Dyneley House Surgery

Updated 6 September 2016

Dyneley House Surgery is based in the centre of Skipton and is part of the NHS Airedale, Wharfedale and Craven Clinical Commissioning Group (CCG). It provides a service to patients in the Skipton and surrounding areas and is located in an area of low deprivation. The building was constructed in 1982 and consists of consulting rooms, reception, two large waiting areas, disabled toilet and baby changing and breast feeding facilities. There is easy access into and throughout the building with automatic doors at the entrance of the building. There is a car park at the back of the practice. There is also the Dyneley Barn building adjacent to the car park which houses additional rooms used by the practice for health promotion and support sessions and by local community groups.

The practice has a patient list size of 11,803 with a higher than national average of patients who are aged between 50 to 85 years. The patient list is made up of approximately 87% White British, 3.8% South East Asian, 3.1% Polish

The practice was open Monday to Friday 8 am to 6:00pm. Appointments were from 08.00 am each day and the last at 6pm. Extended hours appointments were offered Wednesday 6:30pm to-8:30pm and Saturday 8am to-10 am.

When the practice is closed out-of-hours (OOH) services are provided by Local Care Direct, which can be accessed via the surgery telephone number or by calling the NHS 111 service.

There are seven female GPs and three male GPs (eight of whom are partners). There are also four female practice nurses and two female health care assistants. The practice is supported by the practice manager and a team of administration and reception staff.

The practice is also a GP training practice, providing support and guidance to trainee GPs.

General Medical Services (GMS) are provided under a contract with NHS England.

Updated 6 September 2016

Letter from the Chief Inspector of General Practice

We carried out an announced comprehensive inspection at Dyneley House Surgery on 28 June 2016. Overall the practice is rated as outstanding.

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 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 many areas of outstanding practice that impacted on all population groups including people with dementia, people with mental health problems, isolated people and young people.: The practice proactively worked in partnership with the local community and several organisations to support patients’ health and social care needs. For example;

• facilitating a variety of drop-in session for patients who had mental health issues and holding regular dementia and stroke support group sessions for patients and their carers

• educational and peer group support sessions for diabetes,multiple sclerosis and Parkinson’s disease.

• facilitating events and being involved in a ‘well-being’ café to engage and support patients who were socially isolated

• GPs gave health related talks at educational sessions in the local community

• provided a young person sexual health and self-care education event at the local college

• provided healthy eating information and advice sessions for young children and staff at the local primary school

• support of homeless and travelling people to access the health care facilities at the practice and being a collection point for Skipton food bank

• There was a proactive well planned approach to ‘self-care’ reaching out to patients of all ages offering focused self-help programmes and information sessions.

• The practice has a health promotion officer to support weight management, alcohol reduction and smoking cessation and could demonstrate this had a positive impact for patients using this service.

• The educational and self-care programmes were a contributory factor in a reduction in emergency hospital admissions for those patients who had a long term condition.The practice could evidence a reduction in hospital emergency admissions and at 17% per 100 patients were the lowest for the local CCG and compared to 21% nationally.

• The practice had also been awarded ‘highly commended’ in the 2015 national self-care awards, in recognition of the work they had undertaken in encouraging patients in the self-management of their condition. They were short-listed in the top five and were the only GP practice to receive the award.

• The practice worked proactively with the patient participation group (PPG), which had a good representation from their community, including patients aged 18 years and under. The PPG were active in the self-care management programme to improve outcomes for patients.

• The practice had invited NHS health checks in 97% of eligible patients, which was the highest figure achieved within all the Craven area practices.

Professor Steve Field (CBE FRCP FFPH FRCGP) 

Chief Inspector of General Practice

Updated 6 September 2016

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.

• Specialist clinics were provided in areas such as diabetes and asthma.

• 78% of patients diagnosed with asthma had received an asthma review in the last 12 months compared to 77% locally and 75% nationally.

• 92% of patients diagnosed with chronic obstructive pulmonary disease (COPD) had received a review in the last 12 months, compared to 90% both locally and nationally.

• Longer appointments and home visits were available when needed.

• Patients were provided with individual health coaching via the services of the health promotion officer.

• Support groups and education talks were provided by the practice for patients with diabetes, dementia, stroke and multiple sclerosis. These were open to and attended by people beyond the Dyneley House patient group.

• The practice had hosted a comprehensive programme of patient education events to support patients with; coeliac disease, Parkinson’s disease, arthritis and several areas of cancer support such as breast, prostate and lung cancer.

• Emergency admissions for people who had a long term condition (LTC) had reduced following the introduction of the education programme of patient support and educational events. LTC admission rates were 17% (per 100 people) the lowest in the local CCG and compared with the national average of 22%.

• 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 6 September 2016

The practice is rated as outstanding 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.

• 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.

• 74% of eligible patients had received breast screening in the last 36 months, compared to 70% both locally and 72% nationally.

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

• We saw evidence that regular meetings were held with midwives and health visitors.

• Safeguarding meetings were held at the practice and regular contact with community nursing staff, social services and mental health services were maintained.

• Teenage health sessions, ‘Wellbeing and Teen Health’ master classes, had been held at the local college to promote self-care and sexual health.

• The practice worked regularly with the local primary schools hosting visits to Dyneley House vegetable garden to help educate children in healthy food choices.

Updated 6 September 2016

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.

• Care plans were in place for those patients who were considered to have a high risk of an unplanned hospital admission.

• The practice works within the Gold Standard Framework to help meet the needs of patients who are at the end of their lives.

• In house bereavement counselling is provided at the practice.

• The practice worked in partnership with Horton Housing in providing the ‘Well Being Café’ for patients who may be socially isolated.

• The practice provided support to local nursing and care homes for those with a high need for medical care.

Updated 6 September 2016

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 services as well as a full range of health promotion and screening that reflects the needs for this age group.

• Extended hours services were in place to meet the needs of the working population and telephone consultations were offered to all patients as needed.

• The practice had invited NHS health checks in 97% of eligible aged 40-74 years and upwards , which was the highest in all the Craven practices.

Updated 6 September 2016

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

• 90% of patients diagnosed with dementia had received a face to face review of their care in the last 12 months, compared to 89% locally and 84% nationally. Advanced care planning was in place for these patients

• 91% of patients who had a severe mental health problem had received an annual review in the past 12 months and had a comprehensive, agreed care plan documented in their record. This was comparable to the local 93% and national average of 90%.

• The practice regularly worked with multi-disciplinary teams in the case management of patients experiencing poor mental health, including those with dementia. These patients were supported to access various support groups and organisations as needed.

• The practice had re designed the surgery to be more ‘dementia friendly’ and had won a national award recognising their ‘outstanding contribution to dementia support’. Staff had completed training in how to support patients with dementia.

• The Practice held regular support groups for patients with dementia and their carers.

• 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 or dementia.

• The practice employed two mental health counsellors who held regular sessions at the practice.

• Local Improving Access to Psychological Therapies programme ( IAPT) services are held at the practice for patients in the practice and other practices in the area.

Updated 6 September 2016

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 homeless people, travellers and those with a learning disability.

• Homeless patients were supported to use the facilities at the practice and health support was made available to them as required. The practice works in partnership with a local community group in supporting homeless individuals. The practice is also the local collection hub for the Skipton food bank.

• The practice offered longer appointments and regular health checks for patients with a learning disability.

• The practice regularly worked with other health care professionals in the case management of vulnerable patients.

• The practice informed vulnerable patients about how to access various support groups and voluntary organisations.

• The practice held regular GP led educational sessions to support patients who had a diagnosis of cancer. These events have included, breast, prostate, lung and bowel cancer.

• 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.