Park Parade Surgery

Updated 23 August 2016

Park Parade Surgery is a purpose built surgery in the centre of Harrogate. The building is shared with two other GP practices. The Park Parade practice provides General Medical Services to approximately 6,500 patients living in the town of Harrogate.

At the time of the inspection the practice had three GP partners and two salaried GPs. This has since reduced to two partners as one partner has retired. The practice plan to recruit another salaried GP. At the time of the inspection the practice had two male and three female GPs. The practice has two practice nurses and a healthcare assistant. They are supported by a team of management, reception and administrative staff.

The practice is in an affluent area and has a significantly lower than average proportion of its population who are classed as deprived. It also has a higher than average number of patients who have a long term condition and a higher than average number of patients who are over 65.

The practice is open and provides appointments between 8.00am and 6.00pm on a Monday, Wednesday, Thursday and Friday and between 7.25am and 6.00pm on a Tuesday. Out of Hours services are provided by NHS North Yorkshire and York and are accessed through the 111 telephone number.

The practice also offers enhanced services including childhood vaccination and immunisation scheme, extended opening hours, support for people with dementia, improving patient on line access, influenza and pneumococcal immunisations, learning disabilities, minor surgery, patient participation and unplanned admissions.

Updated 23 August 2016

Letter from the Chief Inspector of General Practice

We carried out an announced comprehensive inspection at Park Parade Surgery on 24 February 2016. 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 assessed and well managed.
• Staff assessed patients’ needs and delivered care in line with current evidence based guidance. Staff had the skills, knowledge and experience to deliver effective care and treatment.
• The practice had a policy of not deregistering vulnerable patients even if they routinely failed to attend appointments.
• Feedback from patients about their care was consistently and strongly positive. Patients said they were treated with compassion, dignity and respect and they were involved in their care and decisions about their treatment.
• The practice would visit patients in hospices or in hospitals to provide support.
• Information about services and how to complain was available and easy to understand.
• Patients said they found it easy to make an appointment with a named GP and that 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.
• 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 areas of outstanding practice.

• The GPs provided additional care and support to patients and their families. They regularly visited patients in the hospice or hospital to provide support, even though they were not responsible for providing clinical care.

• The practices had put in place a comprehensive and closely monitored appointments system which gave patients ease of access to appointments. This was supported by patients having rapid access by telephone or email to their GP, with calls or emails being returned quickly. 

Professor Steve Field CBE FRCP FFPH FRCGP

Chief Inspector of General Practice

Updated 23 August 2016

The practice is rated as good for the care of people with long-term conditions. The practice is rated as good for the care of people with long-term conditions. Nationally reported data for 2014/2015 showed that the practices performance across a range of diabetes related indicators was similar to the national average. Nursing staff had lead roles in chronic disease management and patients at risk of hospital admission were identified as a priority. 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 people with the most complex needs, the named GP worked with relevant health and social care professionals to deliver a multidisciplinary package of care. On each day all of the GPs would act as duty doctors and respond to telephone requests on the day. Patients could request to speak to a specific doctor and that GP would try to call them back within the session. This approach provided patients, particularly those with long term conditions where continuity of care was important, with a responsive personalised access to the service, which improved their care.

Updated 23 August 2016

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 good for standard childhood immunisations. Children and young people were treated in an age-appropriate way and were recognised as individuals. Appointments were available outside of school hours and the premises were suitable for children and babies. There was joint working with midwives, health visitors and school nurses. Nationally reported data for 2014/2015 showed that the practice was in line with the national averages for rates of cervical screening. 77% of patients diagnosed with asthma, on the register, had had an asthma review in the last 12 months; this was comparable to the national average of 75%. The practice provided extensive support to families of children undergoing specialist paediatric care and treatment to ensure that the wellbeing of both the parents and the child were considered. For example we were told that a GP visited a child and their family at a hospital which was out of area and contacted the family by telephone every couple of weeks to provide support. When the child was discharged the GP liaised with the specialist nurse at the hospital to ensure that the best care was provided to the child on discharge and for follow up care and support.  

Updated 23 August 2016

The practice is rated as good for the care of older people. Nationally reported data for 2014/2015 showed that outcomes for patients were good for conditions commonly found in older people and the percentage of people aged 65 or over who received a seasonal flu vaccination was in line with the CCG and national averages. 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. They were responsive to the needs of older people, and offered home visits and rapid access appointments for those with enhanced needs. The practice worked with nine other local practices to enhance the care of patients in Care homes. GP’s regularly visited two local care homes to review the health and care needs of the residents. A local carers association ran fortnightly drop in sessions for carers.

Updated 23 August 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. The practice was proactive in offering online services as well as a full range of health promotion and screening that reflected the needs of this age group. Patients who are registered with the practice for online access could email questions to their GPs and these are usually responded to within a few hours. This was particularly useful to patients who worked as they could access help and advice quickly and easily. The practice was the second highest in North Yorkshire for the provision of NHS health checks, with 88% of the target population having had the health check. The practice offered cervical smear clinics outside of normal working hours.

Updated 23 August 2016

The practice is rated as good for the care of people experiencing poor mental health (including people with dementia). Nationally reported data from 2014/2015 showed 95% of patients diagnosed with dementia had received a face to face review of their care in the last twelve months this was higher than the national average of 84%. The practice performance across a range of mental health related indicators was comparable to the national averages. The practice regularly worked with multi-disciplinary teams in the case management of people experiencing poor mental health, including those with dementia. The practice told patients experiencing poor mental health how to access support groups and voluntary organisations. The practice had a system to provide rapid access to appointments for patients who may be experiencing poor mental health. Staff had a good understanding of how to support patients with mental health needs and dementia.

Updated 23 August 2016

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. The practice offered longer appointments for patients with a learning disability. The practice regularly worked with multi-disciplinary teams in the case management of vulnerable people. The practice informed 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. The practice had a policy of not deregistering vulnerable patients even if they routinely failed to attend appointments. They worked with the patients to offer appointment slots that suited them and communicate with them by telephone and email.