Archived: HOLDERNESS HEALTH OPEN-DOOR SURGERY

Updated 16 August 2017

Holderness Health Open-Door Surgery, 700 Holderness Road, Hull, HU9 3JA is situated to the east of the City of Hull. The practice provides services under a General Medical Services (GMS) contract with NHS England, Hull Area Team. The practice list size of 1,637 and the majority of patients are of elderly background.

There is one GP who is female. The practice also arranges for further consultations by regular locum GPs. There is one practice nurse and they are supported by a practice manager, reception and administrative staff.

The practice is open between 8am to 6.30pm Monday to Friday. Appointments are available from 8.30am to 4.30pm on a Monday. 8.30am to 11am and 2.30pm to 5.30pm on a Tuesday. 10am to 5.30pm on Wednesday. 11am to 6.30pm on a Thursday. 9.30am to 12am and 4pm to 6pm on a Friday.

The proportion of the practice population in the 14-44 years age group is significantly higher than the England average. The practice population in the 45-64 years age group is also higher than the England average. The practice scored four on the deprivation measurement scale, which is the fourth most deprived, the deprivation scale goes from one to ten, with one being the most deprived. People living in more deprived areas tend to have greater need for health services. The overall practice deprivation score is slightly better than the England average, the practice is 23.4 and the England average is 26.6.

The practice, along with all other practices in the Hull CCG area have a contractual agreement for NHS 111 service to provide Out of Hours (OOHs) services from 6.30pm to 8am. This has been agreed with the NHS England area team. When the practice is closed, patients use the NHS 111 service to contact the OOHs provider. Information for patients requiring urgent medical attention out of hours is available in the waiting area, in the practice information leaflet and on the practice website.

Updated 16 August 2017

Letter from the Chief Inspector of General Practice

We carried out an announced comprehensive inspection at Holderness Health Open-Door Surgery on 5 July 2017. The overall rating for the practice was requires improvement.

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 did not have clearly defined and embedded systems to minimise risks to patient safety, in relation to recall of patients on high risk medication and managing alerts.
• 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 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.
• Patients we spoke with said they found it easy to make an appointment with the 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.
• 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 areas where the provider should make improvements are:

• Although patient feedback is being sought in other ways the practice should explore ways of introducing and implementing a patient participation group (PPG) to drive improvement through further suggestions from a patient perspective.

• Consider implementing a system to conduct an analysis of all significant events to assess the trends and impact on patients and the service.

• Plan and conduct multi-disciplinary meetings for patients with defined needs in order to meet their care in a timely manner.

• Ensure all complaints are managed in accordance with procedures in respect of complaint outcomes and reference to other agencies.

• Implement systems to ensure infection control audits and any actions identified are completed and monitored in a timely manner.

The areas where the provider must make improvements are:

• Ensure care and treatment is provided in a safe way to patients, which meets their needs and reflects their preferences.

• Ensure recruitment procedures are established and operated effectively to ensure only fit and proper persons are employed. 

Professor Steve Field (CBE FRCP FFPH FRCGP) 

Chief Inspector of General Practice

Updated 16 August 2017

The practice is rated as requires improvement for the care of people with long-term conditions (LTCs).

• The GP and Nursing staff had lead roles in chronic disease management and patients at risk of hospital admission were identified as a priority.

• Nationally reported data for 2015/2016 showed that outcomes for patients with long term conditions were generally similar or worse than the local CCG and national average. For example, The percentage of patients with Chronic Obstructive Pulmonary Disease (COPD) who had had a review, undertaken by a healthcare professional, including an assessment of breathlessness in the preceding 12 months was 79%. This was worse than the local CCG average of 88% and the national average of 89%.

• 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. However, we did not see any documented evidence that multi-disciplinary meetings had taken place.

Updated 16 August 2017

The practice is rated as requires improvement 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, on the day of inspection, that 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. For example, appointments were arranged out of school our and a private quiet area was provided for breastfeeding.

• The practice worked with midwives, health visitors and school nurses to support this population group.

Updated 16 August 2017

The practice is rated as requires improvement 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 and urgent appointments for those with enhanced needs.

• 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.

• Older patients were provided with health promotional advice and support to help them to maintain their health and independence for as long as possible.

Updated 16 August 2017

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

• The needs of these population groups 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, appointments were available from 8am and until 6.30pm on a Friday.

• 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.

• Telephone consultations were available every day with a call back appointment arranged at a time to suit the patient.

Updated 16 August 2017

The practice is rated as requires improvement 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.

• 95% of patients diagnosed with dementia had had their care reviewed in a face to face meeting in the last 12 months, compared to the CCG average of 95% and the national average of 94%. This was comparable to the national and local CCG average.

• The practice specifically considered the physical health needs of patients with poor mental health and dementia. For example, a register of patients with mental health was maintained and referrals were made to local mental health teams as a result of reviewing reports from psychiatry assessments.

• The practice did not have a system for monitoring repeat prescribing for patients receiving high risk medicines.

• Nationally reported data from 2015/2016 showed the percentage of patients with schizophrenia, bipolar affective disorder and other psychoses who had a comprehensive care plan documented in their record, in the preceding 12 months was 80%. This was comparable to the local CCG average of 84% and comparable to the national average of 89%.

• 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.

• Staff interviewed had a good understanding of how to support patients with mental health needs and dementia.

Updated 16 August 2017

The practice is rated as requires improvement for the care of people whose circumstances may make them vulnerable.

• The practice held a register of patients living in vulnerable circumstances including homeless people, travellers and those 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.