Great Ayton Health Centre

Updated 16 June 2017

Great Ayton Health Centre, Rosehill, Great Ayton, Middlesbrough, TS9 6BL is a semi-rural practice situated in Great Ayton serving this and surrounding villages. The registered list size is approximately 5,530 and patients identify themselves predominantly as white British. The practice is ranked in the ninth least deprived decile (one being the most deprived and 10 being the least deprived), which is significantly below the national average. The practice age profile differs from the England average, having a higher number of patients in the 50 to 85 age range and a lower number in the 0 to 44 age range.

The practice is run by three GP partners and one salaried GP (two male and two female). The practice is a teaching practice. The practice currently has one GP registrar. This means the GP registrar is currently on a three year GP registration course.

The practice employs two practice nurses, a health care assistant, a locum nurse practitioner who works two days a week and a phlebotomist. The practice also receives two half day support sessions per week from a pharmacist provided by the CCG. The team is supported by a team of managers, reception and administration staff. There is a new practice manager.

The practice is open between 8am to 6pm Monday to Friday. Appointments were from 9am to 11am and 3pm to 5.30pm daily. Extended hours are offered on a Monday between 6.30pm and 7.30pm. These appointments are pre-bookable up to two weeks in advance. The Practice Nurse also offers telephone consultations at either 12.30pm to 12.50pm or 3.30pm to 3.40pm daily. The practice operates an appointment system at the Practice called ‘Advanced Access’. This means the practice aims to offer patients an appointment for the same day they make contact with the practice. In addition to this are pre-bookable appointments that can be booked in advance and urgent on the day appointments.

The practice has opted out of providing out-of-hours services to its own patients. Out of hours patients are directed to Harrogate District Foundation Trust (the contracted out-of-hours provider) via the NHS 111 service.

The practice holds a General Medical Services (GMS) contract to provide GP services which is commissioned by NHS England.

Updated 16 June 2017

Letter from the Chief Inspector of General Practice

We previously carried out an announced comprehensive inspection at Drs Blacklidge, Green & Jackson (Great Ayton Health Centre) on 5 October 2016. Overall the rating for the practice was requires improvement (safe was rated as inadequate, effective and well led rated as requires improvement and caring and responsive as good).

We carried out a further comprehensive inspection at Drs Blacklidge, Green & Jackson (Great Ayton Health Centre) on 22 May 2017 to check whether the practice had made the required improvements. The overall rating for the practice following this inspection was good

During the inspection on the 5 October 2016, we found the following areas of concern:

• Systems, processes and practices were not always reliable or appropriate to keep people safe. There were some concerns about consistency of understanding of the practice management in respect of these areas. We found concerns relating to a number of areas, mainly the management of significant events, safeguarding, medicines management, recruitment of staff and the practices ability to respond to an emergency.

• The practice did not have systems in place to ensure mandatory training was completed by all staff. We identified staff that had not completed training in a range of areas that included: safeguarding, fire safety awareness, basic life support and information governance.
• The arrangements for governance did not always operate effectively. The practice was not aware of some of the risks and issues we identified or was aware and had not acted on them.
• The partners demonstrated a commitment to their wider clinical roles and interests in the community which were of benefit to the practice. However, their prolonged absence from the practice caused some concern regarding the impact on the leadership arrangements when they were absent for significant periods of time.

As a result of our findings at this inspection we issued the provider with five requirement notices for the Safe care and treatment, Safeguarding service users from abuse and improper treatment, Good governance, Staffing and Fit and Proper Persons Employed.

Following the inspection on 5 October 2016 the practice sent us an action plan that explained what actions they would take to meet the regulations in relation to the breaches of regulation we identified.

We carried out a further comprehensive inspection at Drs Blacklidge, Green & Jackson (Great Ayton Health Centre) on 22 May 2017 to check whether the practice had made the required improvements.

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

• There was an open and transparent approach to safety and a system in place for reporting and recording significant events.
• The practice had clearly defined and embedded systems to minimise risks to patient safety.
• Staff were aware of current evidence based guidance. Staff had been trained to provide them with the skills and knowledge to deliver effective care and treatment.
• Results from the national GP patient survey were above the national averages for the way patients were treated. They showed patients were treated with compassion, dignity and respect and were involved in their care and decisions about their treatment.
• Information about services and how to complain was available. Improvements were made to the quality of care as a result of complaints and concerns.
• Results from the national GP patient survey showed that patient’s satisfaction with how they could access care and treatment was above national averages. Patients we received feedback from 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.
• A new overarching governance framework which supported the delivery of the strategy and good quality care had been put in place.
• There was a focus on continuous learning and improvement at all levels within the practice. The practice management demonstrated they had acted on the findings of the previous inspection and had taken action to address the issues identified. Whilst many of these changes were in their infancy it was clear the practice was on an improvement trajectory both within the practice itself and in engaging outside of the practice with the likes of the CCG and other local practices. They demonstrated they had put governance arrangements in place to ensure that the new changes introduced were embedded into practice over time.

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

• Review the system for recording refrigerator temperatures and ensure that medicines which are no longer required by patients are disposed of in a timely way.
• Ensure any personal clinical equipment used within the practice is identified and calibrated.
• Consider the frequency of the checking of emergency equipment and medicines at the practice to ensure that it identifies out of date medicines or faulty equipment in a timely way.
• Review the system that identifies patients who are also carers to help ensure that all patients on the practice list who are carers are offered relevant support if appropriate.
• Ensure planned appraisal for nursing and non-clinical staff take place.
• Consider the arrangements in respect of the Accessible Information Standard. The Standard aims to make sure that people who have a disability, impairment or sensory loss are provided with information that they can easily read and understand and with support so they can communicate effectively with health and social care services.
• Ensure the improvements made are monitored and embedded into practice to ensure their

Professor Steve Field (CBE FRCP FFPH FRCGP) 

Chief Inspector of General Practice

Updated 16 June 2017

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

• Nursing staff had lead roles in long-term disease management and patients at risk of hospital admission were identified as a priority.
• Performance for diabetes related indicators was similar to the CCG and national averages. For example 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 (01/04/2015 to 31/03/2016) was 82%, compared to the England average of 78%. The percentage of patients with diabetes, on the register, whose last measured total cholesterol (measured within the preceding 12 months) was 5 mmol/l or less (01/04/2015 to 31/03/2016) was 79%, compared to the national average of 80%.
• The practice followed up on patients with long-term conditions discharged from hospital and ensured that their care plans were updated to reflect any additional needs.
• There were emergency processes for patients with long-term conditions who experienced a sudden deterioration in health.
• All these patients had a named GP and there was a system to recall patients for 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 16 June 2017

The practice is rated as good for the care of families, children and young people.

• From the sample of documented examples we reviewed we found there were systems 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 accident and emergency (A&E) attendances.
• Childhood immunisations were carried out in line with the national childhood vaccination programme. Uptake rates for the vaccines given were comparable to CCG and national averages. Childhood immunisation rates for the vaccinations given up to age two were above the 90% national target at 94% scoring 9.4 out of 10 compared to the national average of 9.1. Vaccinations for five year olds ranged from 87% to 92% compared to the England average of 88% to 94%.
• Appointments were available outside of school hours and the premises were suitable for children and babies.
• The practice worked with midwives, health visitors and school nurses to support this population group. For example, in the provision of ante-natal, post-natal and child health surveillance clinics. Any newly registered patients under the age of five were referred to the Health Visitor.
• The practice had emergency processes for acutely ill children and young people and for acute pregnancy complications.
• The practice operated a drop in sexual health clinic once a week with the practice nurse.

Updated 16 June 2017

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

• Staff were able to recognise the signs of abuse in older patients and knew how to escalate any concerns.
• The practice offered proactive, personalised care to meet the needs of the older patients in its population.
• The practice was responsive to the needs of older patients, and offered home visits, telephone consultations and urgent appointments for those with enhanced needs. For example as part of the CCG Nursing Workforce Project, patients who were identified as elderly or frail and unable to attend the Practice would receive a home visit by the practice nurse. Patients in care or nursing homes were also reviewed under this service.
• The practice identified at an early stage, older patients who may need palliative care as they were approaching the end of life. It involved older patients in planning and making decisions about their care, including their end of life care.
• The practice followed up on older patients discharged from hospital and ensured that their care plans were updated to reflect any extra needs.
• Where older patients had complex needs, the practice shared summary care records with local care services. For example, such patients had an ‘avoiding unplanned admission to secondary care’ plan in place and patients with long-term care needs were referred to Community Matrons. Older patients were provided with health promotion advice and support to help them to maintain their health and independence for as long as possible.

Updated 16 June 2017

The practice is rated as good for the care of working age people (including those recently retired and students).

• The needs of this population group had been identified and the practice had adjusted the services it offered to ensure these were accessible, flexible and offered continuity of care. For example, extended hours were offered one evening a week between 6.30pm and 7.30pm.
• 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.

Updated 16 June 2017

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

• The practice carried out advance care planning for patients living with dementia.
• 89% of patients diagnosed with dementia who had their care reviewed in a face to face meeting in the last 12 months, which is comparable to the national average.
• The practice had a system for monitoring repeat prescribing for patients receiving medicines for mental health needs.
• Performance for mental health related indicators was similar to the CCG and national averages. For example the percentage of patients with schizophrenia, bipolar affective disorder and other psychoses who had had a comprehensive, agreed care plan documented in their record, in the preceding 12 months (01/04/2015 to 31/03/2016) was 92% compared to 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 living with dementia.
• Patients at risk of dementia were identified and offered an assessment.
• The practice had information available for patients experiencing poor mental health about how they could access various support groups and voluntary organisations.
• The practice had a system to follow up patients who had attended accident and emergency where they may have been experiencing poor mental health.
• Staff interviewed mostly had a good understanding of how to support patients with mental health needs and dementia.

Updated 16 June 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 including carers and patients with a learning disability.
• End of life care was delivered in a coordinated way which took into account the needs of those whose circumstances may make them vulnerable.
• 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.
• The practice had information available for vulnerable patients about how to access various support groups and voluntary organisations.
• Staff interviewed knew how to recognise signs of abuse in children, young people and adults whose circumstances may make them vulnerable. They 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.