Archived: Sunfield Medical Centre

Updated 27 January 2017

Sunfield Medical Centre is a member of the Leeds West Clinical Commissioning Group (CCG). Personal Medical Services (PMS) are provided under a contract with NHS England. The practice is also registered with the Care Quality Commission (CQC). They offer a range of enhanced services, which include:

• extended hours access
• delivering childhood, influenza and pneumococcal vaccinations
• facilitating timely diagnosis and support for people with dementia
• identification of patients at a high risk of an unplanned admission and providing additional support as needed
• being a designated Yellow Fever centre

The practice is located at Sunfield Place, Stanningley, Pudsey LS28 6DR. The building had a lot of known history within the community; it had previously been a children’s home and a refugee centre during the war years. In 1986 the building became the practice it is today. We were informed that some patients had been residents in its former life. The property is currently owned by the lead GP and a retired GP partner. It is a three story detached building with car parking and a designated disabled space. There are four consulting rooms and two treatment rooms; all of which are on the ground floor.

The patient list size is currently 4,256 and made up of predominantly white British with a small number of patients from mixed ethnic backgrounds. Patient demographics are comparable to CCG averages. For example, 65% of patients are in paid work or full-time education, compared to the CCG average of 66%. The percentage of patients unemployed is 4% (CCG 5%). There are 53% of patients who have a long standing health condition (CCG 51%). The deprivation score for Sunfield Medical Centre in 2015 was 20%, compared to the CCG average of 23%.

There is a full-time male GP and a female GP locum (who works term-time only). Regular sessional or locum GPs are used to support appointment demand or for holiday cover. Nursing staff consists of an advanced nurse practitioner (two days per week), two practice nurses and a health care assistant; all of whom are female. The clinicians are supported by a business manager, an assistant practice manager and a team of administration and reception staff who oversee the day to day running of the practice. The practice also employs a housekeeper who oversees the cleaning of the building.

The practice is open Monday to Fridays 8am to 8pm (closes at 6pm on Wednesdays) and from 9am to 12 midday on Saturdays. Appointments can be pre-booked, made on the same day or a telephone consultation can be arranged. Appointments are available 8am to 11.30am Monday to Friday and 1.30pm to 3.30pm, 5pm to 7.30pm Monday to Friday (Wednesday is 3.30pm to 5.30pm only). Saturday appointments are 9.30am to 11.30am. 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 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

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.

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

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.

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.

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.

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.