Sleights and Sandsend Medical Practice

Updated 12 January 2017

The Sleights and Sandsend Medical Practice is a rural practice situated in Sleights, North Yorkshire. The practice covers the area bounded by Staithes, Robin Hood’s Bay and Goathland.

The main surgery is at Churchfield Surgery, Iburndale Lane, Sleights, Whitby, YO22 5DP which was purpose built over 20 years ago. At the time of the inspection, the branch surgery at East Row, Sandsend, Whitby, YO21 3SU was being rebuilt and not in use so was not inspected.

There are 5156 patients on the practice list and the majority of patients are of white British background. The practice population profile differs from the England average as the 50+ years age group is higher than the England average and the 0-49 years age group is lower than the England average. The practice scored seven on the deprivation measurement scale, the deprivation scale goes from one to ten, with one being the most deprived. The overall practice deprivation score is lower than the England average; the practice score is 18.3 and the England average is 21.8. People living in more deprived areas tend to have a greater need for health services.

The practice is a dispensing practice and dispenses to approximately 66% of their patients.

The practice has four GP partners and one salaried GP. There is one female doctor and four male. The practice employs three advanced nurse practitioners, two practice nurses and two health care assistants and two psychotherapists who attend one day a week. There is a practice manager, practice administrator, four secretary administration staff, eleven dispensary/reception staff and two housekeepers. One of the  nurse practitioners works closely with four other local practices as part of the nursing workforce project.  The practice  employ a non-prescribing pharmacist two days a week to work equally on CCG prescribing objectives and supporting the practice GPs. 

The practice is a training practice, currently has two third year students from Hull & York Medical School and has applied to be a teaching practice.

The practice is open 8am - 6pm Monday to Friday. Appointments are from 8.30am - 11am and 3pm-5pm daily. Extended hours appointments are offered from 6.45am on Tuesday. In addition to pre-bookable appointments that could be booked up to six weeks in advance, urgent appointments are also available for people that needed them.

The branch surgery is open 8am-1pm Monday, Thursday, Friday and 8am-6pm Tuesday and Wednesday. Appointments are from 8.30am -11am Monday, Tuesday, Wednesday, Friday and 10am-11am on Thursday.

The practice has opted out of providing out-of-hours services to its own patients. Out of hours patients are directed to Harrogate & District NHS Foundation Trust (the contracted out-of-hours provider) via the 111 service.

The practice has a General Medical Services (GMS) contract with NHS England. It is a member of NHS Hambleton, Richmondshire and Whitby CCG.

Updated 12 January 2017

Letter from the Chief Inspector of General Practice

We carried out an announced comprehensive inspection at Sleights and Sandsend Medical Practice on 6 October 2016. Overall the practice is rated as outstanding.

Our key findings across all the areas we inspected were as follows:

• There is a genuinely open culture in which all safety concerns raised by staff and people who use services are highly valued as integral to learning and improvement.
• Risks to patients were assessed and well managed.
• Staff assessed patients’ needs and delivered care in line with current evidence based guidance. Staff had been trained to provide them with the skills, knowledge and experience to deliver effective care and treatment.
• All staff were open and transparent and fully committed to reporting incidents and near misses. The level and quality of incident reporting shows the levels of harm and near misses, which ensures a robust picture of safety.
• The practice used innovative and proactive methods to improve patient outcomes, working with other local providers to share best practice. For example, organised a ‘Warm and Well’ day providing advice from and links to social services and third sector groups.
• Feedback from patients about their care was consistently positive.
• The practice worked closely with other organisations and with the local community in planning how services were provided to ensure that they meet patients’ needs. For example, increasing GP appointment times to 15 minutes. This is above and beyond the requirements of their contract with NHS England.
• The practice implemented suggestions for improvements and made changes to the way it delivered services as a consequence of feedback from patients and from the patient participation group (PPG). For example the practice provides a no-cost medicines delivery service for housebound patients.
• The practice held several support groups on their premises and was actively involved in running most of them.
• The practice had good facilities and was well equipped to treat patients and meet their needs.
• The practice actively reviewed complaints and how they are managed and responded to, and made improvements as a result.
• The practice had a clear vision which had quality and safety as its top priority. The strategy to deliver this vision had been produced with stakeholders and was regularly reviewed and discussed with staff.
• The practice had strong and visible clinical and managerial leadership and governance arrangements.
• Patients said they were treated with compassion, dignity and respect and they were involved in their care and decisions about their treatment.
• Information about services and how to complain was available and easy to understand. Improvements were made to the quality of care as a result of complaints and concerns.
• Patients said they found it easy to make an appointment with a named GP and there was continuity of care, with urgent appointments available the same day.
• The practice had good facilities and was well equipped to treat patients and meet their needs.
• There was a clear leadership structure and staff felt supported by management. The practice proactively sought feedback from staff and patients, which it acted on.
• The provider was aware of and complied with the requirements of the duty of candour.

We saw several areas of outstanding practice including:

• The practice funded a weekly psychotherapy service which they had audited. They provided numerous case studies demonstrating reduced GP consultations, more appropriate use of healthcare services and reduced levels of medication.
• An advanced nurse practitioner visited weekly all seven care homes in the local area to provide training and advice to staff. This had led to an 80% reduction in home visit requests from care homes and a reduction of 30% in all home visits.
• A no-cost medication delivery system to housebound dispensing patients was offered using an eco-car powered by solar panels on the surgery roof.
• The practice had set up various social and community groups to suit the needs of their patient population. For example a“Living with Health and Illness Group” project which worked with people with long term conditions in order to help them understand and learn strategies to live with their condition.

However there were areas of practice where the provider should make improvements:

• Implement procedures to record and monitor near misses and dispensing errors to improve the safety of the service.
• Ensure dispensary staff follow new protocols.

• Maintain appropriate cold storage records to be in line with national guidance.

Professor Steve Field (CBE FRCP FFPH FRCGP) 

Chief Inspector of General Practice

Updated 12 January 2017

The practice is rated as outstanding for the care of people with long-term conditions.

• Nursing staff had lead roles in chronic disease management and patients at risk of hospital admission were identified as a priority.
• Performance for diabetes related indicators was 100%. This was above the CCG average of 95% and the national average of 89%.
• Longer appointments and home visits were available when needed.
• All these patients had a named GP and a structured annual review to check their health and medicines needs were being met. For those patients with the most complex needs, the named GP worked with relevant health and care professionals to deliver a multidisciplinary package of care.
• The practice had established a Living with Health and Illness Group for patients and carers with long-term conditions and a local Diabetes Support Group. Both were available to patients from other practices.

Updated 12 January 2017

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

• Congratulation cards and six-week baby check appointments were sent following births.
• 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, and we saw evidence to confirm this.
• The practice’s uptake for the cervical screening programme was 79%, which was comparable to the CCG average of 79% and better than the national average of 74%. Text reminders were used to encourage patients to keep their appointments, and nurses telephoned patients who did not attend their appointment to encourage them to re-book.
• Appointments were available outside of school hours and the premises were suitable for children and babies.
• Free condoms and anonymous chlamydia screening were available.

Updated 12 January 2017

The practice is rated as outstanding for the care of older people.

• The practice offered proactive, personalised care to meet the needs of the older people in its population.
• The practice was responsive to the needs of older people, and offered home visits and urgent appointments for those with enhanced needs.
• An advanced nurse practitioner visited all seven care homes weekly. A teaching plan had been established every six weeks to cover topics such as parkinson’s disease, dementia and common infections and antibiotic resistance, end of life care, key drug prescribing, deprivation of liberty, advanced care planning and providing support to staff and relatives.

Updated 12 January 2017

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

• The needs of the working age population, those recently retired and students 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 repeat prescriptions service, appointment booking and cancelling services and an on-line form to join the PPG.
• The practice offered a full range of health promotion and screening that reflects the needs for this age group.
• Extended opening hours were offered from 6.45am on Tuesday morning.

Updated 12 January 2017

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

• Performance for mental health related indicators was 99%. This was above the CCG average of 97% and the national average of 93%.
• The practice regularly worked with multi-disciplinary teams in the case management of patients experiencing poor mental health, including those with dementia.
• The practice carried out advance care planning for patients with dementia.
• The practice had told patients experiencing poor mental health about how to access various support groups and voluntary organisations.
• 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.
• Staff had a good understanding of how to support patients with mental health needs and dementia.

• The practice funded a weekly psychotherapy service which they had audited. They provided numerous case studies demonstrating reduced GP consultations, more appropriate use of healthcare services and reduced levels of medication. An audit highlighted excellent patient satisfaction; comments referred to a ‘much improved ability to function on a daily basis’, ‘able to use the strategies taught with no need to seek medical advice’ and ‘improved lifestyle’.

Updated 12 January 2017

The practice is rated as outstanding for the care of people who circumstances may make them vulnerable.

• The practice held a register of patients living in vulnerable circumstances including those with a learning disability.
• The practice offered longer appointments for patients with a learning disability.
• The practice regularly worked with other health care professionals in the case management of vulnerable patients. For example local safeguarding meetings are frequently held at the practice.
• The practice informed vulnerable patients about how to access various support groups and voluntary organisations. For example posters and cards to pick up in the toilets allowing confidential signposting to domestic violence helpline, ChildLine, pregnancy advisory services and genito-urinary clinics.
• 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.
• The practice had a member of staff who had taken on the role of carers’ champion. They engaged with local services such as carers’ resource and with patients. The practice had a designated area of the waiting room where a very comprehensive carers’ resource file was available.