Haxby Group Hull

Updated 18 April 2019

Haxby Group Kingswood Surgery is located at 10 School Lane, Kingswood, Hull, North Humberside, HU7 3JQ.

The practice is registered with the CQC to carry out the following regulated activities - diagnostic and screening procedures, surgical procedures, family planning, maternity and midwifery services and treatment of disease, disorder or injury. These are delivered from three sites. All the sites were visited during the inspection. The three sites are; Haxby Group Kingswood Surgery, which is the registered location, 10 School Lane, Kingswood, Hull, HU7 3JQ,

Burnbrae Surgery, 445 Holderness Road, Hull, HU8 8JS,

Haxby Group, Orchard Park Surgery, The Orchard Centre, 210 Orchard Park Road, Orchard Park Estate, Hull, HU6 9BX

Haxby Group Kingswood Surgery is situated within the NHS Hull Clinical Commissioning Group (CCG) and provides services to 12,707 patients under the terms of a personal medical services (PMS) approx. 4,600 under an alternative provider medical services (APMS) contract. These are contracts between general practices and NHS England for delivering services to the local community. The practice offers enhanced services for example: extended hours and minor surgery. The practice is situated in a newly developed housing estate/area and as such the practice population is changing and growing rapidly (by on average 90 – 100 new patients per month). The sites at Orchard Park and Burnbrae have very different patient demographics, for example; patients living in Orchard Park are classed as living in an area of high deprivation, and a significant percentage of older people are registered at Burnbrae.

Information published by Public Health England, rates the level of deprivation within the practice population group as four, on a scale of one to ten. Level four represents higher levels of deprivation.

The majority of patients at the practice are of white British background (96%). There are a higher proportion of patients under 18 and a lower proportion of patients over 65 on the practice list compared with practices nationally.

Haxby Group comprises a partnership of 20 members who wholly own and operate HBG Limited. Both the partnership and HBG Limited are registered with CQC. Their six surgeries in York are registered with CQC via the partnership and their three in Hull via HBG Limited. However, they operate the entirety as a single organisation with a single identity, brand, culture and values. This system is supported by professional centralised support functions for human resources, finance and business intelligence and senior executive management including the managing partner, senior clinical partners in leadership positions and head of nursing and advanced clinical practice. At practice level each city surgery grouping has a general manager and an assistant manager with a partner leading local management and clinical leadership with the salaried GPs and non-GP clinicians reporting to them, and two deputy heads of nursing and two pharmacist managers. The clinical team includes advanced care practitioners, primary care practitioners, advanced nurse practitioners, nurse practitioners, pharmacists, practice nurses and health care assistants. The whole are supported by a full range of administrative personnel for day to day operations. In addition, there are a number of health care assistants and administrative apprentices. The group operate a training arm, recently incorporated, that provide most of its internal training needs whilst also supporting a wide range of clinical training regionally.

The Group are a party to and very active in two Federations. Hull GP Collaborative Limited and Nimbuscare Ltd. Hull GP collaborative holds sub-contracts for Improving Access and NHS Health checks. Haxby Group human resources and finance business intelligence team support both federations as do the executive management team.

Haxby Group Kingswood surgery is open between 8am and 8pm Monday to Friday. The Kingswood surgery site is also open on a Saturday morning between 9am and 1pm. The other two sites are open between 8am and 6.30pm Monday to Friday. Burnbrae Surgery is open from 7.45am Monday to Friday providing extended hours. The Calls between 6.30pm and 8pm are transferred and handled by the Kingswood surgery.

Out of Hours care is provided by City Health Care Partnership in Hull via the NHS 111 telephone number.

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 18 April 2019

We carried out an announced comprehensive inspection at Haxby Group Kingswood Surgery on 29 November 2018 as part of our inspection programme.

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 practice as outstanding overall. We rated the population groups of families, children and young people and people whose circumstances may make them vulnerable as outstanding and older people, people with long term conditions and people experiencing poor mental health (including people with dementia) as good.

We found that:

• The practice provided care in a way that kept patients safe and protected them from avoidable harm.
• Patients received effective care and treatment that met their needs.
• Staff dealt with patients with kindness and respect and involved them in decisions about their care.
• The practice organised and delivered services to meet patients’ needs. The Group had developed a new access model and was one of the first to introduce new roles into general practice. This meant that patients could access care and treatment in a timely way, with the most appropriate healthcare professional.
• The way the practice was led promoted the delivery of high-quality, person-centred care.

We saw areas of outstanding practice;

• The Group had effective support mechanisms in place for staff training. They had developed bespoke induction packs for different staff roles. They implemented competency based framework for all roles to be effectively assessed and provided support until they were achieved. Staff feedback was consistently positive with regards to the training provided.
• The Group had implemented effective services for their patients including effective approaches to flu and childhood immunisations. They could demonstrate the positive impact this had for patient outcomes.
• The Group offered patients the opportunity to self-administer an injectable contraceptive that was a suitably licensed preparation for patient self-administration. The practice nursing team provided education and support to patients. The service gave patients choice and increased the availability of nurse appointments.

• The Group had developed up to date templates. This reduced variability in coding as well as improving the safety of work carried out by new members of staff, clinical trainees and locums. The templates also promoted patient safety through prompts for clinicians during and after consultations to ensure referrals and investigations were completed.
• The Group had made improvements to their services for palliative care patients. Palliative care champions had been established, the champions had been given extended training in how to deal with bereavement, how to prioritise palliative care issues and how to liaise with specialist services such as the hospice and Macmillan nurses.

• We were shown evidence that GPs were now twice as likely to add a palliative care patient to the palliative care register (22% of palliative care patients identified by a GP in 2015 and 42% of palliative care patients identified by a GP in 2018). We also noted that anticipatory drugs were now being reviewed at regular intervals. (33% in 2015 and 63% in 2018).

• The Advanced Training Practice (ATP) hub was instrumental in supporting pre- registration student nurses to have clinical placement experience, to encourage them to consider practice nursing at the point of qualification.

The areas where the provider should make improvements are:

• Where patients are prescribed medicines not in line with National Institute for Clinical Excellence guidance provide a rationale as to why another medicine was prescribed within the patient record. This should include patients who had not been prescribed a high intensity statin as recommended by National Institute for Clinical Excellence guidance.

Details of our findings and the evidence supporting our ratings are set out in the evidence tables.

Professor Steve Field CBE FRCP FFPH FRCGP
Chief Inspector of General Practice

Updated 18 April 2019

Updated 18 April 2019

Updated 18 April 2019

Updated 18 April 2019

Updated 18 April 2019

Updated 18 April 2019