Archived: The Surgery

Updated 2 May 2017

The Surgery is a member of the Leeds South and East Clinical Commissioning Group (CCG). Personal Medical Services (PMS) are provided under a contract with Leeds South and East CCG. They also offer a range of enhanced services, which include:

• Childhood vaccination and immunisations

• The provision of influenza and pneumococcal immunisations

• Facilitating timely diagnosis and support for patient with dementia

The Surgery is located at 179 York Road, Leeds LS9 7RD an area on the outskirts of the city and is within the 10% of most deprived localities in England.

One Medicare took the contract to provide primary care services form this location in April 2016. NHS England awarded the contract to Onemedicalgroup for a period of initially nine months which was extended to one year and identified the current location as suitable for the delivery of primary care services. We observed many problems with the premises including tears to flooring in consulting rooms and paint lifting due to crumbling wall plaster. The practice was in negotiations with the CCG regarding the suitability of the premises. The provider told us they did home visits to patients who were unable to access the upstairs consulting rooms, but some patients insisted on making efforts to access the consulting rooms.

The practice is situated in a former residential house. There are no facilities for people with disabilities and all consulting rooms are on the first floor. There is no lift available making the building unsuitable for patients with access difficulties. There are no car parking facilities on site, but street parking is available.

The practice has a patient list size of 1,480 which is made up of a population with 30% of patients from the Black and Ethnic Minority Group.

The quality of care prior to April 2016 had been lower than comparable practices, as evidenced by the latest published QOF results contained within this report which reflected a lack of reviews taking place for patients living with long term conditions and medication reviews. Since April 2016 many reviews have taken place and QOF performance has significantly improved. This had resulted in the new provider raising QOF performance from 48% in 2015/16 to 85% for part year (10 months) in 2016/17. This data has yet to be verified or published.

There are two regular GP’s (both male), who are supported by one advance nurse practitioner (female), one practice nurse and two health care assistant. The practice also uses clinicians from other One Medicare group surgeries and locums as necessary. There is a practice manager and a team of administration and reception staff. The group also has support from a range of professionals employed across the surgeries it manages such as pharmacists and support and advice advisor. The practice also has the support of a CCG employed medicines management pharmacists.

The practice is open Mondays to Friday between 8.00am and 6.30pm. When the practice is closed out-of-hours services, are provided by Local Care Direct, which can be accessed via the surgery telephone number or by calling the NHS 111 service.

The practice has good working relationships with local health, social and third sector services to support provision of care for its patients. (The third sector includes a very diverse range of organisations including voluntary, community, tenants’ and residents’ groups.)

Updated 2 May 2017

Letter from the Chief Inspector of General Practice

We carried out an announced comprehensive inspection at The Surgery on 22 February 2017. Overall the practice is rated as good for providing safe, effective, caring, responsive and well-led care for all of the population groups it serves.

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

• The ethos and culture of the practice was to provide good quality service and care to patients.

• Patients told us they were treated with compassion, dignity and respect and were involved in care and decisions about their treatment.

• Patients’ needs were assessed and care was planned and delivered following best practice guidance.

• The practice was able to meet the needs of patients. Information regarding the services provided by the practice and how to make a complaint was readily available for patients.

• Patients reported they were positive about access to the service. They said they found it generally easy to make an appointment, there was continuity of care and urgent appointments were available on the same day as requested.

• The practice of, and complied with, the requirements of the duty of candour. (The duty of candour is a set of specific legal requirements that providers of services must follow when things go wrong with care and treatment.)

• The organisation a culture of openness and honesty which was reflected in their approach to safety.

• Risks to patients were assessed and well managed.

• There were comprehensive safeguarding systems in place; particularly around vulnerable children and adults.

• The practice sought patient views how improvements could be made to the service, through the use of patient surveys and the NHS Friends and Family Test.

• There was a clear leadership structure, s

• The organisation was forward thinking, aware of future challenges to the practice and were open to innovative practice.

The areas of practice where the provider should make improvements are:

• Undertake the fire evacuation drill that has already been planned as a priority

• Take steps to develop a Patient Participation Group for the surgery and consider using their experience and resources in the further development of the surgery.

• Continue to improve the identification of carers to assure themselves that they are identifying them effectively and are able to offer them appropriate support.

• Continue to engage with commissioners regarding the limitations of the premises and as far as practicable take reasonable steps to resolve these.

Professor Steve Field (CBE FRCP FFPH FRCGP) 

Chief Inspector of General Practice

Updated 2 May 2017

The practice is rated as good for the care of people with long term conditions.

• The GPs had lead to check patients’ health care and treatment needs were being met.

• The practice identified those patients who had complex needs. The practice ensured that those patients with life limiting conditions were on the palliative care register. These patients were discussed at the Gold Standards Framework (GSF) meeting to ensure the correct support and care was delivered.

• The latest published QOF data (2015/16 related to the previous provider, who had achieved 49% of the total number of points available compared to a CCG average of 95% and a national average of 96%. However, the practice provided us with data relating to the period 2016/17 which showed improvements they had made.  The data was incomplete and unpublished due to the end of the QOF year not being until 31 March 2017. On the date of the inspection, with six weeks remaining, the practice had already achieved 85% of the QOF points available. This had been achieved by undertaking comprehensive reviews of patients who had long term conditions and patients who were on multiple medications.

Updated 2 May 2017

The practice is rated as good for the care of families, children and young people.

• The practice worked with midwives, health visitors and school nurses to support the needs of this population group
• There were systems in place to identify and follow up children living in disadvantaged circumstances and who were at risk. The practice had meetings with the health visitors where concerns were discussed regarding all the families known to be at risk.
• Patients and staff told us children and young people were treated in an age-appropriate way and were recognised as individuals.
• Appointments were available outside of school hours and the premises were suitable for children and babies. All children who required an urgent appointment were seen on the same day as requested.
• Immunisation uptake rates were better than the CCG and national rates for all standard childhood immunisations.
• Data from the previous provider showed that 79% of eligible patients had received cervical screening (CCG average 82% and national average 80%).
• Appointments were available with both male and female GPs.
• The practice extensively used text messaging to increase uptake and attendance for health care.

Updated 2 May 2017

The practice is rated as good for the care of older people.

• The practice provided proactive, responsive and person-centred care to meet the needs of the older people in its population. All elderly patients had a named GP.
• The practice worked closely with other health and social care professionals, such as the district nursing and local neighbourhood teams, to ensure housebound patients received the care and support they needed.
• The practice participated in Leeds South and East Clinical Commissioning Group (CCG) initiatives to reduce the rate of elderly patients’ acute admission to hospital.
• Health checks were offered for all patients over the age of 75 who had not seen a clinician in the previous 12 months.
• Patients were signposted to other local services for access to additional support, particularly for those who were isolated or lonely.

Updated 2 May 2017

The practice is rated as good for the care of working age people (including those recently retired and students).

• The needs of these patients had been identified and the practice had adjusted the services it offered to ensure these were accessible, flexible and offered continuity of care.
• The practice offered a range of health promotion and screening that reflected the needs for this age group.
• Health checks were offered to patients aged between 40 and 74 who had not seen a GP in the last three years.
• Students were offered public health recommended vaccinations prior to attending university.
• Travel health advice and vaccinations were available.
• The practice utilised electronic booking of appointments, prescribing and telephone appointments to provide improved access for working people.

Updated 2 May 2017

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

• The practice regularly worked with multidisciplinary teams in the case management of people in this population group, for example the local mental health team.
• Patients and/or their carer were given information on how to access various support groups and voluntary organisations.
• Staff had a good understanding of how to support patients with mental health needs or dementia and offered flexible appointments.
• Deprivations of Liberty Safeguards were written in the patient’s clinical notes.
• The practice used the support of voluntary organisations to develop additional services for their patients.

Updated 2 May 2017

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

• Staff knew how to recognise signs of abuse in children, young people and adults whose circumstances may make them vulnerable. They were aware of their responsibilities regarding information sharing, documentation of safeguarding concerns and how to contact relevant agencies in normal working hours and out of hours.
• The practice could evidence a number of children who were on a child protection plan (this is a plan which identifies how health and social care professionals will help to keep a child safe).
• Patients who had a learning disability received an annual review of their health needs and a care plan was put in place. Carers of these patients were also encouraged to attend, were offered a health review and signposted to other services as needed.
• We saw there was information available on how patients could access various local support groups and voluntary organisations.