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Inspection Summary


Overall summary & rating

Good

Updated 16 August 2016

Letter from the Chief Inspector of General Practice

We carried out an announced comprehensive inspection at Dr A Khan and Dr K Muneer’s practice on 26 July 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:

  • There was a clear leadership structure, staff were aware of their roles and responsibilities and told us the GPs 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.
  • 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.
  • Information regarding the services provided by the practice and how to make a complaint was readily available for patients.
  • 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 and their local community.
  • Risks to patients were assessed and well managed.
  • The practice had a very organised approach to working systems and processes, which was evidenced in their policies, staff personnel files and locum recruitment.
  • There was a system in place whereby after all policies had been updated, they were reviewed and signed off by one of the GP partners. We saw evidence of the signed and dated signatory sheet for all policies. Policies were available to all staff via the computer or as a paper copy.
  • There were safeguarding systems in place to protect patients and staff from abuse.
  • The practice promoted a culture of openness and honesty. There was a nominated lead who had a very organised approach for dealing with significant events. 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.)

We saw an area of outstanding practice:

  • Patient comments we received were overwhelmingly positive about the practice. The last two national patient surveys regarding the practice, had shown that patient averages for positive experiences were consistently higher than local and national averages. For example:
  • 96% of respondents said they could easily get through to the practice by telephone, compared to 68% locally and 73% nationally.
  • 99% of respondents said the last appointment they got was convenient, compared to 91% locally and 92% nationally.

Professor Steve Field CBE FRCP FFPH FRCGP 

Chief Inspector of General Practice

Inspection areas

Safe

Good

Updated 16 August 2016

The practice is rated as good for providing safe services.

  • Risks to patients were assessed and well managed
  • There were systems in place for reporting and recording significant events and near misses. There was a nominated lead who ensured all incidents were recorded on the electronic reporting system and could evidence a very organised approach. 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. Systems 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 and the practice was supported by a local Clinical Commissioning Group (CCG) pharmacist.
  • There were systems in place for checking that equipment was tested, calibrated and fit for purpose.
  • There was a nominated lead for infection prevention and control (IPC), who demonstrated a very organised and knowledgeable approach. They undertook regular IPC audits and checks of the building.
  • The practice undertook three yearly Disclosure and Barring Service check (DBS) checks on all staff; as per best practice.

Effective

Good

Updated 16 August 2016

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 need of patients and delivered care in line with local pathways and national guidance. We saw examples of the practice responding to up to date NICE guidance when managing the care of patients.
  • The practice were supported by the local CCG pharmacy team to ensure effective prescribing was undertaken.
  • We saw evidence of appraisals and up to date training for staff.
  • There was evidence of working with other health and social care professionals, such as the community matron, to meet the range and complexity of patients’ needs.
  • We saw evidence of clinical audits which 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 variable compared to local and national averages.
  • As a result of participating in the Winter Pressure Scheme 2015/16, the practice could evidence a reduction in out of hours and accident and emergency attendances; despite an increase in their patient list size during that period.

Caring

Good

Updated 16 August 2016

The practice is rated as good for providing caring services.

  • Data from the National GP Patient Survey showed patients rated the practice higher than other practices for the majority of questions regarding the provision of care. Comments we received from patients on the day of inspection were positive about staff and their care.

  • We observed that staff treated patients with kindness, dignity, respect and compassion.
  • Clinical and administrative staff demonstrated a commitment to providing good care for their patients.
  • There was a variety of health information available for patients, relevant to the practice population, in formats they could understand.

Responsive

Good

Updated 16 August 2016

The practice is rated as good for providing responsive services.

  • The practice worked with Leeds South and East Clinical Commissioning Group (CCG) and other local practices to review the needs of their population.

  • The practice had good facilities and was well equipped to treat patients and meet their needs.
  • National GP patient survey responses regarding access were very positive and consistently rated the practice higher than local and national practices. For example, 96% of respondents said they could easily get through to the practice by telephone, compared to 68% locally and 73% nationally.

  • The practice offered pre-bookable, same day and online appointments. They also provided extended hours appointments one day per week, 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, such as housebound patients or those with complex conditions.
  • The practice prided themselves on their patient access and were constantly looking at how they could improve.
  • There was an accessible complaints system. Evidence showed the practice responded quickly to issues raised and learning was shared with staff.

Well-led

Good

Updated 16 August 2016

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.
  • 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.
  • There were safe and effective governance arrangements in place. These included the identification of risk and policies and systems to minimise risk.
  • The practice had a very organised approach to working systems and processes, which was evidenced in their polices, staff personnel files and locum recruitment.
  • There was a system in place whereby after all policies had been updated, they were reviewed and signed off by one of the GP partners. We saw evidence of the signed and dated signatory sheet for all policies. Policies were available to all staff via the computer or as a paper copy.
  • There were good documented records of checks made within the practice, such as DBS checks, vaccine fridge temperatures, stock and equipment.
  • We saw evidence of comprehensive and detailed formal minutes for meetings, such as practice, multidisciplinary, palliative care and safeguarding.
  • 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 practice proactively sought feedback through engagement with patients and their local community.
  • Patient comments we received were overwhelmingly positive about the practice. The last two national patient surveys regarding the practice, had shown that patient averages for positive experiences were consistently higher than local and national averages.
Checks on specific services

People with long term conditions

Good

Updated 16 August 2016

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

  • The practice maintained a register of patients who were a high risk of an unplanned hospital admission. Care plans and support were in place for these patients.
  • The practice had a same day access policy for those patients who experienced a deterioration in their condition. Longer appointments were also available as needed.

  • The practice delivered care and support for some patients using the Year of Care model. 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, pre-diabetes or coronary heart disease (CHD).
  • In line with best practice, six monthly or annual reviews were undertaken to check patients’ health care and treatment needs were being met. For example:

  • 79% of patients diagnosed with 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 87%, national average 90%)
  • 76% of patients diagnosed with asthma had received a review in the last 12 months (CCG and national average 75%)

Families, children and young people

Good

Updated 16 August 2016

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

  • The practice worked with midwives, health visitors and school nurses to support the needs of this population group. For example, 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.
  • There was a paediatric trained GP who held quarterly meetings with the health visitor to discuss any concerns regarding children aged five years and under.
  • 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. Same day access was available for all children under the age of five.
  • The practice had a dedicated individual who dealt with the recall of children requiring vaccinations. Uptake rates for all standard childhood immunisations were between 97% and 100%.
  • Sexual health, contraceptive and cervical screening services were provided at the practice.
  • 87% of eligible patients had received cervical screening in the preceding five years (CCG and national average 82%).

Older people

Good

Updated 16 August 2016

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.
  • 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. Health checks were offered for all these patients and all had a named GP.
  • 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.
  • Influenza vaccinations were offered and the practice could evidence an 82% uptake between October 2015 and March 2016.

Working age people (including those recently retired and students)

Good

Updated 16 August 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 appointments from 7.30am one morning a 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 of this age group. This included screening for early detection of COPD (a disease of the lungs) for patients aged 35 and above who were known to be smokers or ex-smokers.
  • NHS health checks were offered to patients aged between 40 and 74 who did not have a pre-existing condition.
  • Travel health advice and vaccinations were available.

People experiencing poor mental health (including people with dementia)

Good

Updated 16 August 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.
  • 83% of patients diagnosed with dementia and 80% of patients who had a complex mental health problem, such as schizophrenia, bipolar affective disorder and other psychoses, had received a review of their care in the preceding 12 months. These were both lower than the CCG and national averages of 88%.
  • Staff had a good understanding of how to support patients with mental health needs or dementia.
  • Screening blood tests were undertaken for patients who were prescribed lithium and were under the care of psychiatric services. The results were forwarded onto the psychiatric team for information to support continuity of care.

People whose circumstances may make them vulnerable

Good

Updated 16 August 2016

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.
  • Patients were signposted to other agencies for additional care and support as needed.