Eastgate Medical Group

Updated 1 March 2017

Eastgate Medical Group, 31b East Place, Knaresborough, North Yorkshire HG5 0AD is located in Knaresborough and serves the town of Knaresborough, part of Harrogate and surrounding villages. There is one branch surgery: The Health Centre, Knaresborough Road, Harrogate HG2 7LU. Both surgeries were visited during the inspection. There is a pay and display car park next to the Knaresborough surgery and a car park available including disabled parking at the Harrogate surgery. Both surgeries are in purpose built buildings with disabled access and consulting and treatment rooms on the ground floor.

The practice provides services under a General Medical Services (GMS) contract with the NHS North Yorkshire and Humber Area Team. The registered practice population is approximately 11768, covering patients of all ages.

The proportion of the practice population in the 65 years and over age groups is similar to the local CCG and England average. In the under 18 age group the proportion of the practice population is similar to the local CCG and England average. The practice scores nine on the deprivation measurement scale, the deprivation scale goes from one to ten, with one being the most deprived. People living in more deprived areas tend to have a greater need for health services.

The practice has six GP partners and two salaried GPs, three full time and five part time. There are five female and three male GPs. There are two GP registrars, one full time and one part time, one male and one female. There are four practice nurses and one health care assistant, all part time and all female. There is a practice manager, a practice pharmacist and a team of administrators, secretaries and receptionists.

The Eastgate Surgery and the Health Centre are open between 8am and 6pm Monday to Friday. GP appointments at both surgeries are available from 8.10am to 11am and 3pm to 5.30pm.

Extended opening hours are available with GPs and practice nurses at Eastgate Surgery from 6.30am on Fridays and appointments can be booked between 6.50am and 7.50am. Pre-bookable appointments are also available with the practice nurse on Tuesdays from 7.30am at Eastgate Surgery. The Health Centre, Harrogate is open one Saturday a month between 8am and 10am for pre-bookable GP and practice nurse appointments.

Information about the opening times is available on the website and in the patient information leaflet.

The practice, along with all other practices in the NHS Harrogate and Rural District CCG area have a contractual agreement for the Out of Hours provider to provide OOHs services from 6.00pm. This has been agreed with the NHS England area team.

The practice has opted out of providing out of hours services (OOHs) for their patients. When the practice is closed patients use the NHS 111 service to contact the OOHs provider. Information for patients requiring urgent medical attention out of hours is available in the waiting area, in the practice information leaflet and on the practice website.

The practice is a training practice for GP Registrars; doctors who are training to become GPs.

Updated 1 March 2017

Letter from the Chief Inspector of General Practice

We carried out an announced comprehensive inspection at Eastgate Medical Group on 30 November 2016. We visited the main Eastgate surgery in Knaresborough and The Health Centre branch site in Harrogate during the inspection. 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 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 were able to get same day appointments and pre bookable appointments were available.
• 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.

However there were areas of practice where the provider needs to make improvements.

Importantly the provider should:

• Monitor the process for medication reviews.

• Raise awareness of the chaperone process available to patients.

• Review the management of blank prescription forms at both sites.

• Monitor that fire drills are carried out at both practice sites.

• Monitor that all staff are up to date with mandatory training, including refresher training.

• Monitor the process for seeking consent for minor surgery procedures.

Professor Steve Field (CBE FRCP FFPH FRCGP) 

Chief Inspector of General Practice

Updated 1 March 2017

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

• 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 2015/2016 showed that outcomes for patients with long term conditions were good. For example, the percentage of patients with diabetes, on the register, whose last measured total cholesterol (measured within the preceding 12 months) was 5mmol/l or less was 84%, compared to the local CCG average of 81% and England average of 80%.

• Longer appointments and home visits were available when needed.

• Patients with LTCs had a named GP and a structured annual review to check that their health and medicines needs were being met. For those people with the most complex needs, the named GPs worked with relevant health and care professionals to deliver a multidisciplinary package of care.

Updated 1 March 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 or who failed to attend hospital appointments.

• Immunisation rates for 2015/2016 were comparable to or above the local CCG and England average for all standard childhood immunisations. For example, immunisations given to children aged 12 months, 24 months and five years in the practice ranged from 89% to 100% compared to 91% to 96% for the local CCG area and 73% to 95% for England.

• 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 2015/2016 showed the practice’s uptake for the cervical screening programme was 80%, compared to the local CCG average of 83% and the England average of 81%.

• Joint appointments were available so new mothers and babies could have their eight week check and immunisations together.

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

• We saw good examples of joint working with midwives, health visitors and school nurses. The practice monitored any non-attendance of babies and children at vaccination clinics and worked with the health visiting service to follow up any concerns.

Updated 1 March 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. Patients over the age of 75 had a named GP.

• The practice had assessed the older patients most at risk of unplanned admissions and had developed care plans.

• They were responsive to the needs of older people, and offered home visits and urgent appointments for those with enhanced needs.

• There was a lead GP for care homes and they visited the homes once a week to deal with any issues. All care home patients had an unplanned admissions care plan.
• Nationally reported data for 2015/2016 showed that outcomes were good for conditions commonly found in older people. For example, performance for heart failure indicators was 100%, compared to the local CCG average of 100% and England average of 98%.

Updated 1 March 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.

• 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.

• Telephone consultations were available every day with a call back appointment arranged at a time to suit the patient.

• Extended opening hours were available with GPs and practice nurses at Eastgate Surgery on Tuesdays and Fridays and on Saturday mornings once a month at the Health Centre.

• Family planning clinics, minor surgery and joint injections were provided at the practice so patients did not have to attend hospital to access these services.

Updated 1 March 2017

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

• Nationally reported data from 2015/2016 showed 78% of people diagnosed with dementia had had their care reviewed in a face to face meeting in the preceding 12 months, compared to the local CCG average of 85% and England 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 advanced care planning for patients with dementia.

• Staff had attended a dementia awareness session to increase their understanding of what it is like to live with dementia and turn that understanding into action.

• Nationally reported data from 2015/2016 showed the percentage of patients with schizophrenia, bipolar affective disorder and other psychoses who had a comprehensive care plan documented in their record in the preceding 12 months was 94%, compared to the local CCG average of 92% and the England average of 89%.

• 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.

• The practice had held a ‘Stress Free’ evening in May 2016 and engaged with Orb Arts (a social prescribing project) to support patients living with mental health problems.

Updated 1 March 2017

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

• The practice held registers of patients living in vulnerable circumstances which included those with a learning disability.

• The practice offered longer appointments for people with a learning disability.

• Nursing staff used easy read leaflets to assist patients with learning disabilities to understand their treatment.

• The practice regularly worked with multi-disciplinary teams in the case management of vulnerable people.

• The practice told 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.

• The practice had volunteered to support a refugee family and had engaged with the refugee council to ensure transition from the refugee camp to the local area had been smooth. The family had an allocated GP and interpreters from Leeds Council or the language line were used. Through the interpreters the family had said how the practice had made them feel welcome, comfortable and confident accessing the surgery.

• Telephone interpretation services were available and information leaflets in different languages were provided when required.

• The practice hosted drugs and alcohol misuse clinics.