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Inspection Summary


Overall summary & rating

Good

Updated 27 January 2017

Letter from the Chief Inspector of General Practice

We carried out an announced comprehensive inspection at Sunfield Medical Centre on 15 November 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 practice promoted a culture of openness and honesty. 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.
  • The practice 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.)
  • Risks to patients were assessed and well managed.
  • There were safeguarding systems in place to protect patients and staff from abuse.
  • There was a clear leadership structure. Staff were aware of their roles and responsibilities and told us the GPs and practice manager were accessible and supportive. There was evidence of an inclusive team approach to providing services and care for patients.
  • Staff had the skills, knowledge and experience to deliver effective care and treatment.
  • There was a good range of interventions to support patients to have a healthy lifestyle, such as smoking cessation, weight management, travel health (including being a designated Yellow Fever centre), student health and NHS health checks.
  • Patients’ needs were assessed and care was planned and delivered following local and national care pathways and National Institute for Health and Care Excellence (NICE) guidance.
  • There was good access to clinicians and patients said they found it generally easy to make an appointment. There was continuity of care and if urgent care was needed patients were seen on the same day as requested. Patients' comments were generally positive about access to services. The practice had improved access as a result of patient’s feedback. The practice had extended opening hours four days per week and were also open on Saturday mornings.
  • The GP was an NHS England clinical advisor involved with complaints across Yorkshire and could evidence a comprehensive understanding of complaints and how to respond to them. The practice had an accessible complaints system and evidence showed issues were responded quickly and learning was shared with staff.
  • The practice sought views on how improvements could be made to the service, through the use of patient surveys, the NHS Friends and Family Test and engagement with patients.

  • The practice worked closely with a local elderly action group and staff also undertook fundraising activities and had raised over £1,200 for local charities.

Professor Steve Field CBE FRCP FFPH FRCGP

Chief Inspector of General Practice

Inspection areas

Safe

Good

Updated 27 January 2017

The practice is rated as good for providing safe services.

  • Risks to patients were assessed and well managed
  • There were effective systems in place for reporting and recording significant events. There was evidence of investigation, actions taken to improve safety in the practice and shared learning with staff.
  • There was a nominated lead for safeguarding children and adults. Embedded systems and processes were in place to keep patients and staff safeguarded from abuse. We saw there was safeguarding information and contact details available for staff.
  • There were processes in place for safe medicines management.
  • There were systems in place for checking that equipment was tested, calibrated and fit for purpose.
  • There were regular checks and risk assessments undertaken, which included those relating to health and safety, such as infection prevention and control.

Effective

Good

Updated 27 January 2017

The practice is rated as good for providing effective services.

  • Staff had the skills, knowledge and experience to deliver effective care and treatment. They assessed the needs of patients and delivered care in line with local and national pathway and NICE guidance.
  • We saw evidence of annual appraisals and appropriate training for staff.
  • Clinical audits could demonstrate quality improvement.
  • End of life care was delivered in a compassionate and coordinated way.
  • Services were provided to support the needs of the practice population, such as screening and vaccination programmes, health promotion and preventative care.
  • Data from the Quality and Outcomes Framework (QOF) showed patient outcomes were generally comparable to local and national averages.
  • The practice had identified 2% of their practice population at most risk of unplanned hospital admission. These patients were followed up by the GP within three days of any hospital admission and discharge to review their health and medicine needs.
  • There was evidence of working with other health and social care professionals, such as the mental health team, to meet the range and complexity of patients’ needs.

Caring

Good

Updated 27 January 2017

The practice is rated as good for providing caring services.

  • Data from the National GP Patient Survey showed responses were variable for questions regarding the provision of care. However, comments we received from patients on the day of inspection were very positive about their care.

  • We observed that staff treated patients with kindness, dignity, respect and compassion. Patients’ comments aligned with these observations.
  • There was a variety of health information available for patients, relevant to the practice population, in formats they could understand.
  • The practice maintained a register of those patients who were identified as a carer and offered additional support as needed. Annual health checks were offered and all carers were signposted to Carers Leeds to support access to respite care
  • Appointments for carers were prioritised to minimise the impact of their absence from home.

Responsive

Good

Updated 27 January 2017

The practice is rated as good for providing responsive services.

  • The practice worked with Leeds West Clinical Commissioning Group (CCG) and other local practices to review the needs of their population.
  • The practice had good facilities and was equipped to treat patients and meet their needs.
  • Patients had access to physiotherapy, weight management, minor surgery, health visiting and midwifery services on the premises.
  • National GP patient survey responses and comments made by patients indicated appointments were available when needed. Patients' comments were generally positive about access to services. The practice had improved access as a result of patients' feedback.
  • The practice offered pre-bookable, same day and online appointments. They also provided extended hours appointments during the week and on Saturday mornings, telephone consultations and text message reminders.
  • All patients requiring urgent care were seen on the same day as requested.
  • Home visits and longer appointments were available for patients who were deemed to need them, for example housebound patients or those with complex conditions.
  • The practice staff had a good understanding of the needs of their practice population and were flexible in their service delivery to meet patient demands; such as providing additional GP appointments or telephone consultations when required.
  • The practice had an accessible complaints system and evidence showed the practice responded quickly to issues raised and learning was shared with staff.

Well-led

Good

Updated 27 January 2017

The practice is rated as good for being well-led.

  • There was a clear leadership structure and a vision and strategy to deliver high quality care and promote good outcomes for patients.
  • There were safe and effective governance arrangements in place. These included the identification of risk and policies and systems to minimise risk.
  • The provider complied with the requirements of the duty of candour. There were systems in place for reporting notifiable safety incidents and sharing information with staff to ensure appropriate action was taken.
  • The practice promoted a culture of openness and honesty. Staff and patients were encouraged to raise concerns, provide feedback or suggest ideas regarding the delivery of services.
  • The lead GP was an NHS England clinical advisor involved with complaints across Yorkshire, therefore, there was a comprehensive understanding of significant events and complaints. They utilised their experience to support safety within the practice.
  • The practice proactively sought feedback from patients through engagement with patients and their local community.
  • The practice operated a weekly ‘dress down Friday’, for which staff paid a contribution to a nominated local charity. In addition, staff also undertook fundraising activities and had raised over £1,200 for local charities.
Checks on specific services

Older people

Good

Updated 27 January 2017

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

  • Proactive, responsive care was provided to meet the needs of the older people in its population.
  • They offered rapid access appointments to those patients with enhanced needs and those who could not access the surgery due to ill health or frailty.

  • The practice participated in the enhanced care home scheme, which supported timely assessments of patients' care and treatment needs. They worked with the community consultant in elderly care to support the medical needs of these patients. Weekly ‘ward rounds’ were undertaken at a local care setting where registered patients were resident.

  • Medication reviews were undertaken every six months with those patients who were on multiple medications.
  • Registers of patients who were aged 75 and above and also the frail elderly were in place to ensure timely care and support were provided.
  • Shingles, pneumococcal and influenza immunisations were offered to patients who were eligible.
  • The practice worked closely with other health and social care professionals, such as the district nursing team, to ensure housebound patients received the care and support they needed.
  • End of life care was provided in accordance with the patients' and families/carers’ wishes as appropriate.
  • The practice worked closely with a local elderly action group and patients were signposted for additional support to help combat feelings of isolation and loneliness. The practice also donated funds towards a minibus for use by elderly people in the community.

People with long term conditions

Good

Updated 27 January 2017

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

  • The clinicians in the practice supported the management of long term conditions. Annual or six monthly reviews were undertaken to check patients’ health care and treatment needs were being met. There was an effective system for the follow-up of non-compliant patients and those who did not attend (DNA) appointments.
  • 78% of patients diagnosed with asthma had received an asthma review in the last 12 months (CCG and national averages of 75%).
  • 91% of patients diagnosed with chronic obstructive pulmonary disease (COPD) had received a review in the last 12 months (CCG average 88%, national average 90%).
  • 100% of newly diagnosed diabetic patients had been referred to a structured education programme in the preceding 12 months (CCG average 89%, national average 92%).
  • There were in-house phlebotomy services and a ‘one stop’ appointment, where patients with multiple long term conditions could be seen, to avoid the need for multiple appointments.
  • There were systems in place to support the recall of these patients for influenza and pneumococcal vaccinations.
  • Clinicians liaised with the community matron regarding care, treatment and support of these patients, particularly those who were housebound.

Families, children and young people

Good

Updated 27 January 2017

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

  • The practice worked with midwives and health visitors to support the needs of this population group. For example, through 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.
  • 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. We were informed that same day access was available for all children.
  • At between 92% to 100% immunisation uptake rates were in line with CCG and national rates for all standard childhood immunisations.
  • Sexual health, contraceptive, cervical and chlamydia screening services were provided at the practice. Eighty two percent of eligible patients had received a cervical screening test, compared to the CCG average 79% and the national average 81%.
  • All children aged two to four and those in the at risk groups were offered vaccination against influenza (nasal vaccines are used for the younger generation)
  • Human papillomavirus (HPV) vaccines were available to patients who missed vaccination at school

Working age people (including those recently retired and students)

Good

Updated 27 January 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 provided extended hours appointments on evenings and at the weekend. Telephone consultations, online booking of appointments and ordering of prescriptions were also available.
  • The practice offered a range of health promotion and screening that reflected the needs for this age group. These included NHS health checks for those aged 40 to 74 years and advice regarding smoking and alcohol.
  • Travel health advice and NHS travel vaccinations, including those for the prevention of Yellow Fever, were available.
  • Measles, mumps and rubella (MMR) and Meningitis ACWY vaccinations were offered to students. Temporary registration was also available for patients who were staying in the area for less than three months.

People whose circumstances may make them vulnerable

Good

Updated 27 January 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.
  • We saw there was information available on how patients could access various local support groups and voluntary organisations.
  • The practice identified the 2% of patients who were the most vulnerable or the highest risk of an unplanned hospital admission. Care plans were in place for these patients and collaborative working was undertook with other relevant services, such as social services or community matron.
  • All patients who had a learning disability were flagged on the computer system. Annual health reviews were undertaken and additional support was offered as befit the individual needs of those patients. Carers of these patients were also identified.

People experiencing poor mental health (including people with dementia)

Good

Updated 27 January 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.
  • At 75% the number of patients who had a complex mental health problem and had an agreed care plan documented in their record in the preceding 12 months, was lower than the CCG average of 85% and national average of 89%. However, their incidence of exception reporting was zero percent (CCG 11%, national 13%).
  • Patients and/or their carer were given information on how to access various support groups and voluntary organisations.
  • 83% of patients diagnosed with dementia had received a review of their care in the preceding 12 months. These were comparable to the CCG average of 87% and national average of 84%.
  • The practice followed up those patients who did not attend their appointments.
  • 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.
  • Patients in this category were also placed on the 2% at risk register and an alert was added on their electronic record to make clinicians aware of any additional needs or support the patient may require.