Tadcaster Medical Centre Scheduled Report ... · Tadcaster LS248HD Tel:01937530082 Website: Dateofinspectionvisit:2June2015 Dateofpublication:23/07/2015 1 Tadcaster Medical Centre

This report describes our judgement of the quality of care at this service. It is based on a combination of what we foundwhen we inspected, information from our ongoing monitoring of data about services and information given to us fromthe provider, patients, the public and other organisations.

Ratings

Overall rating for this service Good –––

Are services safe? Good –––

Are services effective? Good –––

Are services caring? Good –––

Are services responsive to people’s needs? Good –––

Are services well-led? Good –––

TTadcadcastasterer MedicMedicalal CentrCentreeQuality Report

Crab GarthTadcasterLS24 8HDTel: 01937 530082Website: www.tadcastermedicalcentre.co.uk

Date of inspection visit: 2 June 2015Date of publication: 23/07/2015

1 Tadcaster Medical Centre Quality Report 23/07/2015

Contents

PageSummary of this inspectionOverall summary 2

The five questions we ask and what we found 4

The six population groups and what we found 6

What people who use the service say 9

Outstanding practice 9

Detailed findings from this inspectionOur inspection team 10

Background to Tadcaster Medical Centre 10

Why we carried out this inspection 10

How we carried out this inspection 10

Detailed findings 12

Overall summaryLetter from the Chief Inspector of GeneralPracticeWe carried out an inspection of Tadcaster Medical Centreon 2 June 2015, as part of our comprehensive programmeof inspection of primary medical services. The inspectionteam found after analysing all of the evidence that thepractice was safe, effective, caring, responsive and wellled. It was rated as good for all of the population groups.

Our key findings were as follow:

• The practice is safe. Staff understood and fulfilled theirresponsibilities to raise concerns, and to reportincidents and near misses. Information about safetywas recorded, monitored, appropriately reviewed andaddressed.

• The practice is effective. Patients received careaccording to professional best practice clinicalguidelines. The practice had regular informationupdates, which informed staff about new guidance toensure they were up to date with best practice.According to the data from Quality and Outcomes

Framework (QOF), an annual reward and incentiveprogramme showing GP practice achievement results,outcomes for patients registered with this practicewere above average.

• The practice is caring. Patients reported the positiveview they had of the doctors and staff at the surgery.Practice staff knew their patients well. We receivedmany examples of how their GPs acted ‘over andabove’ their expectations from them; these includedcontacting patients over the weekend and homevisiting after accidental deaths. The practice ensuredpatients received accessible, individual care, whilstrespecting their needs and wishes. The QOF indicatorsshowed that patients felt listened to and involved indecisions about their care and this was similar to otherpractices in the area.

• The practice is responsive. The appointment systemwas guided by internal audit and evaluation of theneeds and views of the patients. Urgent needs wereaddressed on the day and the patients in general wereable to see the GP of their choice. Although someexpressed concern about not being able to see the GP

Summary of findings


of their choice at a time convenient for them. Theservice had positive working relationships betweenstaff and other healthcare professionals involved in thedelivery of service.

• The practice is well led. The management teamreflected upon the services they provided and activelyexplored ways of improving health and care outcomes.Quality and performance was monitored and riskswere identified and managed.

We saw several areas of outstanding practice including:

• The practice as part of SHIELD (The Selby AreaFederation of GP Practices) had won an innovationfund, to develop social prescribing. This fund was usedinitially to support the local voluntary service toproduce an up to date data base of available voluntarysocial care organisations. Patients were then referredto the most appropriate services.

• The practice was pro-active and reactive to managingpatient access, their needs and expectations. Allpatients who wanted a same day appointment werecalled back and only triaged by the GP. Over 75 years ofage patients always had a same day appointment ifneeded.

• The practice used the term Query–Doc for the GP whohad a shortened morning surgery to ensure allcorrespondence was read and dealt with on the day.This assured any changing or emerging health needsof patients were responded to effectively andefficiently.

Professor Steve Field (CBE FRCP FFPH FRCGP)Chief Inspector of General Practice

Summary of findings


The five questions we ask and what we foundWe always ask the following five questions of services.

Are services safe?The practice is rated as good for providing safe services. There was agenuine open culture in which all safety concerns raised by staff andpatients who used the service were highly valued, as integral tolearning and improvement. Staff understood and fulfilled theirresponsibilities to raise concerns and report incidents and nearmisses. The practice used every opportunity to learn from internaland external incidents, to support improvement. Risk managementwas comprehensive, well embedded and recognised as theresponsibility of all staff. The practice was well staffed and thisensured that patients were safe when receiving care.

Good –––

Are services effective?The practice is rated as good for effective services. Our findings atinspection showed systems were in place to ensure that allclinicians were up to date with both National Institute for Health andCare Excellence (NICE) guidelines and other locally agreedguidelines. We saw evidence to confirm these guidelines werepositively influencing and improving practice and outcomes forpatients. The practice was using innovative and proactive methodsto improve patient outcomes and linked with other local providersto share best practice. We saw collaborative working withmulti-disciplinary teams to reduce unplanned admissions tosecondary care (hospitals). This pro-active approach hadsignificantly reduced admissions and improved patient healthoutcomes.

Good –––

Are services caring?The practice is rated as good for providing caring services. Datashowed patients rated the practice higher than others for almost allaspects of care. Feedback from patients about their care andtreatment was consistently and strongly positive about thecompassionate and sensitive care they received. We observed apatient-centred culture. Staff were motivated and inspired to offerkind and compassionate care and worked to overcome obstacles toachieving this. We found positive examples to demonstrate howpatient’s choices and preferences were valued and acted on. Viewsof external stakeholders were positive and aligned with our findings.

Good –––

Are services responsive to people’s needs?The practice is rated as good for providing responsive services. Theyacted on suggestions for improvements and changed the way theydelivered services in response to feedback from the patientparticipation group (PPG). The practice reviewed the needs of its

Good –––

Summary of findings


local population and engaged with the NHS Area Team and ClinicalCommissioning Group (CCG) to secure service improvements wherethese had been identified. Patients were able to access a wide rangeof services at the practice, which enabled patients to be treatednearer to their home.

Some patients told us it was not always easy to get an appointmentwith a named GP or a GP of their choice. However we were told ofpositive actions taken to improve appointment availability, thedetail is within the report. Urgent appointments were available thesame day and we were told patients were not turned away. Thepractice had good facilities and was well equipped to treat patientsand meet their needs. Information about how to complain wasavailable, however not displayed in the waiting rooms. Evidence wesaw showed the practice responded quickly when issues wereraised. Learning from complaints was shared with staff and otherstakeholders where appropriate.

Are services well-led?The practice is rated as good for being well-led. There was a clearleadership structure and staff felt supported by management. Thepractice had a vision with quality and safety as its top priority.However very few staff could detail this to us. Governance andperformance management arrangements had been proactivelyreviewed and took account of current models of best practice. Thepractice carried out proactive succession planning. There was a levelof constructive engagement with staff. Staff had received inductions,regular performance reviews and attended staff meetings andevents.

We found a high level of staff satisfaction. The practice gatheredfeedback from patients in a variety of formats and they had a veryactive patient participation group (PPG). We saw evidence ofchanges which were made as a result of patient feedback, whichincluded having a duty doctor working each day to triage patientswho wanted to be seen the same day.

Good –––

Summary of findings


The six population groups and what we foundWe always inspect the quality of care for these six population groups.

Older peopleThe practice is rated as good for the care of older patients. Thepractice offered proactive, personalised care to meet their needs.Nationally reported Quality Outcomes Framework (QOF) datashowed the practice had good outcomes for conditions commonlyfound in this age group. The practice was responsive to their needs,understanding the impact of the rural environment for theirpatients. They provided annual health checks for elderly patientsand where suitable home visits. In addition they provided weeklyvisits and annual health checks for patients living in the local carehomes. They followed up those patients who had been dischargedfrom hospital.

Good –––

People with long term conditionsThe practice is rated as good for the care of patients with long-termconditions. Each patient had a personalised care plan includingagreed goals to support patients with self-care and healthimprovement. There were emergency processes in place andreferrals were made for patients whose health deterioratedsuddenly. Longer appointments and home visits were availablewhen needed. These patients had a named GP and a structuredannual review to check their health and medication needs werebeing met. For those people with the most complex needs, thenamed GP worked with relevant health and care professionals todeliver a multidisciplinary package of care. The nationally reportedQuality Outcomes Framework (QOF) showed 100% achievements inall but one of these conditions.

Good –––

Families, children and young peopleThe practice is rated as good for the care of families, children andyoung patients. There were systems in place to identify and followup children living in disadvantaged circumstances and who were atrisk, for example, children and young people who had a highnumber of A&E attendances. Immunisation rates were high for allstandard childhood immunisations. Patients told us that childrenand young people were treated in an age-appropriate way and wererecognised as individuals, and we saw evidence to confirm this.Appointments were available outside of school hours and thepremises were suitable for children and babies. Joint appointmentswere given to all post-natal mothers and their babies for theirappropriate health checks. We saw good examples of joint workingwith midwives, health visitors and school nurses. Emergencyprocesses were in place and referrals were made for children and

Good –––

Summary of findings


pregnant women whose health deteriorated suddenly. The practiceprovided contraceptive and sexual health support at specificwomen’s health clinics. There were named GPs who ensuredcontinuity of treatment and care to these patients.

Working age people (including those recently retired andstudents)The practice is rated as good for the care of working-age patients(including those recently retired and students). The needs of thesepatients had been identified and the practice had adjusted theservices it offered to ensure they were accessible, flexible andoffered continuity of care. They were able to access timelyappointments to meet their specific needs. Every Saturday morningthere were pre-bookable GP appointments available for this patientgroup. The practice was proactive in offering online appointmentbooking and repeat prescription requests. There was a full range ofhealth promotion leaflets and health screening which met the needsfor this age group. This included NHS health checks for identifiedgroups.

Good –––

People whose circumstances may make them vulnerableThe practice is rated as good for the population group of patientswhose circumstances may result in them being vulnerable. We weretold these patients were never turned away. Links had been madewith local health and social care teams and joint monthly patientreview meetings took place to discuss the most vulnerable patients.The practice held a register of patients with learning disabilities andoffered them annual health checks and longer appointment times.Staff knew how to recognise signs of abuse in vulnerable adults andchildren. They were aware of their responsibilities regardinginformation sharing, documentation of safeguarding concerns andhow to contact relevant agencies.

Good –––

People experiencing poor mental health (including peoplewith dementia)The practice is rated as good for patients who experience poormental health (including patients with dementia). Practice staff wereaware of their patients with poor mental health and offered supportto meet their needs. All patients experiencing poor mental healthreceived an annual physical health check. The practice worked withmulti-disciplinary teams in the case management of patientsexperiencing poor mental health. However the specialised servicewho provided further support for these patients did not meet theirneeds in a timely way.

Good –––

Summary of findings


The practice had signed up for specialist training in dementia. Allstaff were to attend this training in July 2015, when the practicewould be closed. This would help to assure all practice staff wereable to provide the most up to date care and support for this patientgroup.

Arrangements were in place for dispensing staff to flag up anyconcerns regarding over or under ordering of medicines and staffworked to a Standard Operating Procedure for patients on certainmedicines. The practice had told patients experiencing poor mentalhealth how to access various support groups and voluntaryorganisations.

Summary of findings


What people who use the service sayWe received 24 CQC patient comments cards where wefound very positive comments about the practice and thestaff. We saw comments about the excellent care patientsand their families had received from members of theclinical team. Three patients described their excellentcare and treatment in emergency situations. All patientsdescribed being involved in all aspects of their care andhow the GPs and nurses explained everything to them.Some of the comments were from people who had beenpatients for over 30 years.

The friends and family test report showed the patientswho had completed the forms were more than happywith the care and treatment they received from the rangeof practice staff.

We spoke with 11 patients, from different populationgroups, including one member of the PatientParticipation Group. They told us the staff were veryhelpful, respectful and supportive of their needs. They felteveryone communicated well with them; they wereinvolved and felt supported in decisions about their care.They felt the clinical staff responded to their treatmentneeds and they were provided with a caring service.However all commented about the lack of availableappointments at times and with a preferred doctor.

The National GP Patient Survey results (an independentsurvey run by Ipsos MORI on behalf of NHS England)published on 8 January 2015 showed the practice scoredhighly against national averages. There were 257 surveyforms distributed for Tadcaster Medical Centre and 122forms were returned. This was a response rate of 47.5% ofthe forms distributed. Statistically this number equates to1.5 % of the total practice population.

Some of the most recent patient survey results showed:

• 98.4% of respondents to the GP patient survey hadconfidence and trust in the last GP they saw or spoketo; compared to the local CCG average of 94.1% and92.2% the national average.

• 92.3% of respondents to the GP patient survey whodescribed the last GP they saw or spoke to was good atgiving them enough time. Compared to the local CCGaverage of 87.2% and 85.3% the national average.

• 88.5% of respondents to the GP patient survey hadconfidence and trust in the last nurse they saw orspoke to; compared to the local CCG average of 87.8%and 85.5% the national average.

• 45.2% of respondents to the GP patient survey with apreferred GP usually get to see or speak to that GP.Compared to the local CCG average of 50.2% and53.5% the national average.

Outstanding practice• The practice as part of SHIELD (The Selby Area

Federation of GP Practices) had won an innovationfund, to develop social prescribing. This fund was usedto support the local voluntary service to produce anup to date data base of available voluntary social careorganisations. Patients were then referred to the mostappropriate services.

• The practice was pro-active and reactive to managingpatient access, their needs and expectations. All

patients who wanted a same day appointment werecalled back and only triaged by the GP. Over 75 years ofage patients always had a same day appointment ifneeded.

• The practice used the term Query–Doc for the GP whohad a shortened morning surgery to ensure allcorrespondence was read and dealt with on the day.This assured any changing or emerging health needsof patients were responded to effectively andefficiently.

Summary of findings


Our inspection teamOur inspection team was led by:

Our inspection team was led by a CQC Lead Inspector.The team included a GP Specialist Advisor (SpA),aPharmacist SpA , a CQC inspector and an expert byexperience.

Background to TadcasterMedical CentreThe Tadcaster Medical Centre is located in a purpose builtbuilding next to the local bus station. The practice providesPersonal Medical Services (PMS) under a contract with NHSEngland, North Yorkshire and Humber Area Team, to thepractice population of 8,359 patients. This is a trainingpractice for qualified doctors who wish to undertake thepostgraduate qualifications to become a GP.

The practice is a dispensing practice. There is a mix of maleand female staff at the practice. Staffing at the practice ismade up of five GP partners (four female and one male),one salaried GP (male). There is one female advancednurse practitioner, one female practice nurse and twofemale health technicians. There is a practice manager,dispensing staff and a range of administration andsecretarial staff.

The practice is open between 8.30 am and 6pm Monday toFriday. The dispensary is closed each day between12.30pm and 1.30pm. The surgery and dispensary are openevery Saturday morning. The appointments arepre-bookable GP only, from 8am until 12.30 pm. Thisextended hours service is to help patients access the GP ata more convenient time for them.

Why we carried out thisinspectionWe carried out a comprehensive inspection of this serviceunder Section 60 of the Health and Social Care Act 2008 aspart of our regulatory functions. This inspection wasplanned to check whether the provider is meeting the legalrequirements and regulations associated with the Healthand Social Care Act 2008, to look at the overall quality ofthe service, and to provide a rating for the service under theCare Act 2014.

Please note that when referring to information throughoutthis report, for example any reference to the Quality andOutcomes Framework data, this relates to the most recentinformation available to the CQC at that time.

How we carried out thisinspectionBefore visiting, we reviewed a range of information we heldabout the practice and asked other organisations such ashealthwatch, to share what they knew. We carried out anannounced visit on 2 June 2015. During our visit we spokewith 12 members of staff, these included GPs, a GP registrar,the practice manager, dispensing staff, nurse practitioner,practice nurse, secretaries and reception staff. We spokewith patients who used the service and a member of thePatient Participation Group (PPG). We observed howpeople were being cared for and talked with carers and/orfamily members. We reviewed comment cards wherepatients shared their views and experiences of the service.

To get to the heart of patients’ experiences of care andtreatment, we always ask the following five questions:

• Is it safe?

TTadcadcastasterer MedicMedicalal CentrCentreeDetailed findings


• Is it effective?• Is it caring?• Is it responsive to people’s needs?• Is it well-led?

We also looked at how well services are provided forspecific groups of people and what good care looks like forthem. The population groups are:

• Older people

• People with long-term conditions• Families, children and young people• Working age people (including those recently retired

and students)• People whose circumstances may make them

vulnerable• People experiencing poor mental health (including

people with dementia)

Detailed findings


Our findingsSafe track recordThe practice had systems in place to record, monitor andlearn from incidents which had occurred within thepractice. Safety was monitored using information from arange of sources. These included the Quality and OutcomesFramework (QOF), patient survey results, the PatientParticipation Group (PPG), clinical audits, professionaldevelopment, and education and training.

Staff were able to give examples of the processes used toreport, record and learn from incidents. They confirmedthese were discussed in the clinical, management meetingsand with relevant staff. We reviewed safety records, incidentreports and minutes of meetings where these werediscussed for the last year. This showed the practice hadmanaged these consistently over time and so could showevidence of a safe track record over the long term.

Learning and improvement from safety incidentsThe practice had a system in place for reporting, recordingand monitoring significant events, incidents and accidents.There were records of significant events that had occurredduring the last year and we were able to review these.Significant events were a standing item on the clinicalpractice meeting agenda and a dedicated meeting washeld six monthly to review actions from past significantevents and complaints. There was evidence the practicehad learned from these and the findings were shared withrelevant staff. Staff, including receptionists, administratorsand nursing staff, knew how to raise an issue forconsideration at their meetings and they felt encouraged todo so.

Staff used incident forms and sent completed forms to thepractice manager. They showed us the system used tomanage and monitor incidents. We tracked six incidentsand saw records were completed in a comprehensive andtimely manner. We saw evidence of action taken as a resultof the wrong prescription being issued to a patient with asimilar name. The actions and investigations were detailedand protocols were revisited. Where patients had beenaffected by something that had gone wrong, in line withpractice policy, they were given an apology and informed ofthe actions taken.

National patient safety alerts were disseminated to practicestaff by email, on-line tasks or in meetings. Staff we spoke

with were able to give examples of recent alerts relevant tothe care they were responsible for. They confirmed alertswere discussed in clinical meetings to ensure staff wereaware of any relevant to their practice and where theyneeded to take action.

Reliable safety systems and processes includingsafeguardingThe practice had systems to manage and review risks tovulnerable children, young people and adults. We lookedat training records which showed all staff had receivedrelevant role specific training on safeguarding. We askedmembers of medical, nursing and administrative staffabout their most recent training. Staff knew how torecognise signs of abuse in older people, vulnerable adultsand children. They were also aware of their responsibilitiesand knew how to share information, properly recorddocumentation of safeguarding concerns and how tocontact the relevant agencies in working hours and out ofnormal hours. Contact details were easily accessible.

The practice had appointed a dedicated GP as leads insafeguarding vulnerable adults and children. They hadbeen trained and could demonstrate they had thenecessary training to enable them to fulfil this role. All staffwe spoke with were aware who the lead was and who tospeak with in the practice if they had a safeguardingconcern.

There was a system to highlight vulnerable patients on thepractice’s electronic records. This included information tomake staff aware of any relevant issues when patientsattended appointments; for example children subject tochild protection plans. This was to ensure risks to childrenand young patients, who were looked after or on childprotection plans, were known and reviewed. We were toldthere was frequent liaison with partner agencies such as,health visitors and social services.

There was a chaperone policy, which was visible on thewaiting room noticeboard and in consulting rooms. (Achaperone is a person who acts as a safeguard and witnessfor a patient and health care professional during a medicalexamination or procedure). All nursing staff, includinghealth care assistants, had been trained to be a chaperone.Reception staff, who were trained, would act as achaperone if nursing staff were not available. Theyunderstood their responsibilities when acting aschaperones, including where to stand to be able to observethe examination.

Are services safe?

Good –––


Medicines managementWe checked procedures for medicines management andthese were available for each process undertaken by staff inthe dispensary. We found staff signed and dated theprocedures to confirm that they had read them. Wechecked medicines stored in the dispensary, treatmentroom and medicine refrigerators. There was a clear policyfor ensuring medicines were kept at the requiredtemperature. We found that storage was safe and secure,and medicines were within their expiry dates. Medicineswere stored at the correct temperature so that they were fitfor use. The temperature of the medicines refrigerators andthe dispensary were monitored daily. There was a systemto check the emergency medicines to ensure the correctstock level and expiry dates.

Patients were able to order their repeat prescriptions inperson, in writing using the medicines list on theprescription counterfoil, on-line, or by using a mobilephone ‘app’. There were strict processes in place so staffcould only issue repeat prescriptions and dispensemedicines, which were up-to-date on the repeatprescription record. Only GPs and the Nurse Practitionerwere able to make changes to repeat prescription recordsfor example, after discharge from hospital or followingmedication review. Dispensary staff were able to makechanges to repeat prescription records for stoma productsonly in line with dispensary procedures. Reception staffissued prescriptions for patients to take to their localpharmacy, and dispensary staff issued prescriptions anddispensed medicines for those eligible for ‘doctordispensing’. Staff explained how they made checks forcompliance such as by checking under-ordering orover-ordering of medicines and how these concerns wereraised with GPs.

The procedure for ensuring prescriptions were signed bythe GP before patients received their dispensed medicineswas recently reviewed. Patients only received dispensedmedicines after a GP had checked and signed theprescription. The dispensary used a ‘bar code’ system sothat dispensed medicines were matched with theprescription electronically to reduce the risk of the wrongmedicine being dispensed.

We discussed the management of high risk medicines, suchas the blood thinning medicine called warfarin, with the GP.They explained the audit processes in place to make surethat patients attended for regular monitoring so that repeatprescriptions could be issued safely.

We checked the arrangements for storing blankprescriptions. These needed to be kept secure to preventmishandling, diversion and misuse. We found that thesewere locked away but there was no audit trail in place. Wediscussed this with the practice manager who was in theprocess of implementing a system of accounting forprescriptions. We discussed the arrangements formanaging national alerts relating to medicines, forexample when medicines had to be removed from use dueto manufacturing quality issues. The dispensary staffexplained how these alerts were processed but there wasno record of those that had been done recently. Thepractice manager was implementing a new system torecord the action taken to confirm that they had been dealtwith.

Medicines liable to misuse, called Controlled Drugs, weremanaged safely. Standard operating procedures were inplace for managing Controlled Drugs that were recentlyreviewed. The keys for the Controlled Drugs cabinet weresecure and accessible only to designated staff. There weresystems for recording and disposing of out-of-date orunwanted Controlled Drugs. Staff were aware of how toraise concerns with the Controlled Drugs AccountableOfficer in their area.

Staff who dispensed medicines were appropriately trainedand had the necessary experience to undertake the tasksafely. The practice manager told us that the practice wassigned up to the Dispensing Services Quality Scheme(DSQS) this rewards practices for providing high qualityservices to patients of their dispensary. The GP who tookthe lead for the dispensary undertook competency checksof dispensers in line with the DSQS competency template.

The nurse practitioner and the practice nursesadministered vaccines using directions that had beenproduced in line with legal requirements and nationalguidance. We saw up-to-date copies of these directionsand evidence that nurses had received appropriate trainingto administer vaccines. A member of the nursing staff was

Are services safe?

Good –––


qualified as an independent prescriber and she receivedregular supervision and support in her role as well asupdates in the specific clinical areas of expertise for whichshe prescribed.

Cleanliness and infection controlWe observed the premises to be clean and tidy. We sawthere were cleaning schedules in place and cleaningrecords were kept. Patients we spoke with told us theyalways found the practice clean and had no concernsabout cleanliness or infection control.

The practice had a lead for infection control who hadundertaken further training to enable them to provideadvice on the practice infection control policy and carry outstaff training. All staff received induction training aboutinfection control specific to their role and received annualupdates. We saw evidence that the lead had carried outaudits for each of the last three years and that anyimprovements identified for action were completed ontime. Minutes of practice meetings showed that thefindings of the audits were discussed. We saw the actionplan to replace the carpets in the consulting rooms tocomply with current guidance. The infection control leadtold us ‘wet procedures’ were only undertaken in roomswith appropriate flooring which could be cleaned toapproved standards

An infection control policy and supporting procedures wereavailable for staff to refer to, which enabled them to planand implement measures to control infection. For example,personal protective equipment including disposablegloves, aprons and coverings were available for staff to useand staff were able to describe how they would use theseto comply with the practice’s infection control policy. Therewas also a policy for needle stick injury and staff knew theprocedure to follow in the event of an injury.

Notices about hand hygiene techniques were displayed instaff and patient toilets. Hand washing sinks with handsoap, hand gel and hand towel dispensers were available intreatment rooms.

The practice had a policy for the management, testing andinvestigation of legionella (a term for particular bacteriawhich can contaminate water systems in buildings). Wesaw records that confirmed the practice was carrying outregular checks in line with this policy to reduce the risk ofinfection to staff and patients.

EquipmentStaff we spoke with told us they had equipment to enablethem to carry out diagnostic examinations, assessmentsand treatments. They told us that all equipment was testedand maintained regularly and we saw equipmentmaintenance logs and other records that confirmed this. Allportable electrical equipment was routinely tested anddisplayed stickers indicating the last testing date. Aschedule of testing was in place. We saw evidence ofcalibration of relevant equipment; for example weighingscales, spirometers, blood pressure measuring devices.

Staffing and recruitmentRecords we looked at contained evidence appropriaterecruitment checks had been undertaken prior toemployment. For example, proof of identification,references, qualifications, registration with the appropriateprofessional body and criminal records checks through theDisclosure and Barring Service (DBS). The practice had arecruitment policy setting out the standards it followedwhen recruiting clinical and non-clinical staff.

Staff told us about the arrangements for planning andmonitoring the number of staff and mix of staff needed tomeet patients’ needs. We saw there was a rota system inplace for all the different staffing groups to ensure thatenough staff were on duty. There was also an arrangementin place for members of staff, including nursing andadministrative staff, to cover each other’s annual leave.

Staff told us there were usually enough staff to maintainthe smooth running of the practice and there were alwaysenough staff on duty to keep patients safe. We were told ofsuccession planning and a recent recruit to the nursingteam. In addition we were told by the nurse practitioner ofthe innovative way they changed the nursing provisionwithin the practice. A member of the team left and the roleswere then broken down, differently. This initially freed upappointments when the newly recruited health technicianswere trained to monitor new patient checks, undertakeelectrocardiograms (ECGs) and blood pressure monitoringand one is now a trained phlebotomist. The practice nursehad specific roles which included cervical smears andvaccinations. Another treatment room nurse was newlyrecruited to complement this role. This meant the nursepractitioner concentrated on managing and monitoringpatients with Long Term Conditions as well as treatingminor illness and injury.

Are services safe?

Good –––


Monitoring safety and responding to riskThe practice had systems, processes and policies in placeto manage and monitor risks to patients, staff and visitorsto the practice. These included annual and monthly checksof the building, the environment, medicines management,staffing, dealing with emergencies and equipment. Thepractice also had a health and safety policy. Health andsafety information was displayed for staff to see and therewas an identified health and safety representative.

Identified risks were included on a risk log. Each risk wasassessed and rated and mitigating actions recorded toreduce and manage the risk. We saw all risks werediscussed at GP partners’ meetings and within teammeetings.

Arrangements to deal with emergencies and majorincidentsThe practice had arrangements in place to manageemergencies. Records showed that all staff had receivedtraining in basic life support. Emergency equipment wasavailable including access to oxygen and an automatedexternal defibrillator (used to attempt to restart a person’sheart in an emergency). When we asked members of staff,they all knew the location of this equipment and recordsconfirmed that it was checked regularly.

Emergency medicines were available in a secure area of thepractice and all staff knew of their location. These included

those for the treatment of cardiac arrest, anaphylaxis andhypoglycaemia (low blood sugar). Processes were also inplace to check whether emergency medicines were withintheir expiry date and suitable for use. All the medicines wechecked were in date and fit for use.

A business continuity plan was in place to deal with a rangeof emergencies which may impact on the daily operation ofthe practice. Each risk was rated and mitigating actionsrecorded to reduce and manage the risk. Risks identifiedincluded power failure, adverse weather, unplannedsickness and access to the building. The document alsocontained relevant contact details for staff to refer to. Forexample, contact details of a heating company to contact ifthe heating system failed. We were told of when they had tosuccessfully implement this plan. Tadcaster was floodedand it impacted on the medical centre, however, theservice was delivered differently and all patients were seenand medications dispensed as required.

The practice had carried out a fire risk assessment thatincluded actions required to maintain fire safety. Recordsshowed that staff were up to date with fire training and thatthey practised regular fire drills.

Risks associated with service and staffing changes (bothplanned and unplanned) were required to be included onthe practice risk log.

Are services safe?

Good –––


Our findingsEffective needs assessmentThe GPs and nursing staff we spoke with could clearlyoutline the rationale for their approaches to treatment.They were familiar with current best practice guidance, andaccessed guidelines from the National Institute for Healthand Care Excellence (NICE) and from local commissioners.We saw minutes of practice meetings where new guidelineswere disseminated, the implications for the practice’sperformance and patients were discussed and requiredactions agreed. The staff we spoke with and the evidencewe reviewed confirmed that these actions were designed toensure that each patient received support to achieve thebest health outcome for them. We found from ourdiscussions with the GPs and nurses that staff completedthorough assessments of patients’ needs in line with NICEguidelines, and these were reviewed when appropriate.

The GPs told us they lead in specialist clinical areas such asdiabetes, paediatrics, minor surgery, heart disease,substance misuse and asthma. The nurse practitioner, thepractice nurse and the health technicians supported thiswork, which allowed the practice to focus on specificconditions. Clinical staff we spoke with were open aboutasking for and providing colleagues with advice andsupport. GPs told us this supported all staff to continuallyreview and discuss new best practice guidelines for themanagement of respiratory disorders and diabetes, whichwere prevalent in the practice population. Our review of theclinical meeting minutes confirmed that this happened.

The GPs told us clinical audits were often linked tomedicines management information, safety alerts or as aresult of information from the quality and outcomesframework (QOF). (QOF is a voluntary incentive scheme forGP practices in the UK. The scheme financially rewardspractices for managing some of the most commonlong-term conditions and for the implementation ofpreventative measures). For example, we saw an auditregarding the prescribing of aspirin. Following the audit,the GPs carried out medication reviews for patients whowere prescribed these medicines and altered theirprescribing practice, in line with the guidelines. GPsmaintained records showing how they had evaluated theservice and documented the success of any changes.

We saw data from the local CCG of the practice’sperformance for antibiotic prescribing, which was

comparable to similar practices. The practice had alsocompleted a review of case notes for patients with highblood pressure which showed all were receivingappropriate treatment and regular reviews. The practiceused computerised tools to identify patients with complexneeds who had multidisciplinary care plans documented intheir case notes. We were shown the process the practiceused to review patients recently discharged from hospital,which required patients to be reviewed within the week bytheir GP according to need.

National data showed that the practice was in line withreferral rates to secondary and other community careservices for all conditions. All GPs we spoke with usednational standards for the referral of suspected cancers.Patients had to be seen by specialists within two weeks ofbeing seen by their GP. We saw minutes from meetingswhere regular reviews of elective and urgent referrals weremade, and improvements to practice were shared with allclinical staff.

Discrimination was avoided when making care andtreatment decisions. Interviews with GPs showed that theculture in the practice was that patients were cared for andtreated based on need and the practice took account ofpatient’s age, gender, race and culture as appropriate.

Management, monitoring and improving outcomesfor peopleStaff across the practice had key roles in monitoring andimproving outcomes for patients. These roles includeddata input, scheduling clinical reviews, and managing childprotection alerts and medicines management. Theinformation staff collected was then collated by thepractice manager to support the practice to carry outclinical audits.

The practice showed us four clinical audits that had beenundertaken in the last two years. All of these werecompleted audits where the practice was able todemonstrate the changes resulting since the initial audit.We looked specifically at two completed audit cycles wherethe practice was able to demonstrate the changes since theinitial audit. Following each clinical audit, changes totreatment or care were made where needed and the auditrepeated to ensure outcomes for patients had improved.All the audits demonstrated improved outcomes for

Are services effective?(for example, treatment is effective)

Good –––


patients. Other examples included audits to confirm thatthe GPs who undertook minor surgical procedures weredoing so in line with their registration and National Institutefor Health and Care Excellence guidance.

The GPs told us clinical audits were often linked tomedicines management information, safety alerts or as aresult of information from the quality and outcomesframework (QOF). (QOF is a voluntary incentive scheme forGP practices in the UK. The scheme financially rewardspractices for managing some of the most commonlong-term conditions and for the implementation ofpreventative measures). For example, we saw an auditregarding the required monitoring of blood analysis whenprescribing Disease Modifying Anti-Rheumatic drugs(DMARDS), all patients who had their health managed atthe practice had, had their blood screening completed. GPsmaintained records showing how they had evaluated theservice and documented the success of any changes.

The practice also used the information collected for theQOF and performance against national screeningprogrammes to monitor outcomes for patients. Forexample, 100% of patients with diabetes had an annualmedication review, and the practice met all the minimumstandards for QOF in diabetes/asthma/ chronic obstructivepulmonary disease (lung disease). This practice was not anoutlier for any QOF (or other national) clinical targets.

The team was making use of clinical audit tools, clinicalsupervision and staff meetings to assess the performanceof clinical staff. The staff we spoke with discussed how, as agroup, they reflected on the outcomes being achieved andareas where this could be improved. Staff spoke positivelyabout the culture in the practice around audit and qualityimprovement, noting that there was an expectation that allclinical staff should undertake at least one audit a year.

There was a protocol for repeat prescribing which was inline with national guidance. In line with this, staff regularlychecked that patients receiving repeat prescriptions hadbeen reviewed by the GP. They also checked that all routinehealth checks were completed for long-term conditionssuch as diabetes and that the latest prescribing guidancewas being used. The IT system flagged up relevantmedicines alerts when the GP was prescribing medicines.We saw evidence to confirm that, after receiving an alert,the GPs had reviewed the use of the medicine in question.

They documented any changes necessary to each patient’srecords. The evidence we saw confirmed that the GPs hadoversight and a good understanding of best treatment foreach patient’s needs.

The practice had achieved and implemented the goldstandards framework for end of life care. It had a palliativecare register and had regular internal as well asmultidisciplinary meetings to discuss the care and supportneeds of patients and their families. As a consequence ofstaff training and better understanding of the needs ofpatients, the practice had increased the number of patientson the register.

The practice also participated in local benchmarking run bythe CCG. This is a process of evaluating performance datafrom the practice and comparing it to similar surgeries inthe area. This benchmarking data showed the practice hadoutcomes that were comparable to other services in thearea.

Effective staffingPractice staffing included medical, nursing, managerial andadministrative staff. We reviewed staff training records andsaw that all staff were up to date with attending mandatorycourses such as annual basic life support. We noted a goodskill mix among the doctors with additional diplomas insexual and reproductive medicine, and diplomas inchildren’s health and obstetrics, diabetes and respiratorydiseases. All GPs were up to date with their annualcontinuing professional development requirements and alleither had been revalidated or had a date for revalidation.(Every GP is appraised annually, and undertakes a fullerassessment called revalidation every five years. Only whenrevalidation has been confirmed by the General MedicalCouncil can the GP continue to practise and remain on theperformers list with NHS England). In addition the practicehad introduced peer review sessions for GPs. They hadprotected time to review cases, to learn from and with eachother, a technique from the GP training scheme which theyfelt benefited all GPs.

All staff undertook annual appraisals where learning needswere identified and action plans were documented. Ourinterviews with staff confirmed the practice was proactivein providing training and funding for relevant courses, forexample two members of administration staff had recentlyundertaken courses which included ‘handling difficultconversations’. As the practice was a training practice,


Good –––


doctors who were training to be qualified as GPs wereoffered extended appointments and had access to a seniorGP throughout the day for support. We received positivefeedback from the trainee we spoke with.

Practice nurses were expected to perform defined dutiesand were able to demonstrate that they were trained tofulfil these duties. For example, on administration ofvaccines, and cervical cytology. The Nurse Practitioner withan extended role saw patients with long-term conditionssuch as asthma, chronic obstructive pulmonary disease(COPD), diabetes and coronary heart disease and they wereable to demonstrate they had appropriate training to fulfilthese roles.

Staff files we reviewed showed that where poorperformance had been identified appropriate action hadbeen taken to manage this.

Working with colleagues and other servicesThe practice worked with other service providers to meetpatient’s needs and manage those of patients withcomplex needs. It received blood test results, X ray results,and letters from the local hospital including dischargesummaries, out-of-hours GP services and the NHS 111service both electronically and by post. The practice had apolicy outlining the responsibilities of all relevant staff inpassing on, reading and acting on any issues arising fromcommunications with other care providers on the day theywere received. The GP who saw these documents andresults was responsible for the action required. All staff wespoke with understood their roles and felt the system inplace worked well. There were no instances identifiedwithin the last year of any results or discharge summariesthat were not followed up appropriately.

We saw the policy for actioning hospital communicationswas working well as they used a GP who had a shortermorning surgery as ‘Query-Doc’. The practice undertook ayearly audit of follow-ups to ensure inappropriatefollow-ups were documented and that no follow-ups weremissed.

The practice held monthly multidisciplinary team meetingsto discuss the needs of complex patients, for examplethose with end of life care needs or children on the at riskregister. These meetings were reported to be well attendedby district nurses, social workers, palliative care nurses anddecisions about care planning were documented in a

shared care record. Staff felt this system worked well andremarked on the usefulness of the forum as a means ofsharing important information. They were very clear theytalked about patients and not tasks.

Information sharingThe practice used several electronic systems tocommunicate with other providers. For example, there wasa shared system with the local GP out-of-hours provider toenable patient data to be shared in a secure and timelymanner. Electronic systems were also in place for makingreferrals, Choose and Book had now been replaced withReferral Support Service (RSS). Staff reported this systemwas easy to use and they felt it was better for patients.

The practice had signed up to the electronic Summary CareRecord. (Summary Care Records provide faster access tokey clinical information for healthcare staff treatingpatients in an emergency or out of normal hours). This willbe in place by November 2015.

The practice had systems to provide staff with theinformation they needed. Staff used an electronic patientrecord to coordinate, document and manage patients’care. All staff were fully trained on the system, andcommented positively about the system’s safety and easeof use. This software enabled scanned papercommunications, such as those from hospital, to be savedin the system for future reference. We saw evidence thataudits had been carried out to assess the completeness ofthese records and that action had been taken to addressany shortcomings identified.

Consent to care and treatmentWe found that staff were aware of the Mental Capacity Act2005, the Children Acts 1989 and 2004 and their duties infulfilling it. All the clinical staff we spoke with understoodthe key parts of the legislation and were able to describehow they implemented it in their practice.

Patients with a learning disability and those with dementiawere supported to make decisions through the use of careplans, which they were involved in agreeing. These careplans were reviewed annually (or more frequently ifchanges in clinical circumstances dictated it) and had asection stating the patient’s preferences for treatment anddecisions. When interviewed, staff gave examples of how apatient’s best interests were taken into account if a patientdid not have capacity to make a decision.


Good –––


All clinical staff demonstrated a clear understanding ofGillick competencies. (Used to help assess whether a childhad the maturity to make decisions about their care andtreatment and to understand the implications of thesedecisions).

There was a practice policy for documenting consent forspecific interventions. For example, for all minor surgicalprocedures, a patient’s written consent was documented inthe electronic patient notes with a record of the relevantrisks, benefits and complications of the procedure.

The practice had not needed to use restraint in the lastthree years, but staff were aware of the distinction betweenlawful and unlawful restraint.

Health promotion and preventionThe practice had met with the Public Health team from thelocal authority and the CCG to discuss the implications andshare information about the needs of the practicepopulation identified by the Joint Strategic NeedsAssessment (JSNA). The JSNA pulls together informationabout the health and social care needs of the local area.This information was used to help focus health promotionactivity.

The practice as part of SHIELD (The Selby Area Federationof GP Practices) had won an innovation fund, to developsocial prescribing. This fund was used to support the localvoluntary service to produce an up-to-date, data base ofavailable voluntary social care organisations. Patients werethen referred to the most appropriate services; thisinnovation was in its infancy. The database had beencompleted in May 2015.

It was practice policy to offer a health check with the healthtechnician / practice nurse to all new patients registeringwith the practice. The GP was informed of all healthconcerns detected and these were followed up in a timelyway. We noted a culture among the GPs to use their contactwith patients to help maintain or improve mental, physicalhealth and wellbeing. For example, by offeringopportunistic chlamydia screening to patients aged 18 to25 years and offering smoking cessation advice to smokers.

The practice also offered NHS Health Checks to all itspatients aged 40 to 75 years. Practice data showed thatover 50% of patients in this age group had taken up theoffer of the health check. 53 patients had been identified ashigh risk after their screening. A GP showed us how patientswere followed up within one week if they had risk factorsfor disease identified at the health check and how theyscheduled further investigations. These patients were nowbeing treated for their identified needs.

The practice had numerous ways of identifying patientswho needed additional support, and it was pro-active inoffering additional help. For example, the practice kept aregister of all patients with a learning disability and theywere offered an annual physical health check. Similarmechanisms of identifying ‘at risk’ groups were used forpatients who were obese and those receiving end of lifecare. These groups were offered further support in line withtheir needs.

The practice’s performance for cervical smear uptake was88.2 %, which was better than others in the CCG area. Therewas a policy to offer telephone reminders for patients whodid not attend for cervical smears and the practice auditedpatients who did not attend. There was also a named nurseresponsible for following up patients who did not attendscreening. Performance for national chlamydia,mammography and bowel cancer screening in the areawere all above average for the CCG and a similarmechanism of following up patients who did not attendwas also used for these screening programmes.

The practice offered a full range of immunisations forchildren, travel vaccines and flu vaccinations in line withcurrent national guidance. Last year’s performance for allimmunisations was above average for the CCG, and againthere was a clear policy for following up non-attenders bythe named practice nurse.


Good –––


Our findingsRespect, dignity, compassion and empathyWe reviewed the most recent data available for the practiceon patient satisfaction. This included information from thenational patient survey published in January 2015, a surveyof patients undertaken by the practice’s patientparticipation group (PPG) and patient satisfactionquestionnaires sent out to patients by each of the practice’spartners. The evidence from all these sources showedpatients were very satisfied with how they were treated andthat this was with compassion, dignity and respect. Forexample, data from the national patient survey showed thepractice was rated ‘among the best’ for patients who ratedthe practice as good or very good. The practice rated highlyfor its satisfaction scores on consultations with doctors andnurses with 92.3% of practice respondents saying the GPwas good at listening to them and 98.4% saying the GPgave them enough time.

Patients completed CQC comment cards to tell us whatthey thought about the practice. We received 24 completedcards and the majority were positive about the serviceexperienced. Patients said they felt the practice offered anexcellent service and staff were efficient, helpful and caring.They said staff treated them with dignity and respect. Wealso spoke with 11 patients on the day of our inspection. Alltold us they were satisfied with the care provided by thepractice and said their dignity and privacy was respected.Three told us of the exceptional ‘service’ they received inemergency situations. They felt the doctors went beyondthe call of duty to ensure their health and well-being.

Staff and patients told us all consultations and treatmentswere carried out in the privacy of a consulting room.Disposable curtains were provided in consulting rooms andtreatment rooms so that patients’ privacy and dignity wasmaintained during examinations, investigations andtreatments. We noted that consultation / treatment roomdoors were closed during consultations and conversationstaking place in these rooms could not be overheard.

We saw staff were careful to follow the practice’sconfidentiality policy when discussing patients’ treatmentsso confidential information was kept private. The practiceswitchboard was located away from the reception deskwhich helped keep patient information private. In responseto patient, PPG and staff suggestions, a system had beenintroduced to allow only one patient at a time to approach

the reception desk. This helped to prevent patientsoverhearing potentially private conversations betweenpatients and reception staff. We saw this system inoperation during our inspection and noted that it enabledconfidentiality to be maintained. We were also told how thewaiting room chairs had been moved away from thereception desk to further maintain privacy and dignity, atthe suggestion of the PPG’s patient feedback.

Staff told us that if they had any concerns or observed anyinstances of discriminatory behaviour or where patients’privacy and dignity was not being respected, they wouldraise these with the practice manager. The practicemanager told us she would investigate these and anylearning identified would be shared with staff.

There was a clearly visible notice in the patient receptionarea stating the practice’s zero tolerance for abusivebehaviour.

Care planning and involvement in decisions aboutcare and treatmentThe patient survey information we reviewed showedpatients responded positively to questions about theirinvolvement in planning and making decisions about theircare and treatment and generally rated the practice well inthese areas. For example, data from the national patientsurvey showed 82.5% of practice respondents said the GPinvolved them in care decisions and 83.2% felt the GP wasgood at explaining treatment and results. Both theseresults were similar to others in the CCG and higher thanthe national average. The results from the practice’s ownsatisfaction survey showed the majority of patients saidthey were sufficiently involved in making decisions abouttheir care.

Patients we spoke with on the day of our inspection told ushealth issues were discussed with them and they feltinvolved in decision making about the care and treatmentthey received. They felt listened to and supported by staffand had sufficient time during consultations to make aninformed decision about the choice of treatment theywished to receive. Patient feedback on the comment cardswe received was also very positive and aligned with theseviews.

We saw anonymised care plans for patients with long termconditions, detailing their involvement and agreement tolife style changes where necessary; we saw the review dateappointments.

Are services caring?

Good –––


Staff told us that translation services were available forpatients who did not have English as a first language.

Patient/carer support to cope emotionally withcare and treatmentThe survey information we reviewed showed patients werepositive about the emotional support provided by thepractice and rated it well in this area. The patients wespoke with on the day of our inspection and the commentcards we received were also consistent with thisinformation. For example, we were told how a GP called ata patients home immediately after a family member haddied unexpectedly. This level of support continued and itwas obviously felt important for us to be told at inspection.Other examples of emotional care and support wereidentified to us by very appreciative patients; who couldnot praise the GPs highly enough.

Staff told us that if families had suffered a bereavement,their usual GP contacted them. This call was eitherfollowed by a patient consultation at a flexible time andlocation to meet the family’s needs and/or by giving themadvice on how to find a support service. Patients we spokewith who had had a bereavement confirmed they hadreceived this type of support and said they had found ithelpful.

Notices in the patient waiting room, and patient websitealso told patients how to access a number of supportgroups and organisations. The practice’s computer systemalerted GPs if a patient was also a carer. We were shown thewritten information available for carers to ensure theyunderstood the various avenues of support available tothem.

Are services caring?

Good –––


Our findingsResponding to and meeting people’s needsWe found the practice was responsive to patient’s needsand had systems in place to maintain the level of serviceprovided. The needs of the practice population wereunderstood and systems were in place to addressidentified needs in the way services were delivered.

The NHS England Area Team and Clinical CommissioningGroup (CCG) told us that the practice engaged regularlywith them and other practices to discuss local needs andservice improvements that needed to be prioritised. Wesaw minutes of meetings where this had been discussedand actions agreed to implement service improvementsand manage delivery challenges to its population. Thisincluded the six federated GP practices who had looked atthe service provision of voluntary support in this semi-ruralarea and had won funding to ensure an up-to-dateinformation about these services was available. The localvolunteer service would take referrals and support patientsin need to access the most appropriate for them.

The practice had also implemented suggestions forimprovements and made changes to the way it deliveredservices in response to feedback from the patientparticipation group (PPG). These included better access tothe practice, a hand rail and automated door. Reviews ofthe appointment systems, the changes have beenimplemented and this included the duty doctor call backservice, which is highly commended by all patients whowere either spoken with or had been in touch with us.

Tackling inequity and promoting equalityThe practice was situated on the ground floor. Consultingrooms and corridors were accessible to all patients whichmade movement around the practice easy and helped tomaintain patients’ independence. We saw the waiting areawas large enough to accommodate patients withwheelchairs and prams and allowed for easy access to thetreatment and consultation rooms. The seats in the waitingarea were of different heights and sizes allowing fordiversity in physical health. An audio loop was available forpatients who were hard of hearing. In addition there was amember of staff who used sign language; patients whowere hard of hearing were mainly booked in when thismember of staff was available. Accessible toilet facilities

were available for all patients attending the practiceincluding baby changing facilities. Records showed regulartests were carried out on the emergency call bell facilities.Parking was available for all patients.

The practice had access to online and telephonetranslation services.

The practice provided equality and diversity trainingthrough e-learning. Staff we spoke with confirmed that theyhad completed the equality and diversity training in the last12 months.

The homeless population was one self-styled ‘man of theroad’ who visited intermittently over the summer. He knewhe could walk in and wait to be seen. The GPs prescribed,arranged review appointments and had attempted toarrange more support via the vicar locally.

Access to the serviceAppointments were available from 8.30am to 5.50pm onweekdays. The practice’s extended opening hours wasparticularly useful to patients with work commitments.These were pre-booked appointments every Saturday from8.00am until 12.15pm. The dispensary was open everyweek day as well as Saturday mornings. However, thedispensary is closed each week day between 12.30pm until1.30pm. Urgent same day appointments were available.The on-call GP would ring the patient /carer back; thereception staff did not triage patients. Appointments werereleased at varying times and this information had beenwell publicised.

Comprehensive information was available to patientsabout appointments on the practice website. This includedhow to arrange urgent appointments and home visits andhow to book appointments through the website, thetelephone automated system, in person or by telephone.There were also arrangements to ensure patients receivedurgent medical assistance when the practice was closed. Ifpatients called the practice when it was closed, ananswerphone message gave the telephone number theyshould ring depending on the circumstances. Informationabout the out-of-hours service was provided to patients.

Longer appointments were available for patients whoneeded them and those with long-term conditions. Thisincluded appointments with a named GP or nurse. Home

Are services responsive to people’s needs?(for example, to feedback?)

Good –––


visits were made to the local care home on a specific dayeach week, by a named GP and to those patients whoneeded one. Appointments were made available forchildren of school age after school hours.

Patients were generally satisfied with the appointmentssystem. They confirmed that they could see a doctor on thesame day if they needed to. They also said they could seeanother doctor if there was a wait to see the doctor of theirchoice. Comments received from patients showed patientsin urgent need of treatment had been able to makeappointments on the same day of contacting the practice.

Listening and learning from concerns andcomplaintsThe practice had a system in place for handling complaintsand concerns. Its complaints policy and procedures were inline with recognised guidance and contractual obligationsfor GPs in England. There was a designated responsibleperson who handled all complaints in the practice.

We did not see information displayed in the waiting roomto help patients understand the complaints system.However, the information was on the practice’s website.Some of the patients we spoke with were aware of theprocess to follow if they wished to make a complaint. Wedrew this to the practice’s attention at the inspection. Noneof the patients we spoke with had ever needed to make acomplaint about the practice.

We looked at 19 complaints received in the last 12 monthsand found they had been dealt with in a timely way andwere open and transparent. There was an active review ofcomplaints and where appropriate improvements made asa result. Positive feedback from patients was also sharedand celebrated among the staff.

The practice reviewed complaints annually to detectthemes or trends. We looked at the report for the lastreview and no themes had been identified. However,lessons learned from individual complaints had been actedon.

Are services responsive to people’s needs?(for example, to feedback?)

Good –––


Our findingsVision and strategyThe practice had a clear vision to deliver high quality careand promote good outcomes for patients. These valueswere not clearly displayed in the waiting areas or the staffroom. The practice vision and values was not known by anyof the 11 staff members we spoke with. We brought this tothe practice manager’s attention.

Governance arrangementsThe practice had a number of policies and procedures inplace to govern activity and these were available to staff onthe desktop on any computer within the practice. Welooked at 10 of these policies and procedures. All 10policies and procedures we looked at had been reviewedannually and were up to date.

There was a clear leadership structure with namedmembers of staff in lead roles. For example, there was alead nurse for infection control and there was a named GPas the lead for safeguarding. We spoke with 11 members ofstaff and they were all clear about their own roles andresponsibilities. They all told us they knew who to go to inthe practice with any concerns.

The practice used the Quality and Outcomes Framework(QOF) to measure its performance. The QOF data for thispractice showed it was performing above nationalstandards. We saw that QOF data was regularly discussedat monthly team meetings and action plans were producedto maintain or improve outcomes.

The practice had an on-going programme of clinical auditswhich it used to monitor quality and their systems toidentify where action should be taken. These includedreviews of new cancer diagnoses in line with nationalreferrals and audits triggered by national guidance alerts.

The practice had arrangements for identifying, recordingand managing risks. The practice manager showed us therisk log, which addressed a wide range of potential issues.We saw that the risk log was regularly discussed at teammeetings and updated in a timely way. Risk assessmentshad been carried out where risks were identified and actionplans had been produced and implemented.

Leadership, openness and transparencyWe saw from minutes that team meetings were heldregularly, at least monthly. Staff told us that there was an

open culture within the practice and they had theopportunity and were happy to raise issues at teammeetings. However most of the staff we spoke with felt theywould value a ‘whole practice team’ meeting if only once ayear. We drew this to the practice manager’s attention.

The practice manager was responsible for human resourcepolicies and procedures. We reviewed a number of policies,such as confidentiality policy which were in place tosupport staff. We were shown the electronic staff handbookthat was available to all staff, which included sections onequality and harassment and bullying at work. Staff wespoke with knew where to find these policies if required.

Practice seeks and acts on feedback from itspatients, the public and staffThe practice had gathered feedback from patients throughpatients’ surveys, 360 degree feedback (each GP whenrevalidated is expected to provide evidence of feedbackfrom colleagues and patients) and the friends and familytest which was available in the waiting area.

The practice had an active patient participation group(PPG). The PPG included representatives from variouspopulation groups. The PPG had carried out surveys andmet regularly. The practice manager showed us theanalysis of the last patient survey, which was considered inconjunction with the PPG. The results and actions agreedfrom these surveys were available on the practice website.

Staff told us they would not hesitate to give feedback anddiscuss any concerns or issues with colleagues andmanagement. Staff told us they felt involved and engagedin the practice to improve outcomes for both staff andpatients.

The practice had a whistleblowing policy which wasavailable to all staff in the staff handbook and electronicallyon any computer within the practice.

Management lead through learning andimprovementStaff told us that the practice supported them to maintaintheir clinical professional development through trainingand mentoring. We looked at staff files and saw regularappraisals took place. We were told and were providedwith examples where staff had been supported to completeadditional training. This was to support their professionaldevelopment and also enhance the care offered topatients.

Are services well-led?(for example, are they well-managed and do senior leaders listen, learnand take appropriate action)

Good –––


The practice was a GP training practice for post-graduatedoctors we were told the support and development theywere given was exemplary.

The practice had completed reviews of significant eventsand other incidents and shared with staff at meetings toensure the practice improved outcomes for patients.

Are services well-led?(for example, are they well-managed and do senior leaders listen, learnand take appropriate action)

Good –––


Tadcaster Medical Centre Scheduled Report ... · Tadcaster LS248HD Tel:01937530082 Website: Dateofinspectionvisit:2June2015 Dateofpublication:23/07/2015 1 Tadcaster Medical Centre

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