Archived: Nova Scotia Medical Centre

Updated 15 June 2016

Nova Scotia Medical Centre is a member of the Leeds South and East Clinical Commissioning Group (CCG). Personal Medical Services (PMS) are provided under a contract with NHS England. The practice is registered with the Care Quality Commission (CQC) to provide the following regulated activities: maternity and midwifery services, family planning, diagnostic and screening procedures and treatment of disease, disorder or injury. They also offer a range of enhanced services, which include:

• Childhood immunisations
• The provision of influenza and pneumococcal immunisations
• Facilitating timely diagnosis and support for patients with dementia
• Extended hours access
• Improving online access

Nova Scotia Medical Centre is located in Allerton Bywater, which is a former mining village in a semi-rural location near to Leeds and Wakefield. The catchment area for the practice is Allerton Bywater, Kippax, Swillington and Great Preston.

The practice is situated in purpose built premises, which were built in 1986. There are facilities for people with disabilities and all patient areas are on the ground floor. There are car parking facilities on site with designated disabled parking.

The practice has a patient list size of 5,474 which is made up of predominantly white British, with an almost 50:50 ratio of male and female patients. The proportion of patients aged over 65 years was greater than the CCG and national averages. Twenty percent of the practice patient list is over 65, as compared with 15% and 17% respectively for the CCG and national averages. The practice has close links with a local residential care home, where some registered patients reside.

There are four GP partners, one female and three male, who are supported by three practice nurses and two health care assistants; all female. There is a practice manager and a team of administration and reception staff. The practice also has the support of two CCG employed medicines management pharmacists.

The practice is open between 8am to 6pm Monday and Thursday, with extended hours from 6pm to 9pm on Monday. GP appointments were available 8.30am to 11.30am and 3pm to 5.30pm Monday to Friday and 6pm to 8.40pm on Monday. 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.)

One of the GP partners is clinical lead for long term conditions and adult mental health, for the Leeds South and East CCG. They are also a GP appraiser for NHS England West Yorkshire.

We were informed of the challenges the practice had undergone over the past three years, when there had been no stable practice manager in post and they had struggled to recruit a GP. During this time they had relied on the services of GP locums to meet patient demands. Two of the GPs had retired but were still working at the practice part-time to maintain GP sessions. A new partner had been successfully recruited in September 2015 and another partner was due to commence in July 2016. A full retirement date was now confirmed for one of the GPs. An experienced practice manager was also recruited in May 2015. The practice reported they felt more confident about the future of the practice and in developing a robust strategic direction.

Due to the demographics of the practice and its population, in addition to hospitals within Leeds, they are also required to liaise with Pinderfields Hospital, Wakefield and Pontefract Hospital; which are based in other CCG areas.

Updated 15 June 2016

Letter from the Chief Inspector of General Practice

We carried out an announced comprehensive inspection at Nova Scotia Medical Centre on 11 May 2016. 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. A recognised tool was used to identify patients who were considered to be at risk of fraility.
• The practice had designed a vulnerable adult search template which encompassed a multitude of factors which could contribute to vulnerability.

• The practice had good facilities and was well equipped to treat and 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 we spoke with 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 had a good understanding 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 partners promoted a culture of openness and honesty and there was a comprehensive ‘being open’ policy in place, which was reflected in their approach to safety. All staff were encouraged and supported to record any incidents using the electronic reporting system. There was evidence of good investigation, learning and sharing mechanisms in place.
• Risks to patients were assessed and well managed. There were safe and effective governance arrangements in place.
• 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, the NHS Friends and Family Test and the patient participation group.
• There was a clear leadership structure, staff were aware of their roles and responsibilities and told us the GPs and manager were accessible and supportive.
• The GP partners were forward thinking, aware of future challenges to the practice and were open to innovative practice.

We saw an area of outstanding practice:

• One of the GPs had devised and designed an effective process for amber drug monitoring. This had been acknowledged by the local CCG and was in the process of being shared with other practices. (Amber drugs are prescribed medicines which require the patient to be closely monitored in line with specific guidelines.)

Professor Steve Field CBE FRCP FFPH FRCGP 

Chief Inspector of General Practice

Updated 15 June 2016

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

• One of the GP partners was the clinical lead for long term conditions at Leeds South and East CCG.

• The GPs had lead roles in the management of long term conditions and were supported by the nursing staff. Annual reviews were undertaken to check patients’ health care and treatment needs were being met. Holistic reviews were undertaken with patients who had several co-morbitiies, which avoided the need for multiple appointments.

• The practice maintained a register of patients who were a high risk of an unplanned hospital admission. Care plans and support were in place for these patients.

• The practice was an early implementer for delivery of patient care using an approach called the Year of Care. This approach enabled patients to have a more active part in determining their own care and support needs in partnership with clinicians and a pharmacist. It was currently used with patients who had diabetes, chronic obstructive pulmonary disease (a disease of the lungs) or coronary heart disease.
• 100% of newly diagnosed diabetic patients had been referred to a structured education programme in the preceding 12 months (CCG average 87%, national average 90%).
• 69% of patients diagnosed with asthma had received an asthma review in the last 12 months (CCG and national averages of 75%).
• 78% of patients diagnosed with chronic obstructive pulmonary disease (COPD) had received a review in the last 12 months (CCG average 88%, national average 90%).
• The practice identified those patients who had complex needs and life limiting conditions and ensured they were on the palliative care register to ensure they received timely care and support.
• Patients who were at risk of developing diabetes were identified and invited in for relevant tests and follow-up.

Updated 15 June 2016

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. For example, the provision of ante-natal, post-natal and child health surveillance clinics.
• There were systems in place to identify and follow up children living in disadvantaged circumstances and who were at risk. The practice had undertaken a search and review of patients aged 0 to 18, who in the preceding 12 months had attended accident and emergency (A&E). This was to identify whether there were any repeat attendances or cause for concern.
• There was a ‘did not attend’ (DNA) protocol in place to follow up any children and young people who failed to attend a hospital appointment or immunisations at the practice.
• 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 in line with the CCG and national rates for all standard childhood immunisations.
• Sexual health, contraceptive and cervical screening services were provided at the practice.
• 81% of eligible patients had received cervical screening (CCG and national average 82%).
• Appointments were available with both male and female GPs.

Updated 15 June 2016

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 and were referred to a geriatric consultant as necessary.
• 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 CCG initiatives to reduce the rate of elderly patients’ acute admission to hospital.
• Patients who were considered to be at risk of frailty were identified and support offered as appropriate.
• Care plans were in place for those patients who were considered to have a high risk of an unplanned hospital admission and patients were reviewed as needed.
• 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 15 June 2016

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 provided extended hours appointments one evening per week, telephone consultations, online booking of appointments and ordering of prescriptions.
• The practice offered a range of health promotion and screening that reflected the needs for this age group. This included screening for early detection of chronic obstructive pulmonary disease (a disease of the lungs) for patients aged 40 and above who were known to be smokers or ex-smokers.
• 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.
• There was an in-house minor surgery clinic and phlebotomist to avoid the need for some patients having to access secondary care.

Updated 15 June 2016

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

• One of the GP partners was the clinical lead for adult mental health at Leeds South and East CCG. 
• 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. The practice had recently held a carers’ coffee morning, where a representative from Carers Leeds was in attendance.
• 87% of patients diagnosed with dementia had received a face to face review of their care in the preceding 12 months (CCG average 88%, national average 84%).
• 63% of patients who had a complex mental health problem, such as schizophrenia, bipolar affective disorder and other psychoses, who had a comprehensive, agreed care plan documented in their record in the preceding 12 months (CCG and national averages of 88%).
• Patients who were at risk of developing dementia were screened and support provided as necessary.
• Staff had a good understanding of how to support patients with mental health needs or dementia.

Updated 15 June 2016

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

• The practice routinely reviewed their patient list in order to assess whether there were any risk factors present that may have contributed to their vulnerability. Clinicians worked with other health and social care professionals, to ensure those patients had their needs met.
• 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.
• Staff were encouraged and supported to use the electronic ‘safeguarding node’ on the practice computer system. This ensured any child protection or safeguarding concerns were recorded in the same place, were linked to individual records and actions could be trackable.
• The practice could evidence the 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.
• Those patients who were on the autistic spectrum disorder were coded, which enabled additional support to be provided as needed.
• We saw there was information available on how patients could access various local support groups and voluntary organisations.
• The practice had worked with some non-English patients who had hearing impairment to understand the difficulties they had in accessing services. As a result, longer appointments were given, interpreters were booked and co-ordinated in line with the appointments and separate practice contact details were provided.