This practice is rated as Good overall. (Previous inspection 07 2016 – Good)

The key questions are rated as:

Are services safe? – Requires Improvement

Are services effective? – Good

Are services caring? – Good

Are services responsive? – Good

Are services well-led? - Good

We carried out an announced comprehensive inspection at Priory Medical Centre on 1 May 20178 as part of our inspection programme.

At this inspection we found:

• The practice had systems to manage risk so that safety incidents were less likely to happen. However we found that learning from incidents and complaints could be improved.
• The practice routinely reviewed the effectiveness and appropriateness of the care it provided. It ensured that care and treatment was delivered according to evidence- based guidelines.
• Staff involved and treated patients with compassion, kindness, dignity and respect.
• Patients found the appointment system difficult to use in particular their ability to get through to the practice by telephone. Patients reported that they were able to access urgent care when they needed it, but that it was difficult to book a routine appointment.
• There was a strong focus on continuous learning and improvement at all levels of the organisation.
• The practice had considered succession planning and the issues that the local area faced. They had a broad range and skill mix of staff.
• The practice were responding to an increase in patient demand and a reduction in the number of GPs by re-shaping services with a multi-disciplinary team.
• Priory Medical Centre was part of a Group known as Priory Medical Group (PMG). PMG were part of a federation that provided care to 130,000 patients and were committed to working at scale with other providers to meet the needs of the population of York. The practice followed the Primary care home model which was developed by the National Association of Primary Care (NAPC), the model brought together a range of health and social care professionals to work together to provide enhanced personalised and preventative care for their local community.

We saw areas of outstanding practice:

The practice had developed a wound care protocol in collaboration with the Clinical Commissioning Group. This had been shared across the locality and had resulted in an improved service to patients and a reduced prescribing cost to the NHS.

PMG employ a range of health care professionals (for example: registered nurses, care workers, physiotherapist and occupational therapists) to work as York Integrated Care Team (YICT). They also work with Social services and voluntary organisations. Their innovative and person centred approach, contacting patients who may be in need of support, assured appropriate support such as short term care and regular reviews. The team reviewed all hospital admissions and discharges each day for patients in the federation practices and another rural practice. They worked with patients to review reasons for admissions and to plan care and support to minimise the risk of readmission. They also reviewed discharges to ensure that the patient had the care and support they needed to enable them to remain independent for longer. We saw evidence that each month 13 – 28 patients avoided admittance to hospital with this support.

The nursing team were innovative and forward thinking. They had won and been nominated for several awards following improvements to the quality of care for patients in wound care and early identification of pre-diabetes. The awards included General Practice Nursing Team of the Year wound care team finalists 2017, General Practice Nursing Team of the Year dermatology team finalists 2017, and General Practice Nursing awards 2018 People’s Choice award finalist. The Nurse Manager had received an invitation to Buckingham Palace in March 2018 in recognition of services for engagement in front line nursing.

The areas where the provider should make improvements are:

Review and improve the system in place and assure themselves there is oversight for checking emergency medicines and equipment.

Implement an action plan to ensure that issues identified during infection control audit are dealt with within an agreed timescale.

Develop a culture of significant event identification, analysis and dissemination of learning to all staff.

Improve the process for analysis and dissemination of learning to all staff from complaints.

Identify and increase the number of patients on the palliative care register to include all patients who have a life-limiting illness.

To improve patient access to routine appointments and named clinicians to improve continuity of care and choice for patients.

Review the higher than average Quality and Outcomes Framework exception reporting figures to assure themselves that these are accurately exception reported.

Letter from the Chief Inspector of General Practice

We carried out a focused desktop inspection of Priory Medical Centre Surgery on 27 July 2016 to assess whether the practice had made the improvements in providing safe care and services.

We had previously carried out an announced comprehensive inspection at Priory Medical Centre Surgery on 2 February 2016 when we rated the practice as good overall. The practice was rated as requires improvement for providing safe care. This was because some non-clinical staff who undertook chaperone duties had not received a Disclosure and Barring Service check (DBS). (DBS checks identify whether a person has a criminal record or is on an official list of people barred from working in roles where they may have contact with children or adults who may be vulnerable). The chaperone policy was re-written to assert that only clinicians who held a current DBS check would perform chaperone duties. We asked the provider to monitor, that the changes made to their chaperone policy were sustainable and that staff who performed this role would be DBS checked.

The provider was also asked to improve the access for patients to named GP to improve continuity of care.

We asked the provider to send a report of the changes they have made.The practice was able to demonstrate that they were meeting the standards. In addition patient access to named GP had improved as reflected in the July 2016 patient survey. We were told that the provider continued to trial different ways of working to improve continuity of care for their patients.  The practice is now rated as good for providing safe care. The overall rating remains good.

This report should be read in conjunction with the full inspection report dated 31 May 2016.

Our key finding across the area we inspected was as follows:

The practice had clearly defined and embedded systems, processes and practices in place to keep patients safe and safeguarded from abuse. Patients were not disadvantaged by the changes to the chaperone policy and this was to be closely monitored to assure sustainability.

Professor Steve Field (CBE FRCP FFPH FRCGP) 

Chief Inspector of General Practice

Letter from the Chief Inspector of General Practice

We carried out an announced comprehensive inspection at Priory Medical Centre on 2 February 2016. Overall the practice is rated as good. Priory Medical Centre is part of one large York provider (Priory Medical Group, PMG) who have nine locations. All patients can be seen at any of the locations; however, most attend one for continuity of their care.

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

• There was an open and transparent approach to safety and a system in place for reporting and recording significant events. However, we found that some of the systems to keep patients safe had not been implemented effectively.
• 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. However some staff had not had the appropriate checks undertaken to carry out some specific duties. For example not all chaperones had had a DBS disclosure check.
• Patients said they were treated with compassion, dignity and respect and they were involved in their care and decisions about their treatment.
• Information about services and how to complain was available and easy to understand.
• Patients had to wait to have an appointment with a named GP and felt there was continuity of care.
• The practice had good facilities and was equipped to treat patients and meet their needs.
• There was a leadership structure and staff felt supported by the management team. The practice proactively sought feedback from staff and patients, which it acted on.
• The provider was aware of and complied with the requirements of the Duty of Candour.

We saw an area of outstanding practice:

• PMG employ a range of health care professionals (for example: registered nurses, care workers, physiotherapist and occupational therapists) to work as York Integrated Care Team (YICT). They also work with local authority social services (specific hours are allocated) and voluntary organisations. Their  innovative approach, contacting patients who may be in need of support, assures appropriate support such as ‘step down care’ can be provided within two hours.  This  integrated person-centred care had enabled patients more choice with their care and support. The team reviews all hospital admissions and discharges each day. We saw that Non Elective Admissions(NEAs) were 5% lower than the CCG average  and Accident and Emergency attendances(A&E)  were 2.4% lower than CCG average. Some patients had become self-caring and had not needed further support  from health and social care teams.

The area where the provider should make improvement are:

• To monitor the changes made to the chaperone policy are sustainable and that staff who undertake chaperoning are DBS checked.

• To improve the access to named clinicians for patients.

Professor Steve Field (CBE FRCP FFPH FRCGP) 

Chief Inspector of General Practice

We carried out an announced, comprehensive inspection of Priory Medical Centre on 1 May 2018. We identified some issues that led to a requires improvement rating in the safe domain. The issues we found were;

The system in place to assure themselves of oversight for checking emergency medicines and equipment required reviewing and improving.

There was no action plan to ensure that issues identified during infection control audits were dealt with within an agreed timescale.

Significant event identification, analysis and dissemination of learning to all staff required improvement.

This announced focused inspection was carried out on 16 October 2018 to check whether the provider had taken steps to improve safety.

The full comprehensive report on the 1 May 2018 inspection can be found by selecting the ‘all reports’ link for Priory Medical Centre on our website at www.cqc.org.uk.

This report covers our findings in relation to those requirements.

Our key findings were as follows:

Improvements had been made with respect to safety following our last inspection on 1 May 2018. For example:

The system in place and oversight for checking emergency medicines and equipment had been reviewed and improved.

An action plan had been implemented to ensure that issues identified during infection control audits were dealt with within an agreed timescale.

The practice had taken steps to develop a culture of significant event identification, analysis and learning for all staff.

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