Dr Duggleby & Partners

Updated 24 January 2017

Stokesley Health Centre, North Road, TS9 5DY, is a semi-rural practice situated in Stokesley, North Yorkshire serving this market town and several surrounding villages. The registered list size is approximately 9260 patients who predominantly identify their ethnicity as White British. The practice is ranked in the ninth least deprived decile (one being the most deprived and ten being the least deprived), significantly above the national average. The practice age profile differs from the England average, having a higher number of patients in the 50 to 85 age range and a lower number in the 0 to 44 age range.

The practice is run by six GP partners and one part-time salaried GP. Four of the GPs are male and three are female. As a teaching practice, medical students are offered placements at the practice. There is a full-time primary care nurse, a part-time nurse practitioner and part-time practice nurse. In addition, Dr Duggleby and partners employ a treatment room nurse, a health care assistant and a phlebotomist. The practice has recruited a pharmacist with some support from the local CCG. The team is supported by a team of managers, reception and administration staff.

The practice is open between 8am to 6pm Monday to Friday. Appointments are available from 8.20am to 10.50am and 2.30pm to 5.20pm daily. Extended hours are offered on one variable evening per week, between 6.30pm and 9pm with a GP. These appointments are pre-bookable up to six weeks in advance. The Practice also offers telephone consultations daily. If any patient requests a same day appointment they are seen by any GP with an available slot. In order to see the GP of their choice, patients can make a pre-bookable appointment that can be booked up to six weeks in advance. During busy periods, the practice fulfils their same-day appointments policy by inviting patients to come to the surgery at the end of morning clinic. These patients are seen by the next available GP, even when all allocated appointment slots are full.

The practice has opted out of providing out-of-hours services to its own patients. Out of hours patients are directed to Harrogate District Foundation Trust (the contracted out-of-hours provider) via the NHS 111 service, except between 6pm and 6.30pm when  are directed to Primecare. .

The practice holds a General Medical Services (GMS) contract to provide GP services which is commissioned by NHS England.

Updated 24 January 2017

Letter from the Chief Inspector of General Practice

We carried out an announced comprehensive inspection at Stokesley Health Centre on16 November 2016. 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 an effective system in place for reporting and recording significant events.
• 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.
• 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 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.

• There was evidence of quality improvement including clinical audit. Patients were supported to live healthier lives.

We saw one area of outstanding practice:

• The nursing service provided by the practice to a local extra care housing scheme (Town Close) has significantly reduced emergency admissions, out of hours care and attendance at Accident and Emergency departments. For example, a comparison between April 2015 and April 2016 indicated that out of hours, Accident and Emergency visits and emergency admissions were reduced from six events to zero events at the Town Close facilty, following the implementation of primary care nurse support.

• Patients could always be seen by a GP from the practice on the same day, if the patient required this, even when all available appointment slots were taken.

The areas where the provider should make improvements:

• Non clinical staff should be offered an annual appraisal and the practice should document where these are declined.

• The provider should take steps to ensure that consultations cannot be overheard from the waiting area.

• Develop a written strategy and supporting business plan which outlines their vision and plan for the future.

• Develop a written consent policy.

Professor Steve Field (CBE FRCP FFPH FRCGP) 

Chief Inspector of General Practice

Updated 24 January 2017

The practice is rated as good 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.

• Nationally reported data for 2014/2015 showed that outcomes for patients with long term conditions were good. For example, the percentage of patients with diabetes, on the register, in whom the last blood pressure reading was 140/80 mmHg or less was comparable to other practices at 80% (local CCG average 80%, England average 78%).

• The practice nurses ran near-patient testing for monitoring of blood thinning medicines and performed complex wound care.

• Longer appointments and home visits were available when needed.

• Patients with complex long-term conditions were offered a personal care plan and were often referred for case management.

• The practice held weekly care planning meetings with a case-manager/community matron to optimise care and share information.

• 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.

Updated 24 January 2017

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

• 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.

• The system for follow up when a child had missed a hospital appointment was not always documented.

• 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.

• Nationally reported data from 2014/2015 showed the percentage of women aged 25-64 whose notes record that a cervical screening test had been performed in the preceding 5 years was higher than other practices at 93% (local CCG average 83%, England average 82%).

• Appointments were available outside of school hours and the premises were suitable for children and babies.

• We saw positive examples of joint working with midwives, health visitors and school nurses.

• There was a system for follow up when children had not attended hospital appointments, but this needed to be recorded in the patient record.

• The practice had a close working relationship with attached health visitors, midwives and school nurses.

• The practice operated a drop in sexual health clinic with the practice nurse.

Updated 24 January 2017

The practice is rated as good 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.

• Town Close, an extra care housing project, was closely supported by the practice’s Primary Care Nurse.

• The primary care nurse provided teaching to the care staff at the Town Close facility.

• The practice provided data evidence to demonstrate the reduction in emergency admissions, urgent appointments and out of hours care required by the residents of Town Close, since the support of the primary care nurse was provided.

• There was a close relationship between case managers and community matrons and the practice held weekly meetings to discuss patients on a personal care-plan.

• Prescribing for the elderly was reviewed by a clinical pharmacist.

• An audit of polypharmacy in the elderly had been undertaken.

Updated 24 January 2017

The practice is rated as good 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.

• Extended hours, one evening per week, allowed working age people to access appointments outside of standard working hours.

• Pre-employment medicals were offered, for example, as part of an application for a heavy goods vehicle licence.

• 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 population group.

• Students returning home from university in the holidays could access appointments as temporary residents or remain registered with the practice.

Updated 24 January 2017

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

• 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.

• Nationally reported data from 2014/2015 showed that 88% of patients diagnosed with dementia that had their care reviewed in a face to face meeting in the last 12 months, which is comparable to the local CCG average of 87% and the England average of 84%.

• Nationally reported data from 2016 showed that the percentage of patients with schizophrenia, bipolar affective disorder and other psychoses who had a comprehensive, agreed care plan documented in the record, in the preceding 12 months was 92% (local CCG average 93%, England average 88%)

• 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.

• A local consultant psychiatrist was invited to the practice several times a year to contribute towards the care the practice offered to vulnerable patients.

• The practice held regular multidisciplinary team clinical meetings to optimise care and inform the clinical team about mental health and dementia.

Updated 24 January 2017

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

• 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.

• It held regular multidisciplinary clinical team meetings to optimise care and inform the clinical team about vulnerabilities.

• The practice informed vulnerable patients about how to access various support groups and voluntary 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 normal working hours and out of hours.