Terrington Surgery

Updated 22 August 2016

Terrington Surgery, North Back Lane, Terrington YO60 6PS is located in the village of Terrington and occupies a converted house with consulting and treatment rooms all on the ground floor. There is a large car park available at the rear of the practice.

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 1097, covering patients of all ages. 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 proportion of the practice population in the 65 years and over age group is above the England average and the proportion below the age of 18 is below the 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 two GP partners and a salaried GP, all part time. There is one female and two male GPs. There is one nurse practitioner and one practice nurse, both female and both work part time. There is a practice manager, an assistant practice manager and a team of secretaries and receptionists/dispensers.

Terrington Surgery is open between 8.30am to 7pm on Monday, 8.30am to 1pm on Tuesday, 8.30am to 4pm on Wednesday, 8.30am to 12pm on Thursday and 8.30am to 6pm on Friday. Appointments are available from 9am to 11am Monday to Thursday and 3.30pm to 6.45pm on Monday and from 1.30pm to 3.30pm on a Wednesday and Friday.

When the practice is closed patients can call Helmsley Surgery until 6pm if they need to be seen or require advice. The practice, along with all other practices in the Vale of York 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.

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 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 final year medical students from the Hull York Medical School.

The practice is a member of the City and Vale Alliance (CAVA) Federation. General practices continue to be independent organisations serving their registered patients. Under a Federation those practices that join agree to work together in defined areas. For example, develop new approaches to enhance access to practices, by using technology/social media including ‘e- consultations’, creating networks of practices able to operate 7 days a week and examine opportunities to share back office functions to free up time for critical practice work.

Whilst preparing for the inspection we identified that the details for the regulated activities the provider was registered for were incorrect. All of the regulated activities undertaken at the practice were not registered with CQC as required by the CQC (Registration) Regulations 2009.

Updated 22 August 2016

Letter from the Chief Inspector of General Practice

We carried out an announced comprehensive inspection at Terrington Surgery, North Back Lane, Terrington YO60 6PS on 20 May 2016. 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:

• Complete an up to date infection control audit.

• Embed detailed record keeping systems and processes in order to assess, monitor, and improve the safe management of medicines.

Professor Steve Field (CBE FRCP FFPH FRCGP) 

Chief Inspector of General Practice

Updated 22 August 2016

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 2014/2015 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 98% compared to the local CCG of 90% and England average of 88%.

• 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 22 August 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 or who failed to attend hospital appointments.

• Data from 2014/2015 showed immunisation rates were relatively high for standard childhood immunisations. For example, rates for all immunisations given to children aged 12 and 24 months were 100%.

• 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 2014/2015 showed the practice’s uptake for the cervical screening programme was 86% compared to the local CCG average of 80% and the England average of 82%.

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

• A joint six week check-up was provided for new mums and their baby for them to see the GP and nurse and any required vaccinations were given.

• 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 22 August 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. 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 which were reviewed regularly.

• 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 2014/2015 showed that outcomes were good for conditions commonly found in older people. For example, performance for heart failure indicators was 100%; this was 0.3% above the local CCG average and 2.1% above the England average.

Updated 22 August 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 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.

• Late evening appointments were available with the GPs.

Updated 22 August 2016

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

• Nationally reported data from 2014/2015 showed 100% of people diagnosed with dementia had had their care reviewed in a face to face meeting in the preceding 12 months. This was compared to the local CCG average of 85% and England average of 84%.

• Nationally reported data from 2014/2015 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 100%. This was compared to the local CCG average of 92% and the England average of 88%.

• 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.

• 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 22 August 2016

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.

• Telephone interpretation services were available and information on the website could be translated into different languages.