Beech House Surgery

Updated 22 December 2017

Beech House Surgery is situated in Knaresborough serving the town and the surrounding villages. The practice dispenses medication to eligible patients and accounts for approximately 20% of registered patients. The practice is run by five partners, three male and two female.

The registered list size is 7,600 and predominantly of white British decent. The practice is ranked in the tenth least deprived decile nationally.

The practice is open between 8am and 6pm Monday to Friday. Appointments and home visits are available throughout the opening times. Extended hours appointments are offered Monday and Thursday evenings from 6.30pm to 7.15pm, and on Saturday mornings once a month between 7.15am and 12pm. Between 1pm and 2pm calls to the practice are handled by the out of hours service, but the practice remains open.

The previously awarded ratings were displayed in the surgery and on the website.

When the practice is closed, patients are directed to Primecare (the contracted out of hours provider) via the 111 service.

Updated 22 December 2017

Letter from the Chief Inspector of General Practice

We previously carried out an announced comprehensive inspection at Beech House Surgery on 25 April 2016. The overall rating for the practice was good. However, the practice was rated as requires improvement for providing safe services. The full comprehensive report on the April 2016 inspection can be found by selecting the ‘all reports’ link for Beech House Surgery on our website at www.cqc.org.uk.

This inspection was an announced focused inspection carried out on 25 October 2017 to confirm that the practice had carried out their plan to make the improvements that we identified in our previous inspection on 25 April 2016. This report covers our findings in relation to those requirements and also additional improvements made since our last inspection.

The practice is now rated as good for providing safe services; overall the practice rating remains good

Our key findings were as follows:

• The process for managing repeat prescriptions was embedded in the practice. All requests for repeat prescriptions were directed to the duty doctor before being sent to the dispensary or reception for collection. All repeat prescription requests were dealt with on the day and were monitored to ensure that none had been left unattended to at the end of the day.

• PGDs and PSDs were all signed and up to date. PGDs were reviewed on a three monthly basis to ensure all were in date and action was taken regarding any that were due to expire within the three month period.

• An identified nurse had now completed the specialist course on infection, prevention and control. There was a quarterly walkthrough audit undertaken and a comprehensive annual audit each February. Legionella risks were managed by the practice and training had been provided by an external provider.

• A new door lock with a key pad had been placed on the access door to the paper medical records ensuring security could be maintained.

• Music was now piped into the waiting area outside the nurses’ room reducing the risks of breach of confidentiality from conversations being overheard.

• The practice had a comprehensive training matrix identifying all training completed and due dates.

• There was an appraisal system that included assessing competencies and the HCAs were observed a minimum of three times a year by the nurse to ensure competencies were maintained.

• Clinical and non-clinical alerts were received into the practice via a surgery email address as well as the practice manager to ensure that in the absence of the practice manager alerts would be dealt with by a nominated person.

• GP letters were monitored bi-weekly to ensure that all letters had been dealt with by the GPs. Any GPs with unattended letters were alerted to this by the practice manager.

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.

• Nursing staff had lead roles in chronic disease management and patients at risk of hospital admission were identified as a priority.
• Data from QOF showed the management of patients with diabetes was comparable to other practices and the national average.
• Longer appointments and home visits were available when needed.
• All these patients had a a structured annual review to check their health and medicines needs were being met. For those patients with the most complex needs, the practice worked with relevant health and care professionals to deliver a multidisciplinary package of care.

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. Immunisation rates were relatively high for all standard childhood immunisations.
• 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.National Cancer Intelligence Network (NCIN) data published March 2015 showed females, 25-64, attending cervical screening within target period (3.5 or 5.5 year coverage) was high when compared to the CCG and national average. The practice achieved 81%, CCG was 78% and national average was 74%
• A weekly young persons drop in clinic was provided at the practice with a senior practice nurse.
• Childhood immunisation uptake was high. The practice performed higher than the CCG average.
• Appointments were available outside of school hours and the premises were suitable for children and babies.
• We saw positive examples of joint working across a wide range of disciples. For example, care homes, Community Mental Health Team, midwives, health visitors and school nurses.

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 the older people in its population.
• The practice was responsive to the needs of older people, and offered home visits and urgent appointments for those with enhanced needs.
• For those patients with the most complex needs, the practice worked with relevant health and care professionals to deliver a multidisciplinary package of care.
• 4% of the practice population had a proactive care plan, a high proportion of these were older people.

Updated 31 May 2016

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 reflects the needs for this age group.

Updated 31 May 2016

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

• Performance for mental health related indicators was comparable to other practices and equal or higher than the national average. 84% of patients diagnosed with dementia who had their care reviewed in a face to face meeting in the last 12 months, which was equal to the national average of 84%.The percentage of patients with schizophrenia, bipolar affective disorder and other psychoses who had comprehensive, agreed care plan documented in the record, in the preceding 12 months (01/04/2014 to 31/03/2015) was comparable to other practices and noted as higher than the national average, 97% compared to 88%
• The practice regularly worked with multi-disciplinary teams in the case management of patients experiencing poor mental health, including those with dementia. For example the lead GP attended a monthly joint visit to a local nursing home with a named member of the Community Mental Health Service.
• The practice actively encouraged patients with patients to consider advanced care planning.
• The practice had told patients experiencing poor mental health about how to access various support groups and voluntary organisations. For example they had hosted a dementia awareness evening organised by the PPG and Dementia/Forward and Carers Resource with the named GP lead for dementia in attendance. A further awareness event was booked at the practice organised by the PPG, MIND and Orb (creative arts and skills focused charity providing opportunities for vulnerable people in Harrogate, and Knaresborough).
• 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.

Updated 31 May 2016

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

• The practice held registers of  vulnerable patients. For example carers and patients with a learning disability.
• The practice offered longer appointments for patients with a learning disability and those assessed as needing them.
• The practice regularly worked with other health care professionals in the case management of vulnerable patients.
• The practice provided a weekly dedicated named senior GP and senior deputy GP for the care homes it provided a service to.
• Weekly visits with senior nurses were carried out at the nursing home the practice provided a service to.
• Monthly joint ward round with named member of Community Mental Health Services and telephone access to dedicated GP (when practicable, phone calls directly to GP’s desk).
• The practice had well established relationships with the care services it provided services to. For example the Practice Manager and dedicated GP met with the management of a home for people with mental and physical disabilities prior to patient registration to determine what was required. A further meeting also took place between the home management, Practice Manager and Lead GP to discuss patients attending with care plans for End of Life Care. The practice did not provide a regular weekly visit to this service as whilst the people there had complex health needs, the patients there were stable and supported by detailed multi-disciplinary care plans and a well versed team.
• The practice informed vulnerable patients about how to access various support groups and voluntary organisations. For example, the practice had hosted an information evening facilited by the PPG in conjunction with Carers Resource to raise awareness of the avenues of support and services available to carers.
• 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. In particular, the safeguarding lead had well established relationships with the three care homes the practice provided services to and regularly attended best interest and safeguarding meetings.
• The whole staff team had received training around capacity and consent provided by the Medical Protection Society.