Ripon Hospital

Updated 7 June 2022

The Yorkshire Health Network is a GP Federation serving the needs of the population of Harrogate and Rural District. The Federation is made up of 17 general practices, with a patient population of approximately 164500, spanning four Primary Care Networks (PCNs) in the North Yorkshire Clinical Commissioning Group. The service offers pre-bookable, routine primary care appointments with a range of health care professionals such as GP’s, Nurses, Advanced Care Practitioners, Phlebotomists and Health Care Assistants. Appointments are available across Hub Extended Access sites from 4.00pm to 8.00pm on Mondays to Fridays and 8.30am to 1.00pm on Saturdays, Sundays and Bank holidays.

Appointments are a mixture of face to face and remote consultation according to patient choice.

The focus of this inspection is the delivery of the extended access service only, which has been operational since November 2017. Extended Access was rolled out as a national target for all primary care to improve access to General Practice routine appointments. Yorkshire Health Network provides other services outside the scope of CQC registration such as providing the local GP led COVID-19 vaccination site.

The extended access service operates from three locations at various times during a month. All three locations are individually registered with CQC. This inspection covered the location registered as Ripon Hospital. The inspection of the other two locations, Mowbray House and the satellite site Beech House is reported separately.

The extended access service runs from the following site:

Ripon Hospital

Firby Lane

Ripon

HG4 2BS

Appointments available 8.30am -12.30pm Saturday and Sunday (face to face and telephone with a GP and face to face with a practice nurse/health care assistant) with 32 appointments available on each day.

We visited Ripon Hospital, and the head office of Yorkshire Health Network.

The extended access service delivers remote and face-to-face consultations dependent on patient choice.

Yorkshire Health Network’s head office operates from Windsor House, Cornwall Road, Harrogate, HG1 2PW. There is an organisation board structure. Day to day operational oversight for extended access is provided by the Executive Chair (who is also the Clinical Lead) and two Extended Access Operations Managers, and other managers who cover areas other than extended access. Staff who work for YHN are either directly contracted by YHN on a fixed hour or a zero-hour contract or employed through a locum agency. There are two Extended Access Operations Managers (both contracted), seventeen GPs (one contracted and 16 locums; a mixture of male and female GPs), two Advanced Nurse Practitioners (ANP) (one contracted and one locum), twelve Practice Nurses (all contracted), eight Health Care Assistants (HCA) (six contracted and two locum) and eight receptionists (seven contracted and one locum).

Yorkshire Health Network is registered with the Care Quality Commission to provide the regulated activities diagnostic and screening procedures and treatment of disease, disorder or injury, maternity and midwifery services, family planning and surgical procedures.

Updated 7 June 2022

We carried out an announced comprehensive inspection of the extended access service run by Yorkshire Health Network on 14 May 2022. Overall, the provider is rated as good.

The key questions are rated as:

Safe - Good

Effective - Good

Caring - Good

Responsive - Good

Well-led – Good

Why we carried out this inspection

This announced comprehensive inspection was the provider’s first inspection. We looked at the key questions safe, effective, caring, responsive and well-led.

How we carried out the inspection

Throughout the pandemic CQC has continued to regulate and respond to risk. However, taking into account the circumstances arising as a result of the pandemic, and in order to reduce risk, we have conducted our inspections differently.

This inspection was carried out in a way which enabled us to spend a minimum amount of time on site. This was with consent from the provider and in line with all data protection and information governance requirements.

This included:

• conducting staff interviews using face to face and video conferencing;
• requesting feedback from staff electronically;
• requesting evidence from the provider;
• reviewing patient records to identify issues and clarify actions taken by the provider; and
• a site visit to the head office and one site where the service is delivered from

As part of this inspection we received feedback via face to face interview, video conference interview, discussions with staff working on-site and an electronic questionnaire. This feedback came from members of the management team, clinical and non-clinical staff.

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 have rated this provider as good overall.

We found that:

• The provider continued to contribute to the local health agenda and work in partnership with stakeholders to deliver patient care during the challenges of the past year with the COVID-19 pandemic.
• The service had systems in place to keep people safe and safeguarded from abuse. Staff we spoke with knew how to identify and report safeguarding concerns.
• The provider regularly carried out quality improvement activity, including clinical audit, and routinely reviewed the effectiveness and appropriateness of the care provided.
• Staff had the skills, knowledge and experience to deliver effective care.
• Staff involved and treated people with compassion, kindness, dignity and respect.
• Leaders demonstrated they had the capacity and skills to deliver high-quality, sustainable care.
• Patient feedback about the service had been positive.

The areas where the provider should make improvements are:

The provider should continue to develop governance and quality assurance processes in respect of the below:

• Review and improve systems for recording the immunisation status of staff.
• Review and improve the arrangements in place for staff in respect of fire evacuation when an on-site service is in operation.
• Review and improve the oversight arrangements in place in respect of building and facilities management at Ripon Hospital.
• Improve governance and oversight processes so that all staff complete required training in a timely way.
• Develop staff awareness of the Freedom to Speak Up Guardian
• Review and improve the arrangements in place to monitor that the provider’s policy is being followed in respect of vulnerable patients/children that Do not Attend (DNA) appointments.

Dr Rosie Benneyworth BM BS BMedSci MRCGP

Chief Inspector of Primary Medical Services and Integrated Care