Archived: The Avenue Surgery

Updated 23 June 2016

The Avenue Surgery operates from a converted semi-detached house in the Alwoodley area of Leeds. The practice also has a branch site on Green Road in Meanwood which is also a converted semi-detached property. We visited both sites as part of our inspection.

The practice serves a population of approximately 4000 patients and the service is provided by one female GP partner and a female business partner/practice manager. The partners are supported by three salaried GPs (female), two practice nurses and a healthcare assistant. The clinical staff are supported by an experienced team of administration staff.

The practice is classed as being one of the lesser deprived areas in England.

Patients can access a number of clinics for example; asthma and diabetes, smoking and baby clinics and the practice offers services such as childhood vaccinations and cervical smears.

The Avenue Surgery is open as follows:

Monday, Wednesday and Friday from 8am to 6pm

Tuesday 7.30am to 6pm

Thursday 8am to 7.30pm

Green Road Surgery is open as follows:

Monday to Friday 8am to 12.30pm

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.

Services are provided under a general medical services contract. This is the contract held between the practice and NHS Commissioners. The practice is registered to provide the following regulated activities; maternity and midwifery services, family planning, diagnostic and screening procedures, surgical procedures and treatment of disease, disorder or injury. They also offer a range of enhanced services such as influenza, pneumococcal and childhood immunisations.

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 diverse range of organisations including voluntary and community groups.

Updated 23 June 2016

Letter from the Chief Inspector of General Practice

We carried out an announced comprehensive inspection at The Avenue Surgery on 25 February 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.
• 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.
• Patients said they found it easy to make an appointment with a named 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 and complied with the requirements of the duty of candour.

There were areas in which the provider should make improvements:

• Ensure that there is an accurate record of vaccination stock levels, expiry dates and running totals are maintained.

• Ensure a children’s mask is available with the emergency oxygen.

Professor Steve Field CBE FRCP FFPH FRCGP

Chief Inspector of General Practice

Updated 23 June 2016

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

• All these patients had a structured review to check that their health and medicines needs were being met. This review was undertaken on an annual basis or more often when required.

• The practice nurses had lead roles in the management of long term conditions. A GP at the practice also had an interest in diabetes which enabled insulin to be initiated without hospital attendance.

• The practice worked closely with the community matron in the management of housebound patients who had complex long term conditions, to ensure they received the care and support they needed.

• Medication reviews were undertaken on a regular basis by the GPs at the practice, with input from the Medicines Waste Workers and local medicines optimisation pharmacist.

• The practice used an electronic system to monitor patients using medicines that required regular blood tests to ensure these were carried out as required.

• The practice was participating in the Year of Care programme. This approach encouraged patients to understand their condition and have a more active part in determining their own care and support needs in partnership with clinicians.

• 100% of newly diagnosed diabetic patients had been referred to a structured education programme in the preceding 12 months; CCG average 79%, England average 90%.

• 87% of patients diagnosed with asthma had received an asthma review in the last 12 months; CCG and England averages of 75%.

• 81% of patients diagnosed with chronic obstructive pulmonary disease (COPD) had received a review in the last 12 months; CCG and England averages 90%.

Updated 23 June 2016

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

• There were systems in place 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.

• 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.

• The practice worked with midwives, health visitors and school nurses to support the needs of this population group. For example, the midwife worked from the practice one day a week and patients were seen for ante natal and post natal appointments.

• The practice had a dedicated baby clinic twice a month for baby checks, immunisations, weighing and general information.

• Immunisation uptake rates were comparable to the CCG and England rates for all standard childhood immunisations.

• Cervical screening, sexual health and contraceptive services, including implant fittings, were provided at the practice.

• 86% of eligible patients had received cervical screening (CCG and England average 82%).

Updated 23 June 2016

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

• The practice provided proactive, responsive and personalised care to meet the needs of the older people in its population.Home visits and urgent appointments were available for those patients in need.

• The practice worked closely with Leeds Community Healthcare via the Meanwood Neighbourhood Team co-ordinator to ensure access to the community matron, district nurses and social services if required.

• The practice took part in the Winter Resilience Scheme and provided additional nursing hours throughout the winter months to support the most vulnerable patients to self care and reduce demand on urgent primary care services.

• The practice used funds from the Leeds North Clinical Commissioning Group to review all patients aged 75 and over who had not attended the surgery for 12 months, with the offer of a home visit by the Health Care Assistant to ensure their needs were being met.

• 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 regularly.

• Patients were signposted to other services for access to additional support, particularly for those who were isolated or lonely.

Updated 23 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 on Monday mornings and Thursday evenings, both GP and nurse appointments were available during these hours.

• Telephone consultations were available if appropriate for patients at work.

• The practice was proactive in offering online services as well as a full range of health promotion and screening that reflected the needs for this age group.

• Health checks were offered to patients aged between 40 and 74 who had not seen a GP in the last three years. The practice were working with the Leeds North Clinical Commissioning Group and the local supermarket to enable patients to access the health checks at a more convenient time, with the result being forwarded on to the practice.

Updated 23 June 2016

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. Patients and/or their carer were given information on how to access various support groups and voluntary organisations, such as Carers Leeds.

• 78% of patients diagnosed with dementia had received a face to face review of their care in the preceding 12 months (CCG average 86%, England average 84%).

• 91% of patients who had a complex mental health problem, such as schizophrenia, bipolar affective disorder and other psychoses, had a comprehensive, agreed care plan documented in their record in the preceding 12 months (CCG average 90% and England average of 88%).

• Staff could demonstrate they had a good understanding of how to support patients with mental health needs or dementia.

• Patients who were at risk of developing dementia were screened and support provided as necessary.

• The clinicians in the practice were aware of and referred to local mental health services as appropriate.

Updated 23 June 2016

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

• Patients who had a learning disability had an annual review of their health needs and a health action plan in place.

• 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 within the practice had attended Female Genital Mutilation training and were aware of how to identify patients who may be vulnerable to this.

• We saw information about various local support groups and voluntary organisations, which patients could access as needed.