Haxby Group Hull

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