Archived: Heworth Green Surgery Also known as Priory Medical Group

Updated 16 April 2015

Heworth Green Surgery delivers primary care under a Personal Medical Services (PMS) Contract between themselves and NHS England. They are part of the PMG which is a General Practice Partnership open to all patients living within our Practice boundary in York and the surrounding areas. They are part of the York CCG NHS York.

The PMG has nine practices in the York area and are responsible for a population of 54120. There are 10,115 patients registered at the Heworth Green practice. There are seven GPs, (six female and one male) this equating to 45 sessions per week of GP time.

The practice is a teaching practice, there are currently six GP registrars working in the PMG. One GP registrar is based at Heworth Green and supported by a trained GP trainer.

The practice locations which are part of the Priory Group are Priory Medical Centre , Lavender Grove Surgery, Rawcliffe Surgery, Clementhorpe Health Centre, Fulford Surgery, Parkview Surgery, Tang Hall Lane Surgery and Victoria Way Surgery. We visited only Heworth Green as part of this inspection.

Patients can book appointments face to face, by the telephone or online. The practice treats patients of all ages and provides a range of medical services. The practice GPs do not provide an out-of-hours service to their own patients and patients are signposted to the local out-of-hours service via 111 when the surgery is closed and at the weekends. In an emergency patients are advised to ring 999 or attend the nearest accident and emergency department.

There is an all-female nursing team of an advanced nurse practitioner and two practice nurses The team are supported by health care assistants and counsellors. The nurses promote healthy living; provide support for patients with long term conditions such as diabetes, asthma and chronic obstructive pulmonary disease (COPD).

The practice has car parking facilities and access for the disabled. There are good links to public transport.

There were no previous performance issues or concerns about this practice prior to our inspection.

Updated 16 April 2015

Letter from the Chief Inspector of General Practice

This is the report of findings from our inspection of Heworth Green surgery which is part of the Priory Medical Group. The practice is registered with the Care Quality Commission to provide primary care services.

We undertook a planned, comprehensive inspection of Heworth Green surgery on 8 December 2014. There are nine surgeries in the Priory Medical Group (PMG) across the York Clinical Commissioning Group (CCG) area.

The practice is rated as Good. A safe, effective, caring, responsive and well-led service is

provided that meets the needs of the population it serves.

Our key findings were as follows:

• 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).

• Feedback from patients was positive, they told us staff communicated effectively and treated them with respect and kindness. Most patients told us they were able to access timely appointments in the practice. However we received some comments about the difficulty accessing appointments via the current telephone system.

Staff reported feeling supported and able to voice any concerns or make suggestions for improvement.

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 a good 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).

Professor Steve Field (CBE FRCP FFPH FRCGP) 

Chief Inspector of General Practice

Updated 16 April 2015

The practice is rated as good for the care of people with long-term conditions. There were emergency processes in place and referrals were made for patients whose health deteriorated suddenly. Longer appointments and home visits were available when needed. All 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 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. We saw that the practice had developed self-help guides for specific conditions. An example of this was ‘Managing your Diabetes’. This provided a patient booklet explaining the medical condition, annual review, management and staying healthy.

Updated 16 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 and the premises were suitable for children and babies. Antenatal clinics were run by district midwifes with most care delivered at the practice. Emergency processes were in place and referrals were made for children and pregnant women whose health deteriorated suddenly.

We saw that the practice had introduced a children’s colouring competition which provided an activity and distraction to children awaiting treatment.

Following consultation with students from two local schools the PMG have developed a teenage health clinic using the students’ suggestions on how to make the clinic teenage friendly. The clinic provides services one evening a week for patients between 11 to 19 years of age. They can book appointments in advance or just drop in and ask to be seen.This ensures that young people have access to an age appropriate, dedicated service which is delivered in a way they want. The service is available to all young people who are registered with the PMG group and gives them the option of attending the evening clinic or attending their own practice.

Updated 16 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 three care homes in the practice area and two dedicated GPs provide input into the homes. In the largest of the care homes the GPs visits twice weekly and in the interim for urgent requests. 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. We saw that the staff in the practice had become dementia friends and promoted dementia awareness within the practice. The staff we spoke with were proactive in screening for dementia and referring patients for ongoing care and treatment.

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 team who were able to provide support to patients in the group seven days a week. The PMG community team was made up of care managers and health and social care assistants to support patients and assess patient’s needs. The team were based at one of the other practices in the group but accessible to all patients. This helped patients remain independent and avoid unnecessary admission. We saw that the practice linked with other services and voluntary agencies to support older people. For example promoting the Carers Centre in York to carers who may need support.

Updated 16 April 2015

The practice is rated as good for the care of working-age people (including those recently retired and students). The needs of these groups 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, telephone consultations and texting 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 16 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 patients who had attended accident and emergency (A&E) where they may have been experiencing poor mental health. Staff had received training on how to care for people with mental health needs and dementia. We saw that all staff had become dementia friends. Dementia friends is about giving people an understanding about dementia and the little things they can do to make a difference to people living with dementia. 

Updated 16 April 2015

The practice is rated as outstanding 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.

The practice has a number of vulnerable patients with substance misuse problems often requiring complex care. One of the GPs explained that they are a level 2 doctor. Level 2 doctors are GPs who are trained to offer the full range of treatment options to patients who are opiate dependant. We saw that the practice and medical group had also developed links with Lifeline. This is a project operating in the city that works with individuals, families and communities to prevent and reduce harm and promote recovery linked with alcohol and drug misuse.