The Care Quality Commission
  • Doctor
  • GP practice

Doctors Lane Surgery

Overall: Good read more about inspection ratings

Aldbrough St John, Richmond, North Yorkshire, DL11 7TH (01325) 374332

Provided and run by:
Doctors Lane Surgery

All Inspections

08 December 2023

During an inspection looking at part of the service

We carried out a targeted assessment of Doctors Lane Surgery in relation to the responsive key question. This assessment was carried out on 8 December 2023 without a site visit. Overall, the practice is rated as Good. We rated the key question of responsive as Good.

Safe - Good

Effective – Good

Caring - Good

Responsive – Good

Well-led – Good

The full reports for previous inspections can be found by selecting the ‘all reports’ link for the

Doctors Lane Surgery on our website at www.cqc.org.uk

Why we carried out this review

We carried out this assessment as part of our work to understand how practices are working to try to meet demand for access and to better understand the experiences of people who use services and providers.

We recognise the work that GP practices have been engaged in to continue to provide safe, quality care to the people they serve. We know colleagues are doing this while demand for general practice remains exceptionally high, with more appointments being provided than ever. In this challenging context, access to general practice remains a concern for people. Our strategy makes a commitment to deliver regulation driven by people’s needs and experiences of care. These assessments of the responsive key question include looking at what practices are doing innovatively to improve patient access to primary care and sharing this information to drive improvement.

How we carried out the assessment

This assessment was carried remotely.

This included:

  • Conducting staff interviews using video conferencing.
  • Requesting evidence from the provider.

Our findings

We based our judgement of the quality of care at this service on a combination of:

  • what we found when we inspected
  • information from our ongoing monitoring of data about services and
  • information from the provider, patients, the public and other organisations.

We found that:

We rated responsive as good because:

  • The practice had a proactive approach to identifying the needs of patients and responding to them.
  • The practice understood the needs of its local population.
  • National GP Patient Survey data was consistently high over several years including during COVID-19. Data was consistently above local and national averages.
  • Feedback we received from patients regarding appointments and access was mostly positive.
  • The practice dealt with complaints in a timely manner and learned from them.

Details of our findings and the evidence supporting our ratings are set out in the evidence tables.

Dr Sean O’Kelly BSc MB ChB MSc DCH FRCA

Chief Inspector of Health Care

21 February to 21 February

During a routine inspection

We carried out an announced comprehensive inspection at Doctors Lane Surgery, Aldbrough St John, Richmond, North Yorkshire DL11 7TH on 21 February 2019. Our inspection team was led by a CQC inspector and included a GP specialist advisor and a CQC Pharmacist.

Our judgement of the quality of care at this service is based on a combination, of what we found when we inspected, information from our ongoing monitoring of data about services, and information from the provider, patients, the public and other organisations.

We have rated this practice as good overall.

We concluded that:

  • Systems were in place to report, record and disseminate learning from significant events and complaints.
  • Staff worked to clear protocols and evidence based clinical guidance to meet patients’ needs.
  • The practice routinely reviewed the effectiveness and appropriateness of the care it provided. It ensured that care and treatment was delivered according to evidence- based guidelines.
  • Quality improvement activity was carried out which resulted in improved outcomes for patients.
  • Staff treated patients with courtesy and respect. Feedback from patients confirmed this.
  • The leadership, governance and culture of the practice promoted an inclusive supportive environment for staff.

Whilst we found no breaches of regulations, the areas where the provider should make improvements are:

The practice should havea regular documented stock balance for controlled drugs. Prescription stationary was recorded upon receipt into the practice and stored securely. However, the practice should review and improve the process for tracking prescriptions throughout the practice.

Details of our findings and the evidence supporting our ratings are set out in the evidence table.

Professor Steve Field CBE FRCP FFPH FRCGPChief Inspector of General Practice

30 June 2016

During a routine inspection

Letter from the Chief Inspector of General Practice

We carried out an announced comprehensive inspection at Doctors Lane Surgery on 30 June 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.
  • Staff assessed patients’ needs and delivered care in line with current evidence based guidance. Staff had been trained. They 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 found it easy to make an appointment with a named GP and there was continuity of care, with urgent and routine 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:

The practice’s care of older people. The practice was working with two other practices as part of a frailty pathway project. The outcome aims of the project included areas such as improved patient satisfaction and quality of life, and improved recognition and diagnosis of frailty. The project was in phase one. Early outcomes from Doctors Lane Surgery demonstrated positive results and that appropriate care and referrals were made to support these patients. For example, of the 87 patients identified for the project, three had been referred to continence, 12 to the falls service, four to the memory clinic, 18 to podiatry, six for hearing aid assessments and 27 to HOT clinic. The function of a HOT clinic is to assess and address patients’ needs rapidly within a multidisciplinary structure with the aim being to link with community teams to ensure appropriate care provision is in place.

The practice offered ‘MyGP' an electronic way for patients to communicate with GPs for routine queries. This was of particular benefit for this rural practice.

The practice offered a range of services as part of the ‘Out of Hospital Basket’ enhanced service aimed at providing care closer to patients home. For example deep vein thrombosis diagnosis and treatment, management of stable prostate cancer patients within the community and routine ring pessary fitting and replacement.

If a patient was receiving end of life care then families/carers were provided with the GPs’ personal numbers. If needed and if possible the GP would attend the patient out of hours.

The areas where the provider should make improvement are:

The practice should ensure recruitment arrangements are in line with Schedule 3 of the Health and Social Care Act 2008 to ensure necessary employment checks are in place for all newly recruited staff.

The practice should assess their access to emergency medicines.

The practice had established a service for people to pick up their dispensed prescriptions at a different location. The practice should review the arrangements for monitoring how the medicines are collected from this location.

The practice should ensure they complete their planned cycle of clinical re-audit.

Professor Steve Field (CBE FRCP FFPH FRCGP) 

Chief Inspector of General Practice