivering a ‘Care Home Scheme’. This ensured patients living in care homes had annual reviews by a Geriatrician and regular review of medication, clinical care and advanced care planning with the GPs and nurses. There was a named GP for individual care homes and they did weekly ‘ward rounds’ in conjunction with the care home staff and the district nurses.

• The practice worked closely with the local care homes and we saw evidence from two homes confirming that the practice provided very good support. They said that the practice provided excellent care and went above and beyond to assist staff with meeting the needs of residents with complex needs.

• 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. There were 126 patients registered to use the service and 426 journeys had been made to the practice in the past 12 months which saved more than one home visit per day.

• 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%; this was 1.4% above the local CCG average and 1.9% above the England average.

• The practice was participating in the EASYcare Project. The practice was working with social care staff to undertake a needs based assessment of all the practice patients over 75 years of age. Also those living in care homes and learning disability units. This would identify a summary of the patient’s needs, allowing them to be signposted to appropriate local resources.

Updated 26 January 2017

The practice is rated as outstanding 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.

• 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.
• The practice had introduced a service where patients had been taught to administer their own injections for long acting contraception so they only had to attend the practice once a year instead of four. The nurses had supported 22 of the 72 patients using long action contraception to change to the self-administered method in the previous 12 months.
• The practice offered a range of sexual health services where patients could get advice and treatment. Information and testing kits for sexually transmitted diseases were available in the practice.

• 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.

Updated 26 January 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 91% of people diagnosed with dementia had had their care reviewed in a face to face meeting in the preceding 12 months. This was above the local CCG and England average of 84%.

• One of the health care assistants (HCA) had undergone training for Memory Assessment Checks. The HCA had completed 101 DEMTECT memory tests in the past 12 months and 15 patients were then referred to secondary care for further investigation. The practice continued to provide this service despite funding for it been withdrawn. The practice had also identified patients living in care homes that had dementia but had not previously been diagnosed with dementia.

• The practice carried out advanced care planning for patients with dementia. Staff had completed dementia training.

• 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 93%. This was comparable to the local CCG average of 88% and the England average of 89%.

• 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.

• 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 26 January 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. Learning disability health checks were undertaken annually and staff had completed specialised training in this area.

• The practice worked closely with a local care home for people living with a learning disability and we saw evidence from the home that they had an excellent relationship with the practice and were provided with very good support. They said staff at the practice had a thorough understanding of the extra requirements needed to care for their service users and the practice were more than happy to go out of their way to fulfil these.

• 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.

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