The Ridings Medical Group

Updated 15 February 2017

The Ridings Medical Group has one main practice and four branches. The main site is in the East Riding of Yorkshire at Brough Surgery. Sites are situated in four locations at, South Cave Surgery, Home on Spalding Moor Surgery, Bubwith Surgery and Little Weighton Surgery. The Little Weighton Surgery is scheduled to close at the end of January 2017 as the building the practice operates from is being refurbished. Patients registered at this branch surgery will be offered patient transport directly to another branch surgery when required. The practice provides services under a General Medical Services (GMS) contract with the NHS England, East Riding of Yorkshire Area Team to the practice population of 26,658, covering patients of all ages.

The practice has 13 GP partners and six salaried GPs partners (seven male and 12 female). There are six advance care practitioners, five practice nurses, eight health care assistants and in-house pharmacists. The practice is also supported by a management team and a team of administration, secretarial and, reception staff.

The Brough, South Cave and Bubwith surgeries are dispensing practices. The Brough, South Cave and Holme on Spalding Moor surgeries are open between 8am and 6.30pm Monday to Friday. The Bubwith Surgery is open between 8.30am and 6.30pm Monday to Friday. The Little Weighton Surgery is open between 1pm and 2pm on a Wednesday and Friday. Extended hours are provided on a Saturday between 9am and 12pm at the Brough Surgery. Other extended hours are provided on a Tuesday at Brough and South Cave Surgery between 6.30pm and 8.15pm on alternate weeks. Extended hours are also provided on a Monday at the Holme on Spalding Moor Surgery between 6.30pm and 7.30pm.

The practices, along with all other practices in the East Riding of Yorkshire CCG area have a contractual agreement for NHS 111 service to provide Out of Hours (OOHs) services from 6pm. This has been agreed with the NHS England area team.

The proportion of the practice population in the 20-34 years age group is 2% - 3%. This is lower than the England average of 3% - 4%. The proportion of the practice population in the 40-54 years age group (4%) is higher than the England average of 3%. The practice scored 10 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 better to the England average, the practice is 5.2 and the England average is 21.8.

The practice was an advanced training practice (ATP) and recruited sixth form students from the local school/college as part of their bespoke mentoring scheme. This enabled students to be supported in work experience with aspirations to do medicine.

Updated 15 February 2017

Letter from the Chief Inspector of General Practice

We carried out an announced comprehensive inspection at The Ridings Medical Group on 7 December 2016. Overall 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.
• Patients’ needs were assessed and care was planned and delivered following best practice guidance. Staff had received training appropriate to their roles and any further training needs had been identified and planned.
• 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.

We saw some areas of outstanding practice including:

• The practice had set up a ‘patient booth’. The patient booth was an additional service for patients to obtain advice and support and was run by in-house patient champions on a voluntary basis.

• The practice ran an Advanced Training Practice (ATP) hub was instrumental in supporting pre- registration student nurses to have clinical placement experience, to encourage them to consider practice nursing at the point of qualification.

• The practice employed a full time community nurse who was responsible for providing chronic disease reviews and vaccinations to housebound and care home patients.
• The PPG managed monetary funds called the ‘PPG Nursing Fund’ which were predominantly donations from patents and book sales in the practice. The funds from these donations had allowed the practice to purchase children’s activity tables and items of clinical equipment.

However there were areas of practice where the provider should make improvements:

• Put systems and arrangements in place to ensure uncollected scripts are managed in a timely manner.

Professor Steve Field (CBE FRCP FFPH FRCGP) 

Chief Inspector of General Practice

Updated 15 February 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. Performance for diabetes related indicators was 92% which were similar to the local CCG average of 92% and the national average of 90%. A Nurse practitioner led on diabetic care and was specialised trained in diabetes and had developed patient pathways for care and had established patient group sessions for patients who had pre-diabetes diagnosis. For example, during 2014/15 548 patients were identified with pre-diabetes which had increased to 805 during 2015/16. The practice had established patient group sessions to ascertain early diagnosis.

• Longer appointments and home visits were available when needed.

• The practice employed a full time community nurse who was responsible for providing chronic disease reviews and vaccinations to housebound and care home patients.

• Patients 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 GP worked with the integrated care team and care professionals to deliver a multidisciplinary package of care.

Updated 15 February 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.

• There were systems in place to identify and follow up children who had not attended their immunisation appointment and who were at risk. 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.

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

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

Updated 15 February 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.

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

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

Updated 15 February 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.

• The practice provided ‘Skype’ consultations over the internet in order to meet patients’ different needs.

Updated 15 February 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 98%. This was better than the local CCG average of 88% and the national average of 89%.

• Nationally reported data from 2015/2016 showed 95% of people diagnosed with dementia had their care reviewed in a face to face meeting in the last 12 months. This was better than the local CCG average of 85% and the national average of 84%.

• The practice had a lead to manage dementia who was engaged in a local scheme to improve the identification of dementia which achieved the practice prevalence of 0.8% compared with the national average of 0.6%.

• 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.

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

Updated 15 February 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 also had a dedicated nominated lead to support patients with a learning disability. Regular assessments of needs took place as part of a patients disability check. For example, seasonal reviews and examinations. Reviews took place in conjunction with the known carers of the patients to ensure continuity of care and support.

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

• The practice regularly worked with the integrated care team and 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.