St Hilda's Surgery

Updated 31 October 2017

St Hilda’s practice delivers primary care under a General Medical Services Contract between themselves and NHS England. As part of the NHS Scarborough and Ryedale Clinical Commissioning Group (CCG) they are responsible for a population of 5124. The practice covers an area of 250 square miles of the North Wolds. There is a branch surgery at Rillington. The practice locations are Sherburn Surgery, St Hilda’s Street Sherburn and Rillington Surgery, Rillington. We visited the main surgery at Sherburn and the dispensary at Rillington Surgery.

Services include access to four GPs (two male and two female) between Monday and Friday. The practice provides early morning appointments at Rillington surgery from 7.00am on Tuesday and 7.30am on Thursday mornings with access to both a GP, nurse and a phlebotomist. All patients registered with the practice can access these services. Appointments can be booked in advance for the doctor and nurse. Detailed information is available on the web site and practice brochure. Patients who require more time with the doctor or nurse are asked to book a double appointment to facilitate this. Patients can book appointments face to face, by the telephone or online.

The practice GPs do not provide an out-of-hours service and patients are signposted to the local out-of-hours service via 111 when the surgery is closed and at the weekends. In an emergency patients are advised to ring 999 or attend the nearest accident and emergency department.

The practice is a dispensing practice and is supported by a team of dispensers. This service is available at both practice locations. There is a free medicine delivery service available to registered patients on Tuesdays, Wednesdays and Thursdays. Prescriptions can also be collected at the practice locations.

Both practice locations have car parking facilities and access for the disabled.

Updated 31 October 2017

Letter from the Chief Inspector of General Practice

We carried out an announced comprehensive inspection at St Hilda’s Surgery on 20 September 2017. Overall the practice is rated as good.

We had previously inspected the practice in November 2014 and they required improvement in safe. At this inspection the practice was good in safe.

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 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 the requirements of the duty of candour. Examples we reviewed showed the practice complied with these requirements.

The areas where the provider should/must make improvement are:

Staff should routinely check stock balances of controlled drugs in accordance with the Standard Operating Procedures (SOP) to ensure the amounts held reflected what was recorded in the registers.

There should be a risk assessment in place for legionella (Legionella is a term for a particular bacterium which can contaminate water systems in buildings).

Professor Steve Field CBE FRCP FFPH FRCGPChief Inspector of General Practice

Updated 31 October 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.

• The percentage of patients with diabetes, on the register, in whom the last IFCC-HbA1c was 64 mmol/mol or less in the preceding 12 months, was 83%, which was comparable with the local average of 80% and the national average of 78%.

• 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.

• There were emergency processes for patients with long-term conditions who experienced a sudden deterioration in health.

• 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 31 October 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. The practice telephoned parents to remind them of their child's vaccinations and 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.

• The practice provided support for premature babies and their families following discharge from hospital.

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

• The practice worked with midwives, health visitors and school nurses to support this population group. For example, in the provision of ante-natal, post-natal and child health surveillance clinics. Health visitors and schoolnurses attended the clinical practice meetings on alternate months.

• The practice had emergency processes for acutely ill children and young people and for acute pregnancy complications.

Updated 31 October 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 identified at an early stage older patients who may need palliative care as they were approaching the end of life. It involved older patients in planning and making decisions about their care, including their end of life care.

• The practice followed up on older patients discharged from hospital and ensured that their care plans were updated to reflect any extra needs.

• Where older patients had complex needs, the practice shared summary care records with local care services.

• Older patients were provided with health promotional advice and support to help them to maintain their health and independence for as long as possible.

The practice provided a free delivery service for medications for all patients three times a week.

Updated 31 October 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, for example, extended opening hours.

• 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.

Updated 31 October 2017

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

• The practice carried out advance care planning for patients living with dementia.

• 93% of patients diagnosed with dementia who had their care reviewed in a face to face meeting in the last 12 months, which is higher than the national average of 83%.

• The practice specifically considered the physical health needs of patients with poor mental health and dementia.

• 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 31 October 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 those with a learning disability.

• A new advanced nurse practitioner was joining the practice and part of her role was to be developing the service further for those patients 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 regularly worked with other health care professionals in the case management of vulnerable patients.

• The practice had information available for vulnerable patients about how to access various support groups and voluntary organisations.

• 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.

• A current initiative being used in the practice was using a risk profile tool for those patients who were vulnerable. Patients were being assessed using that Edmonton Frailty score and had a dedicated contact to a Nurse Co-ordinator for times of crisis or advice and assistance when needed.