York Medical Group

Updated 14 January 2016

The surgeries are located in five locations in the centre and within the boundaries of the City of York. There are 32,464 patients on the practice list and the majority of patients are of white British background.

YMG is a research, teaching and training practice; there are 12 Partners and eight salaried GPs. There is a practice manager, who is supported by a number of managers in very specific roles. There is a clinical manager , 12 practice nurses (four are nurse prescribers) one treatment room nurse, two assistant practitoners and three healthcare assistants. In addition there are 60 ancillary staff who provide a range of administrative activities to support everyday activities. All of the surgeries (Acomb, 32 Clifton, Monkgate, Woodthorpe and York St John, University (YSJ)) are open Monday to Friday from 8am-6pm. There are late evening appointments available each week at all sites (apart from YSJ)until 7.30pm. Saturday morning surgeries are held at Monkgate from 8am-10.30am by appointment only. Patients requiring a GP outside of normal working hours are advised to contact the GP out of hours service provided by Northern Doctors Urgent Care.

YMG have a General Medical Service (GMS) contract and offer enhanced services, for example extended hours, minor surgery, Patient Participant Group (PPG), and they offer patients with Learning Disabilities to have their physical health pro-actively managed. They have additional contractual service level agreements which include providing care and treatment at:  Bootham & St Peters Schools’ boarding school. Also at Garrow House, The Retreat and York House. In addition they provide an Enhanced Service to people who use Arclight (a homeless hostel).

Updated 14 January 2016

Letter from the Chief Inspector of General Practice

We carried out an announced comprehensive inspection of York Medical Group (YMG) on 16 and 17 November 2015. Overall the practice is rated as good.

Our key findings across all the areas we inspected were as follows:

• Staff understood and fulfilled their responsibilities to raise concerns, and to report incidents and near misses. Information about safety was recorded, monitored, appropriately reviewed and addressed.
• Risks to patients were pro-actively and actively 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.
• 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. However not all surgeries had a ‘how to complain’ notice displayed in their waiting rooms.
• Patients said they found it easy to make an appointment with their named GP and that there was good continuity of care, with urgent appointments available the same day.
• On the whole the surgeries had good facilities and were well equipped to treat patients and meet their needs.
• There was a leadership structure and staff felt supported by management. The practice proactively sought feedback from staff and patients, which it acted on.

We saw several areas of outstanding practice including:

• Patients had the opportunity to attend any surgery, which gave them flexibility to suit their circumstances.
• York Medical Group(YMG) had an access team who specifically looked at ‘patient demand mapping’ to enable them to try new ideas for providing appointments when patient need was higher. This pro-active approach had shown patients’ needs were met in a timely manner. Appointment availability could be changed, using the techniques associated with mapping of previous times when demand was high.

• YMG were working to support patients who were at risk of hospital admission, to stay at home with support from health and social care professionals. This had reduced their number of in-patient admissions, in identified at risk groups. This was known as 'Admission avoidance'.

• All patients had a named GP and if an appointment was not available with them, their named GP consulted with them via the telephone. Patients commented favourably to us about how helpful this was when consulting their GP.

Professor Steve Field (CBE FRCP FFPH FRCGP) 

Chief Inspector of General Practice

Updated 14 January 2016

The practice is rated as good for the care of people with long-term conditions (LTCs).Clinical leads and specialist nursing staff had lead roles in chronic disease management. Patients at risk of hospital admission were identified as a priority. To support uniformity of management decisions. Consistency of approach and high quality record keeping for patients with LTCs the practice used appropriate care plans which were condition specific. Longer appointments and home visits were available when needed. All of these patients had a named GP and a structured annual review to check that their health and medication needs were being met. For those patients with the most complex needs, the named GP worked with the relevant health and social care professionals to deliver individualised multidisciplinary packages of care.

Updated 14 January 2016

The practice is rated as good for the care of families, children and young patients. 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 patients 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 adults were treated in an age-appropriate way and were recognised as individuals, and we saw evidence to confirm this. We were told children and young babies were seen as a priority whenever required. Patients we spoke with confirmed this. YMG provided General Practice services to boarders at Bootham & St Peters Schools’, they worked closely with the school’s health and welfare team.

Appointments were available outside of school hours and the premises were suitable for children and babies. The practice offered a 24 hour hospital delivery, baby discharge examination. We saw good examples of joint working with midwives and health visitors.

Updated 14 January 2016

The practice is rated as good for the care of older people. Nationally reported data showed that outcomes for these patients were good for conditions commonly found in older people. This patient group numbers was lower than the CCG and the national average reported for GP practices. However, they offered proactive, personalised care to meet the needs of their older patients and they had a range of enhanced services, for example, in dementia and end of life care. All patients in this age group were made aware of their named GP; who co-ordinated their care and treatment. Named GPs attended the local care homes regularly for routine appointments and reviews, as well as providing care and treatment in emergencies. YMG was responsive to the needs of their older patients and offered care co-ordination. Which included working with relevant health and social care professionals to support the vulnerable to stay at home. This was known as 'Admission Avoidance'. Home visits and rapid access appointments were available for those with enhanced needs. Care reviews were with their named GP and could be in their own home.

Updated 14 January 2016

The practice is rated as good for the care of working-age people (including those recently retired and students). The needs of their working age population, those recently retired and students had been identified and YMG had adjusted the services they offered to ensure these were accessible, flexible and offered continuity of care. Extended hours had been operationalised throughout YMG. 32 Clifton and Monkgate had their opening times extended. YMG was proactive in offering online services and used social media to reach this population group. There was a full range of health promotion and screening that reflected the needs of this age group. These included minor operations, and NHS health checks. YMG had improved their influenza immunisations uptake in this patient group, since last year, as they had improved their system to actively identify their 'at risk' patients.

Updated 14 January 2016

The practice is rated as good for the care of people experiencing poor mental health (including people with dementia). Patients experiencing poor mental health had received an annual physical health check. YMG regularly worked with multi-disciplinary teams in the case management of people experiencing poor mental health, including those with dementia. They supported patients with dementia to consider advance care planning for their future, when appropriate.

Patients experiencing poor mental health were supported by clinical practitioners with specific skills. They worked in collaboration with specific teams in local in-patient units where YMG provided an Enhanced Service. Various support groups and voluntary organisations were available to YMG’s patient population and leaflets or posters were seen in the surgery waiting rooms. There was a system in place to follow up patients who had attended accident and emergency (A&E) when they may have been experiencing poor mental health. Staff had received training on how to care for people with mental health needs and dementia and further training had recently been organised.

Updated 14 January 2016

The practice is rated as good for the care of patients whose circumstances may make them vulnerable. A register of patients with a learning disability was held. They all had a named GP who provided continuity of care. YMG was in the process of providing annual health checks for all of these patients and where necessary, these patients were followed up with apporpiate health interventions.

Longer appointments were offered for all patients within this population group.YMG worked with service providers to assure appropriate care and treatment was delivered to these patients, such as with Arclight, a homeless persons’ charity. They regularly worked with multi-disciplinary teams in the case management of vulnerable patients.

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.