Archived: Fulford Surgery Also known as Priory Medical Group

Updated 30 April 2015

The practice delivers primary care under a Personal Medical Services (PMS) Contract between themselves and NHS England for patients living in Fulford, York and surrounding areas. The practice has six GP partners, two male and four female. The practice is a teaching practice and there are currently six GP registrars working throughout the group of practices. The practice also has links with the local college and employs a trainee student nurse.

They are part of the PMG which is a General Practice Partnership open to all patients living within the practice boundary in York and the surrounding areas. They are part of the York Clinical Commissioning Group (CCG) NHS York. The PMG has nine practices in the York area and are responsible for a population of 54,120. There are approximately 6,500 patients registered at Fulford surgery.

The practice opening times are from 8.00am – 18.00pm. In addition, there are extended hours appointments available on evenings from 18.30 – 20.00 at the Heworth Green practice. Saturday appointments run from 08.30 – 11.45 held at the Priory Medical Centre. The practice does not provide an out-of-hours service to their own patients directly and patients are automatically diverted to the local out-of-hours service Prime care when the surgery is closed in the evenings and at the weekends.

The CQC intelligent monitoring placed the practice in band six. The intelligent monitoring tool draws on existing national data sources and includes indicators covering a range of GP practice activity and patient experience including the Quality Outcomes Framework (QOF) and the National Patient Survey. Based on the indicators, each GP practice has been categorised into one of six priority bands, with band six representing the best performance band. This banding is not a judgement on the quality of care being given by the GP practice; this only comes after a CQC inspection has taken place.

Updated 30 April 2015

Letter from the Chief Inspector of General Practice

We carried out an announced comprehensive inspection at Fulford Surgery on 03 December 2014. Overall the practice is rated as good.

Specifically, we found the practice to be good for providing safe, effective, caring, responsive and for being well led. It was also outstanding for providing services for the older people and families, children and younger people.

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

• Staff understood and fulfilled their responsibilities to raise concerns and report incidents and near misses. All opportunities for learning from internal and external incidents were maximised.

• The practice provided services to the local community that had been designed to meet the needs of the local population. Patients registered with this practice are able to access all services at the other nine practices in the Priory Medical Group (PMG).

• The practice had a clear vision which had quality and safety as its top priority. A business plan was in place, was monitored and regularly reviewed and discussed with all staff. High standards were promoted and owned by all practice staff with evidence of team working across all roles.

We saw several areas of good practice including:

• A patient centred approach to delivering care and treatment. All staff were aware of and sympathetic to, the particular difficulties faced by the local population. The practice was proactive in improving health and access to services. We saw that the practice was engaged with other health and social care agencies to improve access and patients health.

• The practice had an effective governance system in place, was well organised and actively sought to learn from performance data, complaints, incidents and feedback.

• The practice actively sought the opinions of staff and patients, working with a well-established patient participation group (PPG).

We saw one area of outstanding practice:

The practice used innovative and proactive methods to improve patient outcomes, working with other local providers to share best practice. For example a ‘people care focus group’ was established. This group was responsible for providing direct care in the community and for patients that found it difficult to attend the practice location.

Professor Steve Field (CBE FRCP FFPH FRCGP) 

Chief Inspector of General Practice

Updated 30 April 2015

The practice is rated as good for the care of people with long-term conditions. There were emergency processes in place and regular reviews took place for patients whose health deteriorated suddenly. Longer appointments and home visits were available when needed. Patients in this group had a named GP and a structured annual review to check that their health and medication needs were being met. For those people with the most complex needs, the named GP and or specialist nurses worked with relevant health and care professionals to deliver a multidisciplinary package of care. The staff had received appropriate training in the management of long term conditions. An ‘avoiding admissions team’ was established to review patients that had frequent attendances to A&E and the team followed up and provided support to that patient group.

Updated 30 April 2015

The practice is rated as outstanding 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 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. Appointments were available outside of school hours when it was convenient for children and teenagers to attend the surgery.

The PMG have developed a teenage health clinic consulting with students from two local schools to make the clinic teenage friendly. The clinic provides services for 11 to 19 year olds with booked appointments and a drop in service one evening a week. This ensures that young people have access to an age appropriate, dedicated service delivered in a way they want. The service was available to all young people within the group. If young people registered with the PMG they could attend their own or any practice in the group.

Updated 30 April 2015

The practice is rated as outstanding for the care of older people. Nationally reported data showed that outcomes for patients were good for conditions commonly found in older people. There were two care homes in the practice area and a named dedicated GP provided health care support and input to the homes on a weekly basis.

Protected time was allocated to the GP to ensure continuity of care was delivered consistently and in line with older patient’s needs. The practice offered proactive, personalised care to meet the needs of the older people in its population and had a range of enhanced services, for example, in dementia and end of life care.

The practice was responsive to the needs of older people, and offered home visits and rapid access appointments for those with enhanced needs. We saw that personalised care plans had been developed for patients who were at risk. The PMG provided a team of community nurses in partnership with NHS York District Hospital Foundation Trust who were able to provide support to patients in the group seven days a week. The PMG were responsible for implementing a community team was made up of care managers and health and social care assistants to support patients and assess patient’s needs. This helped patients remain independent and avoid unnecessary admission to hospital.

Updated 30 April 2015

The practice is rated as good for the care of working-age people (including those recently retired and students). The needs of this group 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 reflects the needs for this age group. We saw that the practice provided a range of services patients could access at times that best suited them or close to their work by accessing an appointment in one of the other practices within the PMG.

Updated 30 April 2015

The practice is rated as good for the care of people experiencing poor mental health (including people with dementia). People experiencing poor mental health had received an annual physical health check. The practice regularly worked with multi-disciplinary teams in the case management of people experiencing poor mental health, including those with dementia. It also 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. It had a system in place to follow up and review patients’ needs who had attended A&E who had been experiencing poor mental health. Staff had received training on how to care for people with mental health needs and dementia.

Updated 30 April 2015

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 those with a learning disability. It had carried out annual health checks for people with a learning disability and offered longer appointments for people with a learning disability or those who required it.

The practice regularly worked with multi-disciplinary teams in the case management of vulnerable people. It had told 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