York Street Medical Practice

Updated 16 February 2017

York Street Medical Practice is a purpose built practice situated in Cambridge, Cambridgeshire. The practice provides services for approximately 9800 patients. It holds a General Medical Services contract with Cambridgeshire and Peterborough Clinical Commissioning Group.

According to information taken from Public Health England, the practice population has a higher percentage of patients aged between 20 and 44 years old when compared to the practice average across England. The practice is situated in a central urban area with a low level of deprivation and a large transient population of students and visiting academics, and has a 10% patient turnover each year.

The clinical team consists of six GP partners, a salaried GP, three practice nurses, a healthcare assistant and a phlebotomist. They are supported by a business partner, a deputy practice manager, and a team of multiskilled staff with administration, reception and secretarial duties. The practice works alongside co-located teams of health visitors, district nurses and midwives.

York Street Medical Practice is a training practice and supports trainee GPs (qualified doctors who are undertaking further training to become GPs). The practice has up to two trainee GPs working at any one time. The practice also supports the education of Foundation Year 2 doctors (qualified doctors who undertake a four month placement in the practice to gain experience of primary care). The practice also teaches medical students.

The practice is open from Monday to Friday. It offers GP appointments from 8.30am to 11.20pm and 3.30pm to 5.50pm daily. Nursing appointments are available from 8.30am to 12.40pm and 3.30pm to 5.50pm daily. Extended hours appointments are available between 7.30am and 8am on Monday mornings, and between 6.25pm and 7.15pm on Monday and Tuesday evenings. Out of hours care is provided by Urgent Care Cambridge via the NHS 111 service.

Updated 16 February 2017

Letter from the Chief Inspector of General Practice

We carried out an announced comprehensive inspection at York Street Medical Practice on 18 October 2016. At this time we noted that systems and processes were not established to ensure the effective monitoring of uncollected prescriptions being held in the reception area prior to destruction. Furthermore, there was no system in place to ensure that medical oxygen was in date and accessible to all members of staff within the practice.

We undertook this focused inspection to check that they had followed their plan and to confirm that they now met legal requirements. This report only covers our findings in relation to those requirements.

The overall rating for the practice is good. You can read our previous report by selecting the ‘all reports' link for on our website at www.cqc.org.uk

Professor Steve Field (CBE FRCP FFPH FRCGP) 

Chief Inspector of General Practice

Updated 10 November 2016

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

• Nursing staff had lead roles in chronic disease management and patients at risk of hospital admission were identified as a priority.
• The practice used the information collected for the Quality and Outcomes Framework (QOF) to monitor outcomes for patients (QOF is a system intended to improve the quality of general practice and reward good practice). Data from 2014/2015 showed that performance for diabetes related indicators was 99%, which was above the local and national averages of 89%. Exception reporting for diabetes related indicators was 15%, which was higher than the local average of 13% and the national average of 11% (exception reporting is the removal of patients from QOF calculations where, for example, the patients are unable to attend a review meeting or certain medicines cannot be prescribed because of side effects).

• Longer appointments and home visits were available when needed.
• Patients with complex needs had a named GP and a structured annual review to check their health and medicines needs were being met. There was a robust recall system in place to ensure that patients were invited and attended annual reviews.
• 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 10 November 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 in line with local and national averages 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.
• The percentage of women aged 25-64 whose notes recorded that a cervical screening test had been performed in the preceding five years was 92%, which was above the local and national averages of 82%.
• Appointments were available outside of school hours and the premises were suitable for children and babies, with a dedicated area of the reception area designed for young children.
• The practice offered a full range of contraception services and chlamydia screening.
• We saw positive examples of joint working with midwives, health visitors and school nurses. Midwives and health visitors were located on site.

Updated 10 November 2016

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

• The practice was responsive to the needs of older people, and offered home visits and urgent appointments for those with enhanced needs. All home visits were triaged by a clinician to prioritise visits and ensure appropriate and timely intervention.
• The practice contacted all patients after their discharge from hospital to address any concerns and assess if the patient needed GP involvement at that time.
• Nationally reported data showed that outcomes for patients for conditions commonly found in older people, including rheumatoid arthritis and heart failure, were above local and national averages.
• The practice worked closely with local admissions avoidance services, such as the Joint Emergency Team.
• The practice had a strong relationship with the community district nursing team, who were based on site.

Updated 10 November 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.
• Extended hours appointments were available for patients who were unable to access the practice in core business hours.
• The practice was proactive in offering online services as well as a full range of health promotion and screening that reflects the needs for this age group.
• Practice staff carried out NHS health checks for patients between the ages of 40 and 74 years.
• The practice offered many NHS services in house, reducing the need for outpatient referral and therefore improving patient convenience.

Updated 10 November 2016

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

• 89% of patients diagnosed with dementia had received a face to face care review in the last 12 months, which was above the local and national averages of 84%.
• 93% of patients experiencing poor mental health had a comprehensive care plan, which was above the local average of 88% and the national average of 89%.
• 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 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 patients with mental health needs and dementia.

Updated 10 November 2016

The practice is rated as requires improvement in the safe and responsive domains for the care of people whose circumstances may make them vulnerable.

• The practice held a register of patients living in vulnerable circumstances including travellers and those with a learning disability. The practice had regular contact with patients on the learning disability register; however they had not undertaken any formal health checks for these patients in the past 12 months. The practice were working with the local CCG to implement actions to increase the amount of reviews for these patients.
• The practice offered longer appointments for patients with a learning disability.
• The practice regularly worked with other health care professionals in the case management of vulnerable patients, and held regular multidisciplinary team meetings.
• The practice informed vulnerable patients about how to access various support groups and voluntary organisations, such as the local drug and alcohol support service.
• The practice was engaged with the local Carers’ Prescription Service, which provided respite for carers. Written information was available to direct carers to the various avenues of support available to them.
• 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.