Ayton and Snainton Medical Practice

Updated 24 January 2017

Dr Bartlett and Partners, West Ayton Surgery, 53 Pickering Road, West Ayton, Scarborough North Yorkshire YO13 9JF is located in the village of West Ayton. There is car parking available at the practice. The practice is in a converted house which also has purpose built extensions to the ground and first floors. There are three branch sites:

Snainton Surgery, Station Road, Snainton Scarborough YO13 9AP located in the village of Snainton, approximately four miles from West Ayton.

Seamer Surgery, 8a Denison Avenue, Seamer YO12 4QU located in the village of Seamer, approximately three miles from West Ayton.

Thornton-Le-Dale Surgery, Roxby Road, Thornton-Le-Dale, Pickering YO18 7TJ located in the village of Thornton-Le-Dale, approximately ten miles from West Ayton.

There is disabled access and consulting and treatment rooms are available on the ground floor at all four surgeries. The Snainton and Seamer surgeries were also visited during the inspection.

The practice provides services under a General Medical Services (GMS) contract with the NHS North Yorkshire and Humber Area Team to the practice population of 8100, covering patients of all ages. The practice covers a large rural area including 20 villages and approximately 200 to 250 square miles. The practice is a ‘dispensing practice’ and is able to dispense medicines for patients who live more than one mile from the nearest pharmacy. The practice dispenses medicines for approximately 60% of its patients from their surgeries in West Ayton and Snainton.

The proportion of the practice population in the 65 years and over age group is higher than the local CCG and England average. The proportion of the practice population in the under 18 age group is lower than the local CCG and England average. The practice scored eight 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 eight GP partners, all part time. There are five female and three male GPs. There is one nurse practitioner/lead nurse, four practice nurses, two health care assistants and a phlebotomist. All work part time and all are female. There is a practice manager, an assistant practice manager and a team of administrators, secretaries and receptionists. There is a clinical pharmacist and five dispensers.

The West Ayton and Snainton Surgeries are open between 8am and 6.30pm Monday to Friday, and on a Saturday from 8.30am to 9.30am for booked appointments and 9.30am to 10.30am for an emergency surgery. GP appointments at West Ayton surgery are available from 8.15am to 10.40am and 2.30pm to 6pm on Monday, 8.15am to 11am and 3pm to 6pm on Tuesday, 8.15am to 10.30am and 3pm to 6pm on Wednesday, 8.30am to 11.15am and 3.30pm to 6pm on Thursday and 8.15am to 11am and 3pm to 6pm on Friday.

GP appointments at Snainton surgery are available from 8.30am to 10.30am on Monday, Tuesday and Thursday, 8.30am to 9.30am on Wednesday and 8.30 to 10am on Friday. Afternoon GP appointments are available from 3pm to 6pm Monday to Friday.

GP Appointments at Seamer surgery are available 10.30am to 11.30am Monday to Friday and at Thornton le Dale surgery 9am to 11am on Monday and 11am to 12pm Tuesday, Wednesday and Friday.

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

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 teaching practice for medical students from the Hull York Medical School. The practice is also a training practice for GP registrars and student nurses.

Updated 24 January 2017

Letter from the Chief Inspector of General Practice

We carried out an announced comprehensive inspection at Dr Bartlett and Partners on the 8 September 2016. We visited the main surgery in West Ayton and the branch surgeries at Snainton and Seamer 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.

We saw an area of outstanding practice:

• The PPG had supported the practice to run two successful ‘Health Information Days’ in one in 2015 which 70 people attended and one in July 2016 which 200 people attended. There were various local statutory and voluntary organisations represented on the day for example; Dementia Friends, the Carers Resource Centre, a local housing provider and the local library. Practice staff also provided opportunistic health checks such as blood pressure and diabetes for people attending the event. A PPG member was available to talk to patients about joining the PPG. The PPG was working with the practice on their next event, ‘Keep Well for Winter’ which was going to be held in November 2016.

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

Importantly the provider should:

• Develop a documented cleaning programme for carpets and privacy curtains in all four surgeries.

• Implement processes so that all Standing Operating Procedures (SOPs) include all aspects of the dispensing process and new SOPs have been read and signed by staff.

• Put systems in place to monitor blank prescriptions in line with national guidance.

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

• Monitor minor surgery outcomes including the process for obtaining consent.

Professor Steve Field (CBE FRCP FFPH FRCGP) 

Chief Inspector of General Practice

Updated 24 January 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 on the diabetes register, with a record of a foot examination and risk classification within the preceding 12 months was 93%. This was comparable to the local CCG average of 91% and England average of 89%.

• 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 patients with the most complex needs, the named GPs worked with relevant health and care professionals to deliver a multidisciplinary package of care.

• Practice nurses visited patients at home to do long term conditions reviews and administer flu vaccinations during the flu season.

Updated 24 January 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 were comparable to the local CCG and England national average for all standard childhood immunisations. For example, data from 2015/2016 showed rates for immunisations given to children aged 12 months, 24 months and five years in the practice ranged from 90% to 99% compared to 89% to 97% for the local CCG and 73% to 95% for the England national average.

• Children and young people were treated in an age-appropriate way and were recognised as individuals.

• A child and adolescent mental health service worker provided a clinic in the surgery which the GPs could refer into.

• Nationally reported data from 2015/2016 showed the practice’s uptake for the cervical screening programme was 83%. This was comparable to the local CCG average of 85% and the England average of 81%.

• The practice offered a range of sexual health services where patients could get advice and treatment, for example contraception and sexually transmitted diseases.

• 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 health visitors were based in the West Ayton surgery and had regular contact with the GPs and nurses to discuss any patients who were identified as at risk. 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 24 January 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 invited older patients who were well and were not seen regularly by the GP for an annual ‘Elderly Health’ check. In the past 12 months 78 patients over the age of 75 had been invited for an elderly health check.

• The nurse practitioner developed care plans for patients aged over 75. They gave patients a pack which included their care plan, the practice leaflet, the ‘feeling off colour’ CCG leaflet and the Age UK leaflet covering keeping warm and exercise. They also included information about how to contact local services and details of the practice Patient Participation Group healthy living days, which were held each year.

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

• There was a named GP for individual care homes and they did weekly ‘ward rounds’ in conjunction with the care home staff and the district nurses.

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

• Nationally reported data for 2015/2016 showed that outcomes were good for conditions commonly found in older people. For example, the percentage of patients with atrial fibrillation (a heart condition) with a record of a CHA2DS2-VASc score of 2 or more, who were currently treated with anticoagulation therapy (a blood thinning medicine) was 90%; compared to the local CCG average of 90% and the England average of 87%.

Updated 24 January 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.

• 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.
• The practice offered a range of sexual health services where patients could get advice and treatment.

• 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, for example during their lunch break.

• Appointments were available until 6.30pm Monday to Friday and on Saturday mornings at the west Ayton and Snainton surgeries.

Updated 24 January 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. This was below the local CCG and England average of 84%.

• The practice carried out advanced care planning for patients with dementia. Staff had completed Dementia Friends training.

• 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 84%. This was below the local CCG average of 92% and the England average of 89%.

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

• 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.

Updated 24 January 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. Learning disability health checks were undertaken annually and staff had completed specialised training in this area. At the time of the inspection 32 patients were on the register. In the past year 78% of these had received a formal health check at the practice, or appropriate care and screening through regular attendance at the practice, care from the hospital or the learning disabilities service.

• Nursing staff used easy read leaflets to assist patients with learning disabilities to understand their treatment. The nurses used appropriate printed resources to help explain and support access to cervical smears for female patients. They worked with patients over a few appointments at a pace driven by the patient until they felt comfortable enough to have the smear test taken.

• 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.

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