Gildersome Health Centre

Updated 28 June 2017

Gildersome Health Centre is located on Finkle Lane, Morley, Leeds, West Yorkshire, LS27 7HL. The service operates from a single storey, purpose built building with car parking available for staff and patients. A pharmacy is located close to practice.

The practice is situated within the Leeds West Clinical Commissioning Group (CCG) and provides primary medical services under the terms of a General Medical Services (GMS) contract. This is a contract between general practices and NHS England for delivering services to the local community.

At the time of our inspection, the service was provided by two GP partners (both male), a locum GP on a temporary contract (female), a practice nurse (female) and a health care assistant (female). The clinical team were supported by a practice manager and a team of administrative and reception staff.

The current provider registered with the Care Quality Commission in November 2016 when it moved from operating as a single handed GP practice to a partnership. There is continuity of leadership and staffing between the previous provider and the current provider.

The practice serves a population of around 3,340 patients who can access a number of clinics for example; minor surgery, asthma and diabetes. The practice has a high percentage of older patients with 23% of the patient list being over 65 years old (10% of the list were aged over 75 years). The population is predominantly White British in composition.

The practice is open between 8am to 6.15pm on Monday, Tuesday, Thursday and Friday and from 7am to 6.15pm on Wednesday. Telephone contact with the practice is available on these days up to 6.30pm.

GP and nursing team appointments are available on Monday, Thursday and Friday from 8.30am to 11.30am and 3.30pm to 6pm, on a Tuesday from 8.30am to 11.30am and 2.30pm to 6pm, and on a Wednesday from 7am to 11.30am and 3.30pm to 6pm.

T he practice also works with other local GPs to offer appointments via the Morley Hub on Saturdays from 8am to 4pm and Sundays from 8am to 12 noon. This service is delivered from a nearby surgery.

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.

Updated 28 June 2017

Letter from the Chief Inspector of General Practice

We carried out an announced comprehensive inspection at Gildersome Health Centre on 17 May 2017. Overall the practice is rated as good.

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

• There was an open and transparent approach to safety and a system in place for reporting and recording significant events. We saw that incidents and events were analysed and learning shared with others in the practice.

• The practice delivered enhanced services, or participated in programmes to meet the needs of their specific population.

• The practice had defined and embedded systems to minimise risks to patient safety with regard to medicines, vaccines and the competency and training of staff.

• Staff were aware of current evidence based guidance. Staff had been trained to provide them with the skills and knowledge to deliver effective care and treatment.

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

• Information about services and how to complain was available. Improvements were made to the quality of care as a result of complaints and concerns.

• Patients we spoke with said they found it easy to make an appointment with a GP and there was continuity of care, with urgent appointments available the same day.

• The practice had good facilities and was well equipped to treat patients and meet their needs.

• There was a clear leadership structure and staff felt supported by management. The practice proactively sought feedback from staff and patients, which it acted on.

• The provider was aware of the requirements of the duty of candour. Examples we reviewed showed the practice complied with these requirements.

There were areas where the provider should make improvements:

• Review the immunity status of staff in relation to measles, mumps, rubella and chickenpox in order to assure themselves that their staff were adequately protected in line with the latest guidance.

• Review the practice health and safety risk assessments to ensure that these are fully completed, and that they have identified the necessary controls and monitoring processes to keep patients safe. In addition implement improvements to comply with the findings of the last fire risk assessment carried out in November 2016.

Professor Steve Field (CBE FRCP FFPH FRCGP) 

Chief Inspector of General Practice

Updated 28 June 2017

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

• Nursing staff had lead roles in long-term disease management and patients at risk of hospital admission were identified as a priority. Care plans had been developed and were regularly reviewed to meet the needs of these patients. To support this work staff had received additional specialist training.

• The practice worked closely with long term condition patients to develop specific care packages and offer support. For example, the practice had adopted and implemented the ‘Year of Care’ model for management of diabetic patients. This supported patients to learn about their condition, how to self-manage and how to be involved in the care planning process.

• The practice participated in a Patient Empowerment Project. The practice referred patients with long term conditions on to local groups and community activities in the voluntary sector. Referred patients were supported to develop the skills, knowledge and confidence to self-manage their condition and by this improve their overall health and wider wellbeing.
• Performance for diabetes related indicators was consistently above both the CCG and national averages. For example, 94% of patients with diabetes, on the register, had a record of a foot examination and risk classification being carried out in the preceding 12 months compared to a CCG average of 88% and a national average of 89%.
• Longer appointments and home visits were available to patients when needed, and appointments wherever possible were coordinated with the GP/nurse to prevent patients having to attend the practice unnecessarily.

• The practice followed up on patients with long-term conditions discharged from hospital and ensured that their care plans were updated to reflect any additional needs.

• All these patients had a named GP and there was a system to recall patients for a structured annual review to check their health and medicines needs were being met. For those patients with the most complex needs, the named GP worked with relevant health and care professionals to deliver a multidisciplinary package of care.

Updated 28 June 2017

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

• From the sample of documented examples we reviewed we found there were systems to identify and follow up children living in disadvantaged circumstances and who were at risk, for example, children and young people who had a high number of accident and emergency (A&E) attendances.

• Immunisation rates were relatively high for all standard childhood immunisations. The practice carried out audits to identify any child that may not have received their childhood immunisations and made contact with the parents of patients to increase uptake.

• Patients told us, on the day of inspection, that 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.

• The practice worked with midwives and health visitors to support this population group. For example, the practice hosted a midwife clinic every Tuesday morning for practice patients, and in addition provided a room for the midwife to see patients from other surgeries on a Tuesday afternoon.

• The practice had emergency processes and appointments available for acutely ill children and young people.

Updated 28 June 2017

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

• Staff were able to recognise the signs of abuse in older patients and knew how to escalate any concerns they had identified.

• The practice offered proactive, personalised care to meet the needs of the older patients in its population, and made regular reviews of patients identified on their proactive case management register.

• The practice was responsive to the needs of older patients, and offered home visits, urgent appointments and telephone consultations for those with enhanced needs.

• The practice identified at an early stage older patients who may need palliative care as they were approaching the end of life. It involved older patients in planning and making decisions about their care, including their end of life care.

• Where older patients had complex needs, the practice worked closely with other health and care partners to develop effective care packages.

• The practice nurse provided an extensive wound care service which included Doppler assessments and treatment for complex leg ulcers. A Doppler assessment helps assess the blood supply in the limbs in order to assist with treatment and care planning. This avoided the need for patients to attend secondary care services some distance from where they lived.

• Flu vaccination uptake at the practice was good and 76% of eligible patients over 65 years old had received a vaccination in 2016/2017.

Updated 28 June 2017

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

• The needs of these populations had been identified and the practice had adjusted the services it offered to ensure these were accessible, flexible and offered continuity of care.

• The practice was proactive in offering online services which included appointment booking, prescription ordering and access to some health records.

• The practice offered a full range of health promotion and screening that reflected the needs for this age group, such as NHS Health Checks, pre-diabetes screening and lifestyle advice.

• Patients could access appointments with the practice nurse and health care assistant from 7am until 8am on Wednesday mornings.

• The practice also worked with other GP partners as part of the Morley Hub which offered patients weekend appointments.

Updated 28 June 2017

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

• We saw that the practice regularly worked with multi-disciplinary teams in the case management of patients experiencing poor mental health, including those living with dementia. For example; the practice worked with a local mental health service provider who actively assessed and reviewed referred dementia patients to ensure medication was up to date and that any ongoing concerns were dealt with.

• The practice held a register of patients who were experiencing poor mental health. They used this data to plan the delivery of services such as advanced care planning and reviews.

• 92% of patients with schizophrenia, bipolar affective disorder and other psychoses had a comprehensive care plan documented in the record, in the preceding 12 months, agreed between individuals, their family and/or carers as appropriate compared to a CCG average of 85% and a national average of 89%.

• 81% of patients diagnosed with dementia had their care reviewed in a face to face meeting in the last 12 months, which was below the CCG average of 87% and the national average of 84%.

• The practice had review systems in place for monitoring repeat prescribing for patients which included those receiving medicines for their mental health needs.

• The practice had information available for patients experiencing poor mental health about how they could access various support groups and voluntary organisations.

• Staff demonstrated they had a good understanding of how to support patients with mental health needs and dementia and had received update training in this area of speciality.

• The practice made telephone calls to patients with memory issues to remind them when appointments and reviews were due.

Updated 28 June 2017

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

• The practice held registers of patients living in vulnerable circumstances including those with a learning disability and the frail elderly with complex needs. They used this information to plan and deliver specific care, and allocated additional time to deal with their needs.

• End of life care was delivered in a coordinated way which took into account the needs of those whose circumstances may make them vulnerable.

• We saw evidence that the practice regularly worked with other health care professionals in the case management of vulnerable patients.

• The practice used the frailty index audit and case management register to offer health checks, support and initiate care plans. The frailty index is used to measure the health status of ageing individuals.

• We were told by the practice that staff offered additional support to patients. For example; they had delivered prescriptions to patient’s homes, and had assisted patients with the completion of personal forms at their request.

• The practice informed vulnerable patients about how to access various support groups and voluntary organisations.

• GPs carried out reviews of vulnerable patients whilst on home visits.

• Staff interviewed 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 and report such concerns to relevant agencies in normal working hours and out of hours.