Archived: Gildersome Health Centre

Updated 12 January 2017

Gildersome Health Centre is located on Finkle Lane, Morley, Leeds, West Yorkshire, LS27 7HL. The service operates from a single storey, purpose built building with car parking available for staff and patients.

The practice is situated within the Leeds West Clinical Commissioning Group (CCG) and provides primary medical services under the terms of a General Medical Services (GMS) contract. This is a contract between general practices and NHS England for delivering services to the local community.

At the time of our inspection, the service was provided by a lead GP (male) and a salaried GP (male), a practice nurse (female) and a health care assistant (female). Although there was no female GP at the practice, patients had access to a chaperone. The clinical team were supported by a practice manager and experienced team of administrative and reception staff.

Following the inspection the practice submitted an application to the Care Quality Commission to register as a partnership and at the time of publication this application is being considered.

The practice serves a population of 3,329 patients who can access a number of clinics for example; minor surgery, asthma and diabetes

The practice is open between the hours 8am until 6.30pm Monday to Friday. Extended hours are also provided between 7am and 8am on Wednesday morning (for nurse and health care assistant appointments). From 6.30pm until 8pm on Monday evenings and from 6.30pm until 7pm on Wednesday and Thursday evenings.

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.

Updated 12 January 2017

Letter from the Chief Inspector of General Practice

We carried out an announced comprehensive inspection at Gildersome Health Centre on 12 July 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.
• 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.

The areas where the provider should make improvements are:

• Review their arrangements for clinical audit at the practice. Clinical audits should be clearly linked to patient outcomes, monitored for effectiveness and be comprised of two or more cycles to monitor improvements to patient outcomes.
• Take steps to review and improve the recording of meetings that are taking place within the practice, including the subject matter discussed, decisions made and action taken as a result.
• The practice should review their significant event and incident reporting systems in order to ensure that they are identifying, reporting, recording, investigating and learning from all such incidents, including near misses.

Professor Steve Field (CBE FRCP FFPH FRCGP) 

Chief Inspector of General Practice

Updated 12 January 2017

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

• Nursing staff had lead roles in chronic disease management and patients at risk of hospital admission were identified as a priority.
• The practice had implemented the ‘Year of Care’ model for management of diabetic patients. This supports patients to learn about their condition, how to self-manage and be involved in the care planning process.
• 97% of patients with diabetes, on the register, had a record of a foot examination and risk classification. This was better than the CCG and national averages of 88%.
• 100% of patients newly diagnosed with diabetes, on the register, the in the preceding 12 months had a record of being referred to a structured education programme, compared to the CCG average of 88% and national average of 90%.
• Longer appointments and home visits were available when needed.
• Where possible, appointments were co-ordinated with the GP and practice nurse to save patients having to attend the surgery more than once.
• All these patients had a named GP and a structured annual review to check their health and medicines needs were being met. For those patients with the most complex needs, the named GP worked with relevant health and care professionals to deliver a multidisciplinary package of care.

Updated 12 January 2017

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 A&E attendances.
• Immunisation rates were relatively high for all standard childhood immunisations. The practice carried out audits to identify any child that may not have received their childhood immunisations and made contact with the parents of patients to increase uptake.
• Patients told us that children and young people were treated in an age-appropriate way and were recognised as individuals, and we saw evidence to confirm this.
• Appointments were available outside of school hours and the premises were suitable for children and babies.
• The practice had a policy to add extra appointments to accommodate any sick child with a same day appointment.
• We saw positive examples of joint working with midwives, health visitors and school nurses. The practice hosted a midwife session on Wednesday morning for patients registered at the practice.

Updated 12 January 2017

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

• The practice offered proactive, personalised care to meet the needs of the older people in its population.
• The practice was responsive to the needs of older people, and offered home visits and urgent appointments for those with enhanced needs.
• The practice offered health checks for patients aged 75 years and over and produced care plans where appropriate.
• Telephone appointments were available for patients with mobility difficulties who were not able to attend the practice for an appointment.
• The practice nurse provided an extensive wound care service including Doppler assessments and complex leg ulcer treatments for patients at the practice. A Doppler assessment helps to assess the blood supply in the arms and legs in order and assist with treatment plans.

Updated 12 January 2017

The practice is rated as good for the care of working-age people (including those recently retired and students).

• The needs of the working age population, those recently retired and students 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 was proactive in offering online services as well as a full range of health promotion and screening that reflects the needs for this age group.
• The practice offered extended hours from 6.30pm until 8pm on Monday evenings and from 6.30pm until 7pm on Wednesday and Thursday evenings. In addition, patients could also access appointments with the practice nurse and health care assistant from 7am until 8am on Wednesday mornings.
• The practice was also part of the Morley hub which offered patients appointments between the hours of 8am and 12pm on Saturday mornings.
• NHS health checks were offered to patients aged between 40 and 74. This included pre-diabetic screening and lifestyle advice to tackle obesity.

Updated 12 January 2017

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

• 71% of patients diagnosed with dementia had their care reviewed in a face to face meeting in the last 12 months, which was lower than the CCG average of 83% and national average of 84%
• 93% of patients with schizophrenia, bipolar affective disorder and other psychoses had a comprehensive care plan, documented in the record, in the preceding 12 months. This was higher than the CCG and national averages of 88%.
• The practice regularly worked with multi-disciplinary teams in the case management of patients experiencing poor mental health, including those with dementia.
• The practice carried out advance care planning for patients with dementia.
• The practice had told patients experiencing poor mental health about how to access various support groups and voluntary organisations.
• The practice had a system in place to follow up patients who had attended accident and emergency where they may have been experiencing poor mental health.
• Staff had a good understanding of how to support patients with mental health needs and dementia.

Updated 12 January 2017

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

• The practice held a register of patients living in vulnerable circumstances including homeless people, travellers and those with a learning disability.
• The practice offered longer appointments for patients with a learning disability.
• The practice regularly worked with other health care professionals in the case management of vulnerable patients.
• The practice used the frailty index audit and case management register to offer health checks, support and initiate care plans. The frailty index is used to measure the health status of ageing individuals.
• Staff within the practice offered additional support to patients. For example; delivering prescriptions and assisting with completion of personal forms at the patient’s request.
• The practice informed vulnerable patients about how to access various support groups and voluntary organisations.

Staff knew how to recognise signs of abuse in vulnerable adults and children. Staff 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. However, the practice had recently changed the nominated lead and at the time of our inspection this had not been communicated to all staff.