Pickering Medical Practice

Updated 19 November 2015

The surgery is located in the town of Pickering. There are 10,536 patients on the practice list and the majority of patients are of white British background. The practice manager told us there were a higher proportion of patients over 65 on the practice list compared with other practices in the area.

The practice dispenses medications to their patients who live more than one mile from the local pharmacy. The practice is a teaching practice; there are seven GPs (3 male and 4 females). There is a Practice Manager, a nurse practitioner, six practice nurses and three healthcare assistants and a phlebotomist. There is a dispensary team leader and part-time dispensers. In addition there are a range of administrative personnel to support everyday activities. The main practice in Pickering is open 8am-6.30 pm on Monday-Friday. There are early morning appointments available from 7am on Wednesday and Thursday. There are late surgeries until 7.00pm on Wednesday and until 7.15pm on Monday & Thursday. At the branch surgery in Thornton le Dale, GP surgeries are held on Monday 4-5.30pm, Tuesday 9-11.30am and Friday 8.40-11am. Patients requiring a GP outside of normal working hours are advised to contact the GP out of hours service provided by Yorkshire Doctors Urgent Care (YDUC).

The practice has a General Medical Service (GMS) contract and also offers enhanced services for example: minor surgery, a Patient Participant Group (PPG), and patients with Learning Disabilities have their physical health pro-actively managed.

Updated 19 November 2015

Letter from the Chief Inspector of General Practice

We carried out an announced comprehensive inspection at Pickering Medical Practice on 30 September 2015. Overall the practice is rated as good.

Our key findings across all the areas we inspected were as follows:

• Staff understood and fulfilled their responsibilities to raise concerns, and to report incidents and near misses. Information about safety was recorded, monitored, appropriately reviewed and addressed.
• Risks to patients were assessed and well managed.
• Patients’ needs were assessed and care was planned and delivered following best practice guidance. Staff had received training appropriate to their roles and any further training needs had been identified and planned.
• 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.
• Patients said they found it easy to make an appointment with a named GP and that 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.

We saw areas of outstanding practice:

• The practice was working with Dementia Forward to facilitate support for patients and their carers. In addition they had developed a dementia study module for medical students, which had specific project work to improve local services.
• We saw good relationships had been developed with the local secondary school and a system was in place to assure confidentiality. The practice had recently opened a weekly sexual health hub in conjunction with the local GUMed ( Genito-Urinary Medicine) Service. There was a separate waiting area for teenagers to use when required.
• The 12 practice federation although in its infancy was already providing benefits for staff and patients. The federation had agreed that all practice roles would have a minimum requirement of training to improve consistency and to eventually help each other by sharing staff when required. They would know what was expected from them wherever they worked within these 12 practices.

Professor Steve Field (CBE FRCP FFPH FRCGP) 

Chief Inspector of General Practice

Updated 19 November 2015

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. To support uniformity of management decisions, consistency of approach and high quality record keeping for patients with LTCs practice protocols were in each consulting room. Longer appointments and home visits were available when needed. All of these patients had a named GP and a structured annual review to check that their health and medication 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 multidisciplinary packages of care.

Updated 19 November 2015

The practice is rated as good for the care of families, children and young patients. 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 patients who had a high number of A&E attendances. Immunisation rates were relatively high for all standard childhood immunisations. Patients told us that children and young adults were treated in an age-appropriate way and were recognised as individuals, and we saw evidence to confirm this. 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 and health visitors. In addition we saw good relationships had been developed with the local secondary school and a system was in place to assure confidentiality. The practice had recently opened a weekly sexual health hub in conjunction with the local GUMed (Genito-Urinary Medicine) Service. There was a separate waiting area for teenagers to use when required.

Updated 19 November 2015

The practice is rated as good for the care of older people. Nationally reported data showed that outcomes for these patients were good for conditions commonly found in older people. This patient group numbers were  39% of the practice population. This was significantly higher than the CCG average and the national average reported for GP practices. However, the practice offered proactive, personalised care to meet the needs of their older patients and they had a range of enhanced services, for example, in dementia and end of life care. All patients in this age group were made aware of their named GP; who co-ordinated their care and treatment. The practice was responsive to the needs of older patients especially in such a rural area, and offered home visits and rapid access appointments for those with enhanced needs. Care reviews were with their named GP and often in their own home. Each week there were multi-disciplinary meetings (with other health and social care professionals) to establish appropriate care packages to help prevent admission to hospital.

Updated 19 November 2015

The practice is rated as good for the care of working-age people (including those recently retired and students). The needs of their 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 and the GPs were happy to consult via email if preferred by patients. There was a full range of health promotion and screening that reflected the needs of this age group.

Updated 19 November 2015

The practice is rated as good for the care of people experiencing poor mental health (including people with dementia). Patients experiencing poor mental health had received an annual physical health check. The practice regularly worked with multi-disciplinary teams in the case management of people experiencing poor mental health, including those with dementia. They supported patients with dementia to consider advance care planning for their future, when appropriate. The practice was working with Dementia Forward to facilitate support for patients and their carers. In addition they had developed a dementia study module for medical students, which had specific project work to improve local services.

The practice had told patients experiencing poor mental health about the various support groups and voluntary organisations which were available. There was a system in place to follow up patients who had attended accident and emergency (A&E) when they may have been experiencing poor mental health. Staff had received training on how to care for people with mental health needs and dementia.

Updated 19 November 2015

The practice is rated as good for the care of patients whose circumstances may make them vulnerable. The practice held a register of patients living in vulnerable circumstances including those with a learning disability. They all had a named GP who provided continuity of care. They had carried out annual health checks for patients with a learning disability and all of them had received a follow-up, where necessary. Longer appointments were offered for all patients within this population group.

The practice regularly worked with multi-disciplinary teams in the case management of vulnerable patients. They were signposted to various support groups and voluntary organisations, when appropriate. 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.