Archived: Tollerton Surgery

Updated 19 January 2018

Tollerton Surgery, 5-7 Hambleton View, Tollerton, North Yorkshire, YO61 1QW is situated in a rural area outside York. There is a small car park available to the rear of the practice and road side parking. The practice is a converted bungalow with disabled access. Consulting and treatment rooms are on the ground floor. The practice provides services under a General Medical Services (GMS) contract with the NHS North Yorkshire and Humber Area Team to the practice population of 3281,

covering patients of all ages. The practice covers a rural population in a village outside of the city of York. The practice is a dispensing practice and is able to dispense medicines for patients who live more than one mile from the nearest pharmacy.

The proportion of the practice population in the 45 years and over age group is slightly above the local CCG and England average and in the under 39 age group is slightly below the local CCG and England average with the exception of the 10 to14 age group which is slightly higher. The practice scored ten on the deprivation measurement scale, the deprivation scale goes from one to ten, with one being the most deprived.

The practice has two GP partners and two salaried GPs. The lead GP partner is in the process of retiring. There are two practice nurses and one nurse practitioner. All the nurses are female. There is a practice manager, organisational manager, dispensary staff, secretaries, a cleaner and receptionists.

Tollerton Surgery is a teaching partner with Hull and York Medical School providing placements and teaching for fifth year medical students.

Tollerton Surgery is open between 8am and 6.30pm Monday to Friday with the exception of Thursdays when the practice closes at 4pm. GP appointments are available between 8.30am and 11.10am and 2pm and 5.50pm Monday to Friday except for on a Thursday when they are available between 8.30am and 11.10am (The exact timing of individual surgeries varies from day to day). Information about the opening times is available on the website and in the patient information leaflet. The practice has opted out of providing out of hours services (OOHs) for their patients. When the practice closes early on a Thursday patients calling the practice are advised to contact the out of hours provider. OOHs care is provided by Vocare. 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 19 January 2018

Letter from the Chief Inspector of General Practice

We carried out an announced comprehensive inspection at Tollerton Surgery on 7 June 2017. The overall rating for the practice was good but the safe key question was rated as requires improvement. The full comprehensive report on the June 2017 inspection can be found by selecting the ‘all reports’ link for Tollerton Surgery on our website at www.cqc.org.uk.

This inspection was an unannounced focused inspection carried out on 11 December 2017 to confirm that the practice had carried out their plan to meet the legal requirements in relation to the breaches in regulations that we identified in our previous inspection on 7 June 2017. This report covers our findings in relation to those requirements and also additional improvements made since our last inspection.

Overall the practice is now rated as good.

Our key findings were as follows:

• The practice dispensed medicines for patients on the practice list who did not live near a pharmacy.The practice had standard operating procedures (SOPs) which were regularly reviewed and covered all aspects of the dispensing process (these are written instructions about how to safely dispense medicines). A system was in place to ensure relevant staff had read and understood the SOPs.

• The practice held stocks of controlled drugs (medicines that require extra checks and special storage arrangements because of their potential for misuse), and had SOPs in place covering all aspects of their management. Controlled drugs were stored in a controlled drugs cupboard, access to them was restricted and the keys were held securely. Previously, full balance checks of controlled drugs had not been recorded. We found staff had carried out regular checks and recorded them on the electronic document management system.

• Expired and unwanted medicines were disposed of in accordance with waste regulations.

• We found a new SOP had been introduced to guide staff how to handle uncollected prescriptions. Appropriate arrangements were now in place for the regular checking of uncollected prescriptions. Checks also included ensuring all prescriptions awaiting collection were signed by an appropriate prescriber, however some unsigned prescriptions had not been picked up by the checks.

• A new checking process had been introduced to ensure Patient Group Directions remained legally valid and fit for use.

• A “near miss” record (a record of errors that have been identified before medicines have left the dispensary) was in place, allowing the practice to identify trends and patterns in errors and take action to prevent reoccurrence.

• There were arrangements in place for the recording of significant events involving medicines.

• A new system had been introduced to track the use of blank prescriptions since our last inspection. However, the system of recording was not fit for purpose, and staff could not accurately account for the prescriptions on the premises on the day of our visit.

• The practice had increased the number of identified carers from 0.7% to just over 1%.

• Infection control issues identified at the last infection had been addressed.

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

The provider should:

Review the checking process for prescriptions awaiting collection, in particular to ensure they are signed by an appropriate practitioner

Review the system for recording and tracking blank prescription forms

Professor Steve Field (CBE FRCP FFPH FRCGP) 

Chief Inspector of General Practice

Updated 16 August 2017

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

• Nursing staff had lead roles in long-term 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 good. For example, the percentage of patients with diabetes, on the register, whose last measured total cholesterol (measured within the preceding 12 months) was 5mmol/l or less was 87%. This was above the local CCG average of 81% and the England average of 80%.

• The practice had increased reviews for diabetic patients from annual to every six months and the local lead nurse for diabetes visited the practice to jointly review patients with the advanced nurse practitioner (ANP).

• 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.

• Longer appointments and home visits were available when needed.

• Patients with LTCs had a named GP and there was a system to recall patients for a structured annual review to check that their health and medicines needs were being met. For those people with the most complex needs, the named GPs and nurse worked with relevant health and care professionals to deliver a multidisciplinary package of care.

• The practice hosted retinal screening clinics for patients with diabetes.

Updated 16 August 2017

The practice is rated as good for the care of families, children and young people.

• From the sample of documented examples we reviewed we found there were systems 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 accident and emergency attendances.

• Immunisation rates were relatively high for all standard childhood immunisations. Uptake rates for the vaccines given were comparable to CCG/national averages. Childhood immunisation rates for the vaccinations given up to age two were above the 90% national target at 94% scoring 9.4 out of 10 compared to the national average of 9.1. Vaccinations for five year olds ranged from 92% to 100% compared to the England average of 88% to 94%.

• 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.

• The premises was suitable for children and babies. However space was limited in the practice and access to baby changing and breast feeding depended on a room being available.

• The practice used a traffic light system to identify acutely ill children.

• The practice worked with midwives, health visitors and school nurses to support this population group. For example, in the provision of ante-natal, post-natal and child health surveillance clinics.

• The practice had emergency processes for acutely ill children and young people and for acute pregnancy complications.

Updated 16 August 2017

The practice is rated as good 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 had access to local support services such as Dementia café, the unplanned care practitioners and other community teams.

• The practice 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. We saw record summaries were shared with the out of hours service.

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

• The practice had admission rights to the local community hospital that provided rehabilitation and palliative care.

• There was a named clinician for each care home the practice provided care to in the area.

Updated 16 August 2017

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

• The needs of these populations 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 as well as a full range of health promotion and screening that reflected the needs for this age group.

• Telephone consultations were available daily with a call back appointment arranged at a time to suit the patient. There was early morning appointments available with the nurse on Wednesday mornings with the last appointment available with the GP at 5.50pm.

Updated 16 August 2017

The practice is rated as good for the care of people experiencing poor mental health (including people with dementia).

• The practice carried out advanced care planning for patients living with mental health needs, including dementia.

• Nationally reported data from 2015/2016 showed 87% of people diagnosed with dementia had had their care reviewed in a face to face meeting in the preceding 12 months. This was comparable to the local CCG of 85% and England average of 84%.

• 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 92%. This was comparable to the local CCG average of 91% and the England average of 89%.

• The practice specifically considered the physical health needs of patients with poor mental health and dementia.

• The practice had a system for monitoring repeat prescribing for patients receiving medicines for mental health needs.

• The practice regularly worked with multi-disciplinary teams in the case management of people experiencing poor mental health, including those with dementia.

• The practice had a system in place to follow up patients who had attended accident and emergency where they may have been experiencing poor mental health.

• The practice experiencing poor mental health about how they could access various support groups and voluntary organisations.

• Staff were aware of patients with severe mental health problems and were at risk and alerted the clinician if they were concerned.

• 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 good for the care of people whose circumstances may make them vulnerable.

• The practice held registers of patients living in vulnerable circumstances which included those with a learning disability. The practice offered longer appointments for people with a learning disability and there was a named GP.

• Nursing staff used easy read leaflets to assist patients with learning disabilities to understand their treatment.

• 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 regularly worked with multi-disciplinary teams in the case management of vulnerable people.

• 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 . 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.

• Telephone interpretation services were available and information in different languages was provided when required.