Archived: Conway Medical Centre

Updated 23 February 2017

Conway 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 has signed up to a number of local and national enhanced services (these services require an enhanced level of service provision above what is normally required under the core GP contract). These services include participating in the childhood vaccination and immunisation scheme; providing influenza and pneumococcal vaccinations; provision of extended hours access; blood borne virus and latent TB infection screening.

The practice is located at 51-53 Conway Place, Leeds LS8 5DE, which is situated within the Harehills district of Leeds. The premises were purpose built and are owned by the GP and her husband (who also works as a salaried GP at the practice). All patient areas and consulting rooms are on one level. There is disabled access and a car park to the rear.

On a scale of one to ten, the practice deprivation score is ranked by Public Health England as being one. (One represents the highest levels of deprivation and ten the lowest. Practices who have high levels of deprivation often face the most challenges in primary care.)

The patient list size is currently 2,339, the vast majority of whom are of Asian origin. There are a small number of patients who are white British or Romanian. The practice informed us that there are many patients who are non-English speaking. However, the majority of staff are multilingual befitting the languages used by the patient population. The practice has higher numbers of patients who are in the birth to 49 age range, compared to local and national averages. There is also a higher percentage of male patients than female patients. The percentage of patients who have a long standing health condition is 66%, compared to 55% locally and 53% nationally. The number of patients who are in paid work or unemployed is in line with local and national trends.

The clinical team consist of the female lead GP, a male salaried GP, a locum advanced nurse practitioner and a locum practice nurse (both of whom are female). They are supported by a team of three reception and administration staff; one of whom also works as a part-time healthcare assistant within the practice. A cleaner/housekeeper is also employed by the practice.

The practice is open between 8.30am to 6pm Monday to Friday. There are extended hours on Mondays from 6pm to 7.45pm. Morning appointments are 9.30am to 12.30pm every weekday. Afternoon sessions are Mondays 4.30pm to 7.30pm, Tuesday 4pm to 5.30pm, Wednesday and Friday 3.40pm to 5.30pm. Although the practice is open to patients on Thursday afternoons there are no clinical sessions in operation. When the practice is closed out-of-hours services were provided by Local Care Direct, which could be accessed via the surgery telephone number or by calling the NHS 111 service.

Dr Mansoor had previously been in a partnership but that had ceased mid-2016. She was now registered with the Care Quality Commission as a single handed practice. Since the departure of their employed practice manager, the practice had been supported for a period of time by practice managers from local GP practices. At the time of inspection Dr Mansoor was in the process of forming a partnership with two local GPs. These two GPs (one male, one female) had commenced working some sessions at the practice. The practice manager and a practice nurse from their practice had also been supporting the practice since November 2016.

Updated 23 February 2017

Letter from the Chief Inspector of General Practice

We carried out an announced comprehensive inspection at Conway Medical Centre on 11 and 12 January 2017. Overall, the practice is rated as good, however it is rated as requires improvement for the safe domain. Our key findings across all the areas we inspected were as follows:

• The practice had recently reviewed and updated the majority of their policies and procedures. A signatory sheet had been introduced to ensure all staff signed to say they had read and understood them.

• Staff understood their responsibilities to raise concerns. We saw evidence of investigation, actions and shared learning from those incidents which had been reported. However, it was unclear whether all incidents and near misses had been reported and recorded in the absence of a permanent practice manager. We were assured that systems had been recently reviewed to ensure all incidents were being recorded and staff had been reminded to report any incidents or near misses.
• Some risks to patients were assessed and well managed. However, it was not clear how patient safety alerts had been dealt with prior to the locum practice manager being in post. A system had since been implemented to action all relevant alerts.

• There were health and safety risk assessments in place, including fire risk. Not all staff were up to date with fire safety training. However, we were assured that staff knew what to do in such an event and that training had been arranged for staff to complete by the end of January 2017.
• Staff assessed patients’ needs and delivered care in line with current evidence based guidance.
• A health trainer was available in the practice on a weekly basis, to provide additional support for patients regarding lifestyle choices, health advice and signposting to other appropriate services.
• The most recently published national GP patient survey results showed patient satisfaction rates with the practice were lower than average. However, a practice based survey and patient comments we received on the day, were positive about the service and care they received.
• Data showed patient outcomes were in line with local and national averages.
• 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.
• Staff had a good understanding of their practice population and the majority were multilingual in languages suitable to the needs of their patients.
• We saw that staff were dedicated to improving the quality of care and were positive about any changes which were being made to achieve this.

The areas where the provider must make improvements are:

• Ensure all Patient Group Directions (PGDs) are signed by the nursing staff who are administering vaccines and medicines; in line with the latest legislation.

In addition the provider should:

• Support staff to keep up to date with mandatory training in accordance with current guidelines.
• Improve record keeping from practice, clinical and multidisciplinary meetings.
• Continue to implement, review and maintain the systems and processes which are used to govern the practice and ensure the safety of patients.

Professor Steve Field CBE FRCP FFPH FRCGP 

Chief Inspector of General Practice

Updated 23 February 2017

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

• The practice had a register of patients who had a long term condition. These patients were invited for an annual review to check their health care and treatment needs were being met.
• Regular medication reviews were undertaken, particularly with those patients who were prescribed multiple medications.

• The practice delivered care and support for some patients using an approach called the House of Care. This approach enabled patients to have a more active part in determining their own needs in partnership with clinicians. It was currently used with patients who had chronic obstructive pulmonary disease (COPD), diabetes or a high risk of diabetes.
• 50% of newly diagnosed diabetic patients had been referred to a structured education programme in the preceding 12 months (CCG average 87%, national average 90%).
• 68% of patients diagnosed with asthma had received an asthma review in the last 12 months (CCG and national averages of 75%).
• 76% of patients diagnosed with chronic obstructive pulmonary disease (COPD) had received a review in the last 12 months (CCG average 88%, national average 90%).
• We were informed that due to the impact of a reliance on locum nursing staff this had affected the numbers of reviews which had been undertaken previously. However, the practice assured us this was currently being addressed. We saw evidence of patients being on a recall and review system and an improvement on the 2015/16 review rates.

Updated 23 February 2017

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

• Patients and staff told us that 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 and pregnant women 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, in the provision of ante-natal, post-natal and child health surveillance clinics.
• There were systems 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.
• Immunisation rates were comparable to local and national uptake rates for all standard childhood immunisations.
• Meningitis vaccinations were offered to teenagers and university students in line with the national programme.
• Any children or young person identified as needing extra support were seen by a GP and referred to appropriate children’s services, such as a local mental health charity. This service provided support and advice for both the child and their family during periods of anxiety, worry, bullying or other mental health issues.
• All children and young people at risk of a safeguarding issue or deemed vulnerable were flagged on the practice computer system. These included those who were in families were domestic abuse was known.

Updated 23 February 2017

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

• The practice provided proactive, responsive care to meet the needs of their older patients. Home visits, longer or urgent appointments were available for those who needed them.
• 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.
• 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.
• Annual health checks were offered for all patients over the age of 75. These were used to assess a patient’s social, physical and psychological health and wellbeing.
• Older patients were provided with advice and support to help them to maintain their health and independence for as long as possible.
• Shingles, pneumococcal and influenza vaccinations were offered to eligible patients.
• The practice were able to identify at an early stage older patients who may need palliative care as they were approaching the end of life. Patients were involved in planning and making decisions regarding their care.

Updated 23 February 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 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 those patients at risk of diabetes.
• 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.
• Those patients who had problems with housing, debt or isolation were referred to other agencies as appropriate (this is also known as social prescribing).

Updated 23 February 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 and social services.
• Systems were in place to follow up patients who had attended accident and emergency where they may have been experiencing poor mental health.
• Patients and/or their carer were given information on how to access various support groups and voluntary organisations.
• Patients who were at risk of developing dementia were screened and support provided as necessary. Data showed that 75% of patients diagnosed with dementia had received a face to face review of their care in the preceding 12 months (CCG average 87%, national average 84%). Personalised care plans were in place for these patients.
• Staff could demonstrate how to support patients with mental health needs or dementia.
• The practice had a system for monitoring repeat prescribing for patients receiving medicines for mental health needs.
• 100% 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%).
• Longer appointments were available for patients within this group.

Updated 23 February 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 patients whose circumstances may make them vulnerable. For example, young girls who were at risk of FGM (female genital mutilation). 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.
• Patients who did not attend their appointments were contacted and supported to access care and treatment as needed.
• The practice regularly worked with multidisciplinary teams in the case management of people in this population group, for example MARAC (multi-agency risk assessment conference - a meeting of professionals to support people at high risk of serious harm).
• A register was maintained of all patients who had a learning disability. All these patients were invited for an annual health review.
• Patients’ records were flagged to alert staff to a patient who may be vulnerable. This also included those patients known to encounter domestic abuse. In those instances, children were also flagged as being vulnerable.
• Patients and/or their carer were given information on how to access various support groups and voluntary organisations.
• Longer appointments were available for patients in this group as needed.