Ampleforth Surgery Also known as Ampleforth & Hovingham Surgeries

Updated 18 March 2016

Letter from the Chief Inspector of General Practice

We carried out an announced comprehensive inspection of this practice on 3 November 2014. A breach of legal requirements was found. After the comprehensive inspection, the practice wrote to us to say what they would do to meet legal requirements in relation to;

Regulation 13 HSCA 2008 (Regulated Activities) Regulations

2010 Management of medicines

We undertook this focused inspection on 22 January 2016, to check that they had followed their plan and to confirm that they now met legal requirements. This report only covers our findings in relation to those requirements. You can read the report from our last comprehensive inspection, by selecting 'all reports' link for Ampleforth Surgery on our website at www.cqc.org.uk

From the inspection on 3 November 2014, the practice were told they must:

• Improve the checking and signing of prescriptions by GPs before medicines are dispensed and issued to patients.

• Improve arrangements for checking the expiry dates of medicines to ensure they are safe to use.

We found that on the 22 January 2016 the practice now had improved systems in place.

• Prescriptions were signed before being dispensed to patients and there was a robust process in place to ensure this occurred, including for controlled drugs.
• There was a procedure in place to ensure dispensary stock was fit for use and we were shown examples of how this worked.

Professor Steve Field (CBE FRCP FFPH FRCGP) 

Chief Inspector of General Practice

Updated 5 March 2015

The practice is rated as good for the population group of people with long term conditions. Emergency processes were in place and referrals made for patients in this group that had a sudden deterioration in health. When needed longer appointments and home visits were available. All these patients had a named GP and structured annual reviews and recalls to check their health and medication needs were being met. Access to chronic disease clinics was flexible to suit the needs of this population group. The practice also operated opportunistic screening to ensure patients received regular screening. The practice arranged more frequent reviews for those patients whose condition became unstable.

Updated 5 March 2015

The practice is rated as outstanding for the population group of families, children and young people. The practice have a population well above the national average for young people due to the local college and schools which provide boarding for students. The practice provides daily clinics at the college and weekly clinics at the preparatory school. There are robust processes in place for the monitoring of children and young people who had a high number of A&E attendances. Immunisation rates were good for all standard childhood immunisations and staff could identify the reason for any exceptions.

Same day appointments were available outside of school hours and the premises were suitable for children and babies. We were provided with good examples of joint working with midwives, health visitors and school nurses. Emergency processes were in place and referrals made for children and pregnant women who had a sudden deterioration in health.

Updated 5 March 2015

The practice is rated as outstanding for the care of older people. Nationally reported data showed the practice had good outcomes for conditions commonly found amongst older people. The practice offered proactive, personalised care to meet the needs of the older people in its population and had a range of services, for example to treat and manage long term conditions and end of life care. The practice was responsive to the needs of older people, including offering home visits and rapid access appointments for those with enhanced needs and home visits. All patients were contacted following discharge from hospital to ensure they were reviewed and any changes to their treatment responded to appropriately. A home delivery service for medication was available. The practice provided regular visiting clinics for the elderly monks and nuns into the local monastery and convent. The patient forum (PPG) were successful in obtaining funding to provide a local transport service for people who required transport assistance to and from appointments to the surgery and hospitals. The rural location of the practice meant that many older people were living in isolated areas with poor access to public transport. The practice worked with the local community to promote good health and improve access to services for older people. Each older patient had a named GP. District Nurses, and Palliative Care Nurses were involved in surgery meetings to ensure that care for patients at the end of their lives was co-ordinated.

Updated 5 March 2015

The practice is rated as good for the population group 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 offer continuity of care. The practice was proactive in offering online services as well as a full range of health promotion and screening which reflects the needs for this age group.

Updated 5 March 2015

The practice is rated as good for the population group of people experiencing poor mental health. Patients experiencing poor mental health had received an annual physical health check and review of medicines. The practice could access community mental health support services, and there were good links with the primary care mental health worker who visited the practice. The staff were familiar with the multi-agency support services available in the local area for patients experiencing poor mental health and were able to sign post patients.

The practice had a system in place to provide a joint visit with the community psychiatric nurse for patients. The practice were proactive in following up patients who failed to attend the practice for treatment and those who failed to attend hospital appointments.

Updated 5 March 2015

The practice is rated as good for the population group of people whose circumstances may make them vulnerable. The practice held a register of patients living in vulnerable circumstances, for example those with learning disabilities and was aware of these patients. The practice had carried out annual health checks for people with learning disabilities and patients had received follow-up appointments when required. The staff were aware of how to sign-post vulnerable patients to various support groups and third sector organisations. 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 and out of hours.