This practice is rated as Good overall. (Previous inspection 07 2016 – Good)
The key questions are rated as:
Are services safe? – Requires Improvement
Are services effective? – Good
Are services caring? – Good
Are services responsive? – Good
Are services well-led? - Good
We carried out an announced comprehensive inspection at Priory Medical Centre on 1 May 20178 as part of our inspection programme.
At this inspection we found:
- The practice had systems to manage risk so that safety incidents were less likely to happen. However we found that learning from incidents and complaints could be improved.
- The practice routinely reviewed the effectiveness and appropriateness of the care it provided. It ensured that care and treatment was delivered according to evidence- based guidelines.
- Staff involved and treated patients with compassion, kindness, dignity and respect.
- Patients found the appointment system difficult to use in particular their ability to get through to the practice by telephone. Patients reported that they were able to access urgent care when they needed it, but that it was difficult to book a routine appointment.
- There was a strong focus on continuous learning and improvement at all levels of the organisation.
- The practice had considered succession planning and the issues that the local area faced. They had a broad range and skill mix of staff.
- The practice were responding to an increase in patient demand and a reduction in the number of GPs by re-shaping services with a multi-disciplinary team.
- Priory Medical Centre was part of a Group known as Priory Medical Group (PMG). PMG were part of a federation that provided care to 130,000 patients and were committed to working at scale with other providers to meet the needs of the population of York. The practice followed the Primary care home model which was developed by the National Association of Primary Care (NAPC), the model brought together a range of health and social care professionals to work together to provide enhanced personalised and preventative care for their local community.
We saw areas of outstanding practice:
The practice had developed a wound care protocol in collaboration with the Clinical Commissioning Group. This had been shared across the locality and had resulted in an improved service to patients and a reduced prescribing cost to the NHS.
PMG employ a range of health care professionals (for example: registered nurses, care workers, physiotherapist and occupational therapists) to work as York Integrated Care Team (YICT). They also work with Social services and voluntary organisations. Their innovative and person centred approach, contacting patients who may be in need of support, assured appropriate support such as short term care and regular reviews. The team reviewed all hospital admissions and discharges each day for patients in the federation practices and another rural practice. They worked with patients to review reasons for admissions and to plan care and support to minimise the risk of readmission. They also reviewed discharges to ensure that the patient had the care and support they needed to enable them to remain independent for longer. We saw evidence that each month 13 – 28 patients avoided admittance to hospital with this support.
The nursing team were innovative and forward thinking. They had won and been nominated for several awards following improvements to the quality of care for patients in wound care and early identification of pre-diabetes. The awards included General Practice Nursing Team of the Year wound care team finalists 2017, General Practice Nursing Team of the Year dermatology team finalists 2017, and General Practice Nursing awards 2018 People’s Choice award finalist. The Nurse Manager had received an invitation to Buckingham Palace in March 2018 in recognition of services for engagement in front line nursing.
The areas where the provider should make improvements are:
Review and improve the system in place and assure themselves there is oversight for checking emergency medicines and equipment.
Implement an action plan to ensure that issues identified during infection control audit are dealt with within an agreed timescale.
Develop a culture of significant event identification, analysis and dissemination of learning to all staff.
Improve the process for analysis and dissemination of learning to all staff from complaints.
Identify and increase the number of patients on the palliative care register to include all patients who have a life-limiting illness.
To improve patient access to routine appointments and named clinicians to improve continuity of care and choice for patients.
Review the higher than average Quality and Outcomes Framework exception reporting figures to assure themselves that these are accurately exception reported.