The Care Quality Commission
  • Doctor
  • GP practice

The Dekeyser Group Practice Also known as Fountain Medical Centre

Overall: Good read more about inspection ratings

Fountain Medical Centre, Little Fountain Street,, Leeds, West Yorkshire, LS27 9EN (0113) 295 1600

Provided and run by:
The Dekeyser Group Practice

All Inspections

6 July 2023

During a monthly review of our data

We carried out a review of the data available to us about The Dekeyser Group Practice on 6 July 2023. We have not found evidence that we need to carry out an inspection or reassess our rating at this stage.

This could change at any time if we receive new information. We will continue to monitor data about this service.

If you have concerns about The Dekeyser Group Practice, you can give feedback on this service.

08/01/2020

During an inspection looking at part of the service

The Dekeyser Group Practice had previously been inspected on 20 October 2016, where it had been rated as good overall.

We carried out an announced focused inspection of The Dekeyser Group Practice on 8 January 2020, following our annual review of the information available to use, including information provided by the practice. This inspection focused on the following key questions:

  • are services effective
  • are services responsive
  • are services well-led.

Because of the assurance received from our review of information, we carried forward the ratings for the following key questions:

  • are service safe (good)
  • are services caring (good).

We based our judgement of the quality of care at this service on a combination of:

  • what we found when we inspected
  • information from our ongoing monitoring of data about services
  • information from the provider, patients, the public and other organisations.

We have rated this practice as good overall. We have rated responsive and all population groups as being requires improvement because:

-Patient satisfaction regarding how easy it was to get through to someone at the practice on the telephone was significantly below local and national averages.

-Patient satisfaction regarding their experience of making an appointment was below the local and national averages.

-Patients’ comments on CQC comment cards aligned with the above.

We found that:

  • There were effective and comprehensive systems and processes in place to support good governance of the practice.
  • Staff were aware of their roles and responsibilities. They were encouraged and supported with training and development opportunities, suitable for their individual roles.
  • There was evidence of effective leadership and management. Leaders and managers had a good understanding of the challenges they faced regarding the provision of primary care services for their patient population. Staff reported there had been a positive cultural change.
  • There was a range of risk assessments, data analysis and audit to support quality improvement. Any identified areas for improvement were acted upon.
  • Staff were committed to providing high-quality accessible services.
  • Patient comments were mixed about the service. All were positive about the care they received, the premises and how staff communicated with them. However, some patients commented negatively regarding telephone access. We were informed of the difficulties the practice had encountered with the telephone system and the changes they had subsequently made.
  • The practice had introduced initiatives to support older and vulnerable patients accessing the service at their point of need.

The areas where the provider should make improvements are:

  • Continue to monitor telephone access and improve patient satisfaction regarding this issue.
  • Improve the system for filing correspondence and test results which have been acted upon.
  • Improve and reduce the exception reporting relating to the Quality and Outcome Framework mental health indicators, to support patient care.

Details of our findings and the evidence supporting our ratings are set out in the evidence table.

Dr Rosie Benneyworth BM BS BMedSci MRCGP

Chief Inspector of Primary Medical Services and Integrated Care

20 October 2016

During a routine inspection

Letter from the Chief Inspector of General Practice

We carried out an announced comprehensive inspection at The Dekeyser Group Practice on 20 October 2016. 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 an effective system in place for reporting and recording significant events.
  • Risks to patients were assessed and well managed.
  • Staff assessed patients’ needs and delivered care in line with current evidence based guidance. Staff had been trained to provide them with the skills, knowledge and experience to deliver effective care and treatment.
  • Recruitment and induction policies were in place and were appropriately used. We saw that newly recruited staff did not complete a health assessment or have their immunisation status reviewed.
  • 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. Improvements were made to the quality of care as a result of complaints and concerns.
  • Appointments with GPs were all booked on the day. In addition there were two duty doctors available each day to offer appointments or telephone triage to those patients with urgent needs. Patients told us that if they required an appointment with a named GP this could mean a longer wait to see the GP of their choice.
  • The practice had good facilities and was well equipped to treat patients and meet their needs. The practice hosted a range of other services such as physiotherapy, alcohol support services and ultrasound scanning services.
  • 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 and complied with the requirements of the duty of candour.

The areas where the practice should make improvements are:

  • Provide all newly recruited staff with access to a pre-employment health assessment to include a review of their immunisation needs, in line with Public Health England guidelines.

  • Develop systems to proactively identify those patients in residential and care homes who are subject to Deprivation of Liberty Safeguards (DOLS).

Professor Steve Field (CBE FRCP FFPH FRCGP) 

Chief Inspector of General Practice