Central Surgery

Updated 15 November 2017

Central Surgery operates from a converted building on King Street, Barton upon Humber, North Lincolnshire DN18 5ER. The practice provides General Medical Services (GMS) to 16604 patients living in Barton upon Humber and the villages in the area bounded by South Ferriby, Elsham, Ulceby, Goxhill and New Holland. There is a branch surgery at Goxhill which we also inspected.

The practice has four male and three female GPs (five partners and two salaried). Three nurse practitioners, a trainee nurse practitioner, five practice nurses, three nurses and four healthcare assistants. They are supported by a practice manager and eleven reception/ administrators and three dispensing staff. The practice is a training practice providing placements for year 4 and year 5 medical students. Placements are also provided for student nurses and GP Specialist Training.

The majority of patients are of white British background. The practice population profile is similar to the England average except the 45-69 years age group is higher than the England average and the 30-45 years age group are 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. People living in more deprived areas tend to have a greater need for health services.

The main surgery at Barton is open 8am to 6.30pm Monday to Friday. Appointments are available Monday to Friday 8am to 11.30am. Afternoon appointments are 2pm to 5.30pm Monday to Friday.

The Village Surgery in Goxhill is open from 8.00am until 1.00pm and 2.00pm until 6.00pm Monday to Thursday. The opening hours for Friday are 8.00am until 1.00pm and 2.00pm until 4.00pm.

Out of Hours care (from 6.30pm to 8am) is provided through the local out of hours service and accessed via NHS 111.

Updated 15 November 2017

Letter from the Chief Inspector of General Practice

We carried out an announced comprehensive inspection at Central Surgery on 2 October 2017. Overall the practice is rated as good.

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

• There was an open and transparent approach to safety and a system in place for reporting and recording significant events.
• The practice had clearly defined and embedded systems to minimise risks to patient safety.

• Staff were aware of current evidence based guidance. Staff had been trained to provide them with the skills and knowledge to deliver effective care and treatment.
• Results from the national GP patient survey showed patients were treated with compassion, dignity and respect and were involved in their care and decisions about their treatment.
• Information about services and how to complain was available. Improvements were made to the quality of care as a result of complaints and concerns.
• Patients we spoke with said they found urgent appointments available the same day however they found it was not easy to make an appointment with a named GP and there was limited continuity of care.
• 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 patients, which it acted on.
• The provider was aware of the requirements of the duty of candour. Examples we reviewed showed the practice complied with these requirements.

However, we saw areas where the provider should make improvement:

• Ensure that standard operating procedures are fit for purpose, regularly reviewed, and have been signed by all dispensary staff.
• Review the checking procedure for emergency medicines and equipment, and carry out a risk assessment for medicines which are not stocked.
• Review the remote collection service to ensure safety and quality.
• Ensure appropriate infection prevention and control training is provided for the lead nurse.
• Review the system that identifies patients who are also carers to help ensure that all patients on the practice list who are carers are offered relevant support if appropriate.
• Monitor patient access to the practice by telephone to identify if meeting patient needs.

Professor Steve Field (CBE FRCP FFPH FRCGP) 

Chief Inspector of General Practice

Updated 15 November 2017

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

• Nursing staff had lead roles in long-term disease management and patients at risk of hospital admission were identified as a priority.
• Performance for diabetes related indicators was 100%, this was better than the CCG average of 92% and the national average of 90%.
• 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.
• All these patients had a named GP and there was a system to recall patients for 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.

Updated 15 November 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 (A&E) attendances.
• Immunisation rates were relatively high for all standard childhood immunisations.
• 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.
• Appointments were available outside of school hours and the premises were suitable for children and babies.
• The practice had emergency processes for acutely ill children and young people.

Updated 15 November 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 followed up on older patients discharged from hospital and ensured that their care plans were updated to reflect any extra needs.

Updated 15 November 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 had online service appointments however some patients we spoke to were unaware of this option. The practice provided a full range of health promotion and screening that reflects the needs for this age group.

Updated 15 November 2017

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

• 78% of patients diagnosed with dementia had their care reviewed in a face to face meeting in the last 12 months, which is comparable to the CCG average of 80% and the national average of 84%.
• 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 patients experiencing poor mental health, including those living with dementia.
• Patients at risk of dementia were identified and offered an assessment.
• The practice had information available for patients experiencing poor mental health about how they could access various support groups and voluntary organisations.
• The practice had a system to follow up patients who had attended accident and emergency where they may have been experiencing poor mental health.
• Staff interviewed had a good understanding of how to support patients with mental health needs and dementia.

Updated 15 November 2017

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

• The practice held a register of patients living in vulnerable circumstances including homeless people, travellers and those with a learning disability.
• 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 offered longer appointments for patients with a learning disability.
• The practice worked with other health care professionals in the case management of vulnerable patients.
• Staff interviewed knew how to recognise signs of abuse in children, young people and adults whose circumstances may make them vulnerable. 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.