South Milford Surgery

Updated 20 August 2015

South Milford Surgery is located in a purpose built building on the High Street in South Milford. There are two branch surgeries, one in Micklefield and one in Thorpe Willoughby. All are dispensing surgeries. The practice provides General Medical Services (GMS) under a contract with NHS England, North Yorkshire and Humber Area Team, to the practice population of 9,753 patients.

There is a mix of female and male staff at the practice. Staffing at the practice is made up of three GP partners (two female and one male) and three salaried GPs (two male and one female). The practice manager is also a managing partner in the practice. There is one female advanced nurse practitioner, two female practice nurses, two female health care assistants and two female phlebotomists. There are dispensing staff and a range of administration and secretarial staff.

Appointments are available Monday to Friday from 8.00am to 11am and 15.20 to 6.00pm. Extended hours are available on Monday evenings until 19.30 and from 7.00am on Tuesday mornings. The practice closes between 1.00pm and 2.00pm each day. Micklefield surgery is open Monday to Friday from 08.30 -11.45 and is open Monday and Wednesday afternoons from 15.20- 18.00. Thorpe Willoughby surgery is open Monday to Friday from 08.30 – 11.45.

When closed the OOH provider is North Yorkshire Doctors; information about this service is provided on the practice’s website and on the surgery telephone answer machine.

Updated 20 August 2015

Letter from the Chief Inspector of General Practice

We carried out an announced comprehensive inspection on 14 July 2015 at South Milford Surgery as part of our comprehensive programme of inspection of primary medical services. We also visited their two branch surgeries in Micklefield and Thorpe Willoughby.

Overall the practice is rated as GOOD.

Specifically, we found the practice provided safe, well-led, effective, caring and responsive services. It was rated as good for all of the population groups.

Our key findings were as follows:

• Staff understood and fulfilled their responsibilities to raise concerns, and to report incidents and near misses. Information about safety was recorded, monitored, appropriately reviewed and addressed.
• Risks to patients were assessed and well managed.
• Patients’ needs were assessed and care was planned and delivered following best practice guidance. Staff had received training appropriate to their roles and any further training needs had been identified and planned.
• Information about services and how to complain was available and easy to understand.
• The practice was clean and hygienic

We saw several areas of outstanding practice including:

• The practice as part of SHIELD (The Selby Area Federation of GP Practices) had won an innovation fund, to develop social prescribing. This fund was used initially to support the local voluntary service to produce an up to date data base of available voluntary social care organisations. Patients were then referred to the most appropriate services.
• The practice provided minor injuries clinics to avoid unnecessary journeys to the nearest hospital. Information showed there were fewer A & E attendances, compared with other GP practices within the CCG.

Professor Steve Field (CBE FRCP FFPH FRCGP) 

Chief Inspector of General Practice

Updated 20 August 2015

The practice is rated as good for the care of patients with long-term conditions.

Nursing staff had lead roles in chronic disease management and had dedicated appointments to review patients with diabetes, asthma and/or chronic respiratory disease. Patients at risk of hospital admission were identified as a priority. 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 worked with relevant health and care professionals to deliver a multidisciplinary package of care. The practice held multidisciplinary meetings every month to review the needs of all patients with complex long term conditions.

Appointments were structured to avoid multiple visits to the practice and home visits were available when needed.

The practice recognised the needs of patients and their difficulty with transport to the hospital for appointments. They had arranged screening for certain conditions to be carried out at the practice. For example, eye screening took place at the practice every year for patients at risk of developing diabetic retinopathy. This was appreciated by some patients we spoke with as it avoided them having to travel to the eye clinic based at the main hospital.

The practice had links with external health care professionals to provide advice and guidance as required.

Health education around diet and lifestyle was promoted by the GPs and nursing staff. The practice took an early intervention approach and helped identify and signpost patients to external support. This included assistance with smoking cessation and contact details for the health worker running this service was given to patients.

Updated 20 August 2015

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

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. Appointments were available outside of school hours and the premises were suitable for children and babies. The waiting room had toys for children to play with whilst waiting for their appointments.

Emergency processes were in place for acutely ill children, young people and pregnant women with acute complications.

The practice worked collaboratively with midwives, health visitors and school nurses to deliver antenatal care, child immunisation and health surveillance.

Parents with children attending the practice confirmed that they were always present during consultations. Staff understood Gillick principles with regard to assessing whether a young person was able to understand and therefore consent to treatment. Parents told us that all of the staff engaged well with their children and they found it a positive experience when attending the practice for appointments.

The practice provided minor injuries clinics to avoid unnecessary journeys to the nearest hospital. Information showed there were fewer A & E attendances from this age group, compared to other GP practices.

Updated 20 August 2015

The practice is rated as good for the care of older patients.

The practice offered proactive, personalised care to meet their needs. Nationally reported Quality Outcomes Framework (QOF) data showed the practice had good outcomes for conditions commonly found in this age group. The practice was responsive to their needs, understanding the impact of the rural environment for their patients. They provided annual health checks for elderly patients and where suitable, home visits. There was a strong commitment to providing co-ordinated, responsive and compassionate care for patients nearing the end of their lives. Individualised care plans were in place for those patients who were being treated by the multi-disciplinary team.

The clinicians were proactive in reducing risks associated with polypharmacy for older people. For example, patients prescribed multiple different medicines had been frequently reviewed and changes made to reduce these, where necessary.

Information systems enabled the practice to appropriately share important clinical and social information about patients with complex needs. This facilitated continuity of care for those patients. Hospital discharges were followed up.

Updated 20 August 2015

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

The needs of this 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 was able to provide the service for working patients so they would be able to book appointments and repeat prescriptions on-line. The practice website offered information about the full range of health promotion and screening available for this group. The practice had extended opening every Monday evening and Tuesday mornings from 7am, for working patients. Appointments were available for patients to see a GP, or the Advanced Nurse practitioner. Patients would be able to request repeat prescriptions on-line, via an automated telephone system or in person at the practice. Repeat prescriptions were given for up to six months, where clinically appropriate.

Overseas travel advice including up-to-date vaccinations was available from the nursing staff within the practice, with additional input from the GPs as required.

Opportunistic health checks were being carried out with patients when they attended the practice. This included offering referrals for smoking cessation, providing health information, routine health checks and reminders for medication reviews.

Updated 20 August 2015

The practice is rated as good for patients who experience poor mental health (including patients with dementia). Practice staff were aware of their patients with poor mental health and offered support to meet their needs. All patients experiencing poor mental health received an annual physical health check. The practice worked with multi-disciplinary teams in the case management of patients experiencing poor mental health.

Arrangements were in place for dispensing staff to flag up any concerns regarding over or under ordering of medicines. Staff worked to a Standard Operating Procedure for patients on certain medicines. Patients who experienced poor mental health were supported appropriately. This included a counselling service as clinics were held at the surgery each week.

Updated 20 August 2015

The practice is rated as good for the population group of patients whose circumstances may make them vulnerable. We were told these patients were never turned away. Links had been made with local health and social care teams and joint patient review meetings took place to discuss the most vulnerable patients. The practice held a register of patients with learning disabilities and offered them annual health checks and longer appointment times. Staff knew how to recognise signs of abuse in vulnerable adults and children. They were aware of their responsibilities regarding information sharing, documentation of safeguarding concerns and how to contact relevant agencies.