Archived: Tang Hall Lane Surgery

Updated 13 September 2016

Tang Hall Lane Surgery provides Personal Medical Services to their practice population.They are also contracted to provide other enhanced services for example: services for violent patients and minor surgery.Tang Hall Lane Surgery is part of one large York practice (Priory Medical Group) who has nine locations. All patients can be seen at any of the locations; however, most attend one for continuity of their care.The total practice population is currently 55, 920. The practice population lives mainly in a less deprived area than average for England.

This is a teaching practice for medical students who are studying at Hull& York Medical School (HYMS).It is also a training practice for qualified doctors wishing to qualify as GPs.

At this location there are three GPs, the Practice Management is from a central location. There are Advanced Nurse Practitioners, Practice Nurses and Health Care Assistants (HCAs). They are supported by, secretaries, administration and reception teams.

Tang Hall Lane Surgery is open from 8.30am-6pm Monday- Friday. There is extended opening and Saturday morning appointments at other surgeries within the group. Priory Medical Centre have appointments available Monday to Thursday from 6.30pm until 8pm and on Saturday morning from 8.30am -11.15am by appointment. Also within the group, Heworth Green Surgery has extended hours Monday –Thursday from 6.30pm until 8pm by appointment.

The practice website and leaflet offers information for patients when the surgery is closed. They are directed to the Out of Hours Service provided by Northern Doctors Urgent Care.

We previously inspected Tang Hall Lane  Surgery on 3 February 2016. Following this inspection, the practice was given a rating of good. The practice was rated as requires improvement for providing safe care. This was because some non-clinical staff who undertook chaperone duties had not received a Disclosure and Barring Service check (DBS). (DBS checks identify whether a person has a criminal record or is on an official list of people barred from working in roles where they may have contact with children or adults who may be vulnerable).

A copy of the report detailing our findings can be found at

www.cqc.org.uk/

Updated 13 September 2016

Letter from the Chief Inspector of General Practice

We carried out a focused desktop inspection of Tang Hall Lane Surgery on 27 July 2016 to assess whether the practice had made the improvements in providing safe care and services.

We had previously carried out an announced comprehensive inspection at Tang Hall Lane Surgery on 3 February 2016 when we rated the practice as good overall. The practice was rated as requires improvement for providing safe care. This was because some non-clinical staff who undertook chaperone duties had not received a Disclosure and Barring Service check (DBS). (DBS checks identify whether a person has a criminal record or is on an official list of people barred from working in roles where they may have contact with children or adults who may be vulnerable). The chaperone policy was re-written to assert that only clinicians who held a current DBS check would perform chaperone duties. We asked the provider to monitor, that the changes made to their chaperone policy were sustainable and that staff who performed this role would be DBS checked.

The provider was also asked to improve the access for patients to named GP to improve continuity of care.

We asked the provider to send a report of the changes they have made. The practice was able to demonstrate that they were meeting the standards. In addition patient access to named GP had improved as reflected in the July 2016 patient survey. We were told that the provider continued to trial different ways of working to improve continuity of care for their patients. The practice is now rated as good for providing safe care. The overall rating remains good.

This report should be read in conjunction with the full inspection report dated 31 May 2016.

Our key finding across the area we inspected was as follows:

The practice had clearly defined and embedded systems, processes and practices in place to keep patients safe and safeguarded from abuse. Patients were not disadvantaged by the changes to the chaperone policy and this was to be closely monitored to assure sustainability.

Professor Steve Field (CBE FRCP FFPH FRCGP) 

Chief Inspector of General Practice

Updated 31 May 2016

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

• Clinical staff had lead roles in chronic disease management and patients at risk of hospital admission were identified as a priority.

• The practice provided ‘Patient Pods’ ( patients could measure their blood pressure in these pods) which helpedpatients with Long Term Conditions feel able to monitor their health and could feel able to self-manage their condition or work in partnership with their clinician.

• The practice worked hard at secondary prevention by screening for patients who were at risk of developing diabetes, by identifying those at risk. They were then invited into the practice to review their lifestyle and to become part of a self-managing group with other patients. Alternatively, there was one to one support available for those who were reluctant to access the group.

• Longer appointments and home visits were available when needed.

• All of 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 social care professionals to deliver a multidisciplinary package of care.

• The practice held weekly meetings with multi-disciplinary teams in the case management of patients who were in need of care and support.

Updated 31 May 2016

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.

• We saw evidence of structured templates to aid assessment of the ‘sick child’ with traffic light (RAG)rated guidance.

• 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.

• All very young patients in this age group were either seen or telephoned by a GP the same day if required.

• Appointments were available outside of school hours (between 4-5.30pm) and the premises were suitable for children and babies.

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

Updated 31 May 2016

The practice is rated as good for the care of older people.

• The practice offered proactive, personalised care to meet the needs of this population group.

• In addition the practice was responsive to the needs of older patients, and offered home visits and urgent appointments for those with enhanced needs.

• The practice held a register of patients who were at risk of unplanned emergency admission to hospital.

• YICTeam had positively influenced the health of the most vulnerable patients in this population group. There was more choice for care and support to be provided in their own homes and in addition ‘carer fatigue’ was proven to be reduced.

• YICTeam’s pro-active way of working helped to ensure everyone was informed in a timely way. Multi-agency working, which included agreed sharing of care documents across all agencies had meant vulnerable patients did not have to repeat the same information each time a new agency became involved. This had reduced anxiety in patients and their carers and we saw positive feedback about the differences this way of working had, had on individuals and families.

• There were weekly ward rounds provided to local residential and nursing homes which had helped to reduce avoidable hospital admissions and A&E attendances. In addition care and treatment plans were updated in a timely way.

Updated 31 May 2016

The practice is rated as good for the care of working-age patients (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 they 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 reflected the needs for this age group.

• The practice hosted various services with direct and targeted benefits to their patient population.

Updated 31 May 2016

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

• 84% of patients diagnosed with dementia had, had their care reviewed in a face to face meeting in the last 12 months, which was the same as the national average of 84%.

• The practice regularly worked with multi-disciplinary teams in the case management of people experiencing poor mental health, including those with dementia.

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

• All patients who did not attend (DNA) a mental health related appointment were contacted.

• 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.

• The practice had told patients experiencing poor mental health how to access various support groups and voluntary organisations, some of which were hosted within the practice.

• One GP partner worked with local forensic psychiatric services on assessments enabling closer liaison with hospital and community psychiatrists.

Updated 31 May 2016

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, travellers and other vulnerable patients.

• The practice informed vulnerable patients 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.

• The practice supported individuals allocated via the alternative medical scheme from the ‘violent patient list’ where other practices had removed a patient from their list. This helped to ensure vulnerable patients had access to the full range of GP services.

• The practice ensured appointment flexibility for the most vulnerable patients in this group. This helped to reduce their anxiety and helped to decrease non-attendance of appointments in this group.

• The practice provided support to their patients with drug addiction alongside ’Lifeline’ drugs support services. This included longer appointments with a named GP.

• A new pilot to introduce ‘Social Prescribing’ to support this group of patients was in its infancy . Its aim was to connect patients to non-medical sources of support to help improve their health and well-being.