Archived: The Petergate Surgery

Updated 28 May 2015

The Petergate Surgery is situated in York and provides primary medical care services, which includes access to GPs, minor surgery, family planning, ante and post natal care to patients living in the city of York. The practice also has a branch surgery in the village of Skelton where regulated activities are also provided, we did not visit the branch surgery during the inspection.

The practice provides services to 6361 patients of all ages. There is a slightly higher percentage of the practice population in the under 18 age group than the England average and a lower percentage in the 65 years and over age group than the England average. The overall practice deprivation score is significantly below the England average, the practice is 9.67 and the England average is 23.6.

The practice has three GP partners and two salaried GPs, one male and four female. The practice is a teaching practice for medical students from the Hull and York Medical School. There are two nurse practitioners, one practice nurse and two health care assistants. There is one practice manager and a team of secretarial, reception, administrative and support staff.

The practice provides services to their patients through a General Medical Services contract.

The practice has opted out of providing out of hours services (OOHs) for their patients. When the practice is closed patients use the 111 service. Information for patients requiring urgent medical attention out of hours is available in the waiting area and on the practice website.

Updated 28 May 2015

Letter from the Chief Inspector of General Practice

We carried out an announced comprehensive inspection at The Petergate Surgery on 16 December 2014. Overall the practice is rated as good.

Specifically, we found the practice to be good for providing safe, well-led, effective, caring and responsive services that meet the needs of the population it served.

Our key findings were as follows:

• Patients who use the service were kept safe and protected from avoidable harm. The building was well maintained and clean.

• All the patients we spoke with were positive about the care and treatment they received. The CQC comment cards and results of patient surveys showed that patients were consistently pleased with the service they received.

• There was good collaborative working between the practice and other health and social care agencies that ensured patients received the best outcomes. Clinical decisions followed best practice guidelines.

• The practice met with the local Clinical Commissioning Group (CCG) to discuss service performance and improvement issues.

• There were good governance and risk management measures in place. The leadership team were visible and staff we spoke with said they found them very approachable.

However there were areas of practice where the provider needs to make improvements

Importantly the provider should:

• Ensure a process is in place to confirm the vaccines remain at required temperature when being transported from the main surgery to the branch surgery.

• Review the practice meetings to ensure all staff groups are represented and information is communicated effectively.

• Implement a planned audit programme to ensure all practice staff are included in the process.

Professor Steve Field (CBE FRCP FFPH FRCGP) 

Chief Inspector of General Practice

Updated 28 May 2015

The practice is rated as good for the care of people with long-term conditions. Staff had a good understanding of the care and treatment needs of these patients and nursing staff had lead roles in chronic disease management. The practice closely monitored the needs of this patient group. Longer appointments and home visits were available when needed. All these patients had a structured annual review to check that their health and medication needs were being met. There was a recall programme in place to make sure no patient missed their regular reviews for conditions, such as diabetes, respiratory and cardiovascular problems. We heard from patients that staff invited them for routine checks and reviews. For those people with the most complex needs, the named GP worked with relevant health and care professionals to deliver a multidisciplinary package of care.

Staff were skilled and regularly updated in specialist areas which helped them ensure best practice guidance was being followed.

Updated 28 May 2015

The practice is rated as good 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. The practice offered comprehensive vaccination programmes which were managed effectively. Immunisation rates were relatively high for all standard childhood immunisations. The practice monitored any non-attendance of babies and children at vaccination clinics and worked with the health visiting service to follow up any concerns. The practice did ‘Booster Vaccination Clinics’ during school holidays for patients aged 14 to 18 years so young people who had not received required vaccinations during term time could access them whilst on holiday.

Appointments were available outside of school hours and the premises were suitable for children and babies. All of the staff were responsive to parents’ concerns and ensured children who were unwell could be seen quickly by the GP or nurse.

Updated 28 May 2015

The practice is rated as good for the care of older people. The practice was knowledgeable about the number and health needs of older patients using the service and actively reviewed the care and treatment needs of these patients. Nationally reported data showed that outcomes for patients were good for conditions commonly found in older people. Patients over the age of 75 had a named GP. The practice was responsive to the needs of older people, and offered home visits and rapid access appointments for those with enhanced needs.

The practice had agreed to deliver the NHS England strategy “Avoiding Unplanned Admissions / Proactive Care Programme Enhanced Services”. This was a strategy where the practice would liaise with local health and social care commissioners to work together for people with complex health needs. The nurses would work specifically with patients over the age of 75 to develop individualised care plans.

Updated 28 May 2015

The practice is rated as good for the care of working-age people (including those recently retired and students). The needs of this population group 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 provided a range of options for patients to consult with the GP and nurse, including on-line booking. Useful information was available in the practice and on the website as well as a full range of health promotion and screening that reflected the needs for this age group.

Updated 28 May 2015

The practice is rated as good for the care of people experiencing poor mental health (including people with dementia). The practice maintained a register of patients who experienced mental health problems including dementia. The register supported clinical staff to offer patients an annual appointment for a health check and a medicines review and 88.2% of patients with dementia had received a face to face review during 2013/2014.

The practice regularly worked with multi-disciplinary teams in the case management of people experiencing poor mental health, including those with dementia. The practice offered access to other services and information was available for patients on counselling services and support groups.

Updated 28 May 2015

The practice is rated as good for the care of people whose circumstances may make them vulnerable. Where required the practice held a register of patients living in vulnerable circumstances including homeless people, travellers and those with a learning disability. The practice offered these patients longer appointments. We found that all of the staff had a very good understanding of what services were available within their catchment area, such as supported living services, care homes and patients with carer responsibilities.

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. They had access to the practices’ policy and procedures and discussed vulnerable patients at the practice meetings.