Tim Hughes The Kirkbymoorside Practice

Practice Profile

The Surgery, Tinley Garth, Kirkbymoorside, York YO62 6AR

Tel: 01751 431254

e.mail: kay.lund@gp-B82077.nhs.uk

The 3-partner practice in Kirkbymoorside serves some 5900 patients spread over a rural area covering almost 200 square miles. The main employers are agriculture, local service and light industries, and tourism. Kirkbymoorside is one of Ryedale’s four market towns, on the southern fringe of the North York Moors. It is very popular both with holidaymakers and as a retirement area because of the natural beauty of the landscape and the local amenities.

The surgery is open between 8am and 6pm. We try to ensure that patients’ needs are all met in one visit, if possible. Telephone consultations are also used as an additional means of managing patient problems. A wide range of minor operations are performed and the surgery is well equipped for investigative procedures. Much of the equipment has been purchased using funds donated by local individuals and groups; the community is very supportive of the practice.

The Practice Team

The team comprises:

Role	Number in Post	W.T.E.
“G” Grade Nurse	2	1.2
“E” Grade Nurse	1	0.32
“D” Grade Nurse	1	0.37
Counsellor	1	0.24
Receptionist/Secretary	7	3.2
Practice Manager	1	0.85
Receptionist/Clerk	1	0.27

The Surgery building is owned by the practice and was specially converted from a Victorian school building in 1989. It was extended in 1997/98 to accommodate Community and Out Patient services including Physiotherapy, X-ray, Speech Therapy, Dietetics, Orthopaedic and Mental Health Outpatient clinics currently provided by Scarborough, Whitby & Ryedale Primary Care Trust and South Tees Mental Health Trust. The district nurses, health visitors and community midwife have their base here. They, along with the therapists, are very much a part of the team and are involved in clinical meetings, "learning lunches" etc as well as social events.

There is a strong emphasis on personal development throughout the team. Individuals are encouraged and supported in their efforts to extend their skills and knowledge.

GP Registrar Timetable

The practice has been approved as a Training Practice for many years. The present Trainer is Dr Tim Hughes. A personal Learning Agenda is prepared with each Registrar as part of the induction programme. The Agenda is completely flexible and planned to meet the training needs of each individual Registrar. All the partners are then involved in the subsequent tutorials and daily clinical support.

The GP Registrar, like the partners, has a standard weekly timetable. However, there is room for flexibility and changes may be arranged if these are operationally feasible. A typical weekly timetable for the GP Registrar is as follows:

Monday MORNING Half Day Off**

12.30/13.00 Partners Business Meeting (occasional involvement)

or "Learning Lunch" / Clinical Meeting some weeks

14.30-15.30 Visits / Paperwork

15.30-17.30 Surgery

18.00 Discussion Time*

Tuesday 08.30-10.30 Surgery/timetabled minor surgery session with

Dr Moulson

10.30 Coffee and discussion time* then visits

12.00-13.30 TUTORIAL (Start time may vary by agreement)

15.30-17.30 Surgery then discussion time*

Wednesday 08.30-10.30 Surgery

10.30 Coffee and discussion time* then visits

Afternoon York VTS

Thursday 08.30-10.30 Surgery

10.30 Coffee and discussion time* then visits

14.00-15.00 Surgery then discussion time*

Time for study, paperwork

Friday 08.30-10.30 Surgery

10.30 Coffee and discussion time* then visits

13.30-15.00 TUTORIAL

15.30-17.30 Surgery then discussion time*

* The trainer or another partner will be available after each surgery to discuss cases, any problems encountered etc.

** The GP registrar's room is required twice monthly (morning only) for the orthopaedic consultant out-patient sessions. For this reason the clinic morning is the GP registrar's designated half-day (currently Monday). However, in weeks when the OP sessions do not run, or when another doctor is away, a different half-day may be selected, by mutual agreement.

Accessibility / Clinical Care

The partners and GP Registrar operate an all appointment system, currently with 10-minute appointments. Great value is placed on patients having the opportunity to make informed choices about their care. Demand is managed in such a way that patients will always be seen the same day, if necessary. The practice nurses offer a combination of appointments and open access on a daily basis. The two senior nurses carry out a significant proportion of the chronic disease management work within the practice.

In recent months new computer templates have been created to assist in the accurate capture of patient data and in essential patient monitoring (eg “amber” drugs and warfarin). We fulfil all the NSF requirements in respect of Diabetes and CHD. A systematic records check of patients on our CHD Register is under way and call/recall is being established. We are developing a Heart Failure Register and associated protocol for care. Clinical tools to assist in identification of patients at greatest risk of future strokes are available on all clinical team PCs.

We perform sigmoidoscopies in-house, thus avoiding much of the need for specialist gastro-enterology referral. Skin punch biopsies are also carried out in-house and we are also equipped for endometrial sampling.

Out of Hours

We are members of NYED (North Yorkshire Emergency Doctors) and operate, when on duty, from the local Ryedale Primary Care Centre in Malton (14 miles away). The practice receives an allocation of shifts - generally 10 - 12 shifts per month in total for the whole practice. The GP Registrar has the opportunity to shadow the partners, by arrangement, in order to gain experience in out of hours duties.

Communication and Shared Learning

The practice manager organises a range of meetings, including clinical and administrative team meetings, representative meetings (one representative from each "department"), "learning lunches" (on a wide variety of relevant topics, often with an outside speaker) and partners' business meetings.

In order to better involve the whole team in planning for the future of the practice, the "Annual Practice Team Workshop" was introduced in 2000. The surgery closes for a half-day to enable everyone to meet together and the outcomes of this workshop are then fed into the Practice Development Plan for the following year.

Information Management and IT

We were connected to NHS Net in May 2001. Direct personal access to the Network is available to all members of the Primary Health Care Team, including district nurses, health visitors and midwife, via PCs in the consulting rooms and all office areas.

During 2002 it is envisaged that the practice will be IT-linked to Pathology for direct transmission of results, also to North Yorkshire Emergency Doctors (NYED) for downloading of patient contact information into our clinical system.

A leaflet for patients outlining the information which is held about them, who has access to it and the uses to which it is put has been drafted and will be in circulation shortly.

Prescribing

We are a prescribing practice with close links to the pharmacy in the town. The practice is consistently one of the most efficient prescribers in North Yorkshire on almost all measures. The practice formulary is reviewed regularly.

Clinical Governance

There is a very strong emphasis on evidence-based practice. We use a range of IT programmes to support us in this.

Clinical Audit is a well established tool within the practice - for fact-finding and reporting and, more importantly, for identifying individual patients in order to review their care. Audit review meetings are generally patient-centred, using significant event analysis methodology. By concentrating on the “story” of individual patients and discussing whether our services have met their needs, we have been able to identify priorities for change. We are keen to expand on the use of MIQUEST so that the “reporting” audit functions may be fulfilled in an automated and consistent way. In this respect there is still work to be done in standardising Read Codes and database housekeeping.

Working with Patients, Carers and Other Organisations

The practice has very strong and positive links with the local Primary Care Trust, North Yorkshire Family Health Service and many other local organisations, including the Scarborough, Whitby & Ryedale Carers' Resource. A survey of patient satisfaction with our services (summer 2002) has been funded by the PCT as a pilot. The results of the survey will help us in our service planning. In addition we are to produce a "toolkit" for circulation to other PCT practices, documenting the survey process and including a resource section to support practices in addressing any issues which may come out of the survey.

Summary

The practice is hard-working, responsive to patients’ needs and generally a lively and cheerful place to work. Even on “difficult” days we all recognise that we are privileged to live and work in such a beautiful area. The majority of the staff have a wealth of experience and local knowledge, which is often invaluable. The staff are very loyal and staff turnover is virtually non-existent. We are forward-looking and encourage the GP Registrar to play a full part in the life and work of the practice.

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