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The Leeds Road Practice Good

Inspection Summary


Overall summary & rating

Good

Updated 29 August 2017

Letter from the Chief Inspector of General Practice

We carried out an announced comprehensive inspection at the surgery of The Leeds Road Practice, Harrogate on 19 May 2016. Overall the practice was rated as good; however a breach of the legal requirements was found which resulted in the practice being as rated as requires improvement for providing safe services.

Following on from the inspection the practice provided us with an action plan detailing evidence of the actions they had taken to meet the standards relating to providing safe services.

We undertook a desk based review on 18 July 2017 and visited the practice on 25 July 2017. This was to review in detail the information the practice had sent to us and to confirm that the practice were now meeting the relevant standards of care.

A full comprehensive report which followed the inspection on 19 May 2016 can be found by selecting ‘all reports’ link for The Leeds Road Practice on our website at www.cqc.org.uk.

The practice is now rated as good for providing safe services.

Our key findings across the areas we inspected were as follows:

  • Staff had completed Disclosing and Barring Service (DBS) checks when appropriate. Risk assessment had been completed for those staff that did not have a DBS check.

  • All significant events were analysed systematically and themes identified. These findings and themes were discussed at multidisciplinary team meetings and acted upon

  • All issues identified in the previous fire risk assessment had been addressed.

  • Patients subject to Alternative Medical Schemes (AMS) contracts were clearly identified on the clinical system. Protocols were in place with clear instructions for staff. AMS contracts are in place where patents are deemed to be a possible risk to practice staff.

  • All drivers delivering medicines to patients’ homes had received appropriate training. DBS checks were in place for these staff.

  • All staff had completed Basic Life Support training and most had also completed training in relation to managing emergencies in general practice.

Professor Steve Field (CBE FRCP FFPH FRCGP) 

Chief Inspector of General Practice

Inspection areas

Safe

Good

Updated 29 August 2017

This inspection was conducted to review issues that were found at the comprehensive inspection carried out on 19 May 2016. The issues at the previous inspection included:

The information as specified in Schedule 3 of regulation 19 of the Health and Social Care Act was not available in relation to each such person employed for carrying on the regulated activities. Specifically, the practice had not completed a Disclosure and Barring Service (DBS) check or risk assessment for delivery drivers that were employed by the practice to deliver medicines to patients in the community.

In addition:

The practice did not have adequate systems in place to undertake detailed analysis of significant events over a period of time to enable themes to be identified and appropriate action taken.

The practice had not ensured they assessed and managed the outstanding issues identified as high risk in the recent fire risk assessment.

The practice did not ensure that they had a specific risk assessment in place in respect to alternative medical schemes (AMS) patients when visiting the practice. The AMS scheme is for patients deemed to pose risk to practices and have been removed from other practice lists.

Not all staff had completed emergency response training.

At this inspection in July 2017 we found;

  • All staff had a DBS check or had a risk assessment in place with the exception of one member of staff who had no patient contact.

  • All significant events were analysed systematically and themes identified. These findings and themes were discussed at multidisciplinary team meetings and acted upon

  • All issues identified in the previous fire risk assessment had been addressed

  • The AMS contract had clear protocols in place and these were accessible on the computer system with alerts and instructions on the individual patient records.

  • The practice had reviewed the delivery of medicines to patient’s protocols and practices and all delivery drivers were now DBS checked and had completed mandatory and specific training relating to this duty.

  • All staff had completed Basic Life Support training and most, with the exception of newly appointed staff, had also completed training in relation to managing emergencies in general practice. Training on emergecies was forward planned to occur every two years..

Effective

Good

Updated 1 July 2016

The practice is rated as good for providing effective services.

  • Our findings at inspection showed that systems were in place to ensure that all clinicians were up to date with both National Institute for Health and Care Excellence (NICE) guidelines and other locally agreed guidelines.
  • We also saw evidence to confirm that these guidelines were positively influencing and improving practice and outcomes for patients. There had been 13 clinical audits completed from May 2015 to April 2016. Seven of these were completed audits where the improvements made were implemented and monitored and three audits were planned to complete the audit cycle.
  • Data showed that the practice was performing highly when compared to practices nationally and in the Clinical Commissioning Group. The practice had achieved 100% of the total number of points available for the Quality and Outcomes Framework (QOF). This was above the CCG average of 98% and the national average of 95%. The practice had an exception reporting rate comparable to national averages with most being below the national averages.
  • The practice used innovative and proactive methods to improve patient outcomes and working with other local providers to share best practice.

Caring

Good

Updated 1 July 2016

The practice is rated as good for providing caring services.

  • The results of the national GP patient survey were mixed with some of the data being above and some being below the national averages for several aspects of care.
  • Patients told us they were treated with compassion, dignity and respect and they were involved in decisions about their care and treatment.
  • Information for patients about the services available was easy to understand and accessible.
  • We saw staff treated patients with kindness and respect, and maintained patient and information confidentiality.
  • We observed members of staff were courteous and very helpful to patients and treated them with dignity and respect.
  • Due to the layout of the reception area conversations could sometimes be overheard. We observed staff trying to manage patient confidentiality well.

Responsive

Good

Updated 1 July 2016

The practice is rated as good for providing responsive services.

  • Practice staff reviewed the needs of its local population and engaged with the NHS England Area Team and CCG to secure improvements to services where these were identified.
  • Patients mostly said they found it easy to make an appointment with a GP and there was continuity of care, with urgent appointments available the same day. The practice had made recent changes to their appointment system in response to challenges patients experienced in accessing appointments.
  • The practice was well equipped to treat patients and meet their needs.
  • Information about how to complain was available and easy to understand and evidence showed the practice responded quickly to issues raised. Learning from complaints was shared with staff and other stakeholders.

Well-led

Good

Updated 1 July 2016

The practice is rated as good for being well-led.

  • The practice had a clear vision and strategy to deliver high quality care and promote good outcomes for patients. Staff were clear about the vision and their responsibilities in relation to it.
  • There was a clear leadership structure and staff felt supported by management. The practice had a number of policies and procedures to govern activity and held regular governance meetings.
  • There was an overarching governance framework which supported the delivery of the strategy and good quality care. This included arrangements to monitor and improve quality and identify risk.
  • The provider was aware of and complied with the requirements of the duty of candour. The partners encouraged a culture of openness and honesty. The practice had systems in place for notifiable safety incidents and ensured this information was shared with staff and the CCG to ensure appropriate action was taken
  • The practice proactively sought feedback from staff and patients, which it acted on.
  • The patient participation group was very active.
  • There was a strong focus on continuous learning and improvement at all levels.
Checks on specific services

People with long term conditions

Good

Updated 1 July 2016

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

  • GPs and nurses had lead roles in chronic disease management and patients at risk of hospital admission were identified as a priority.
  • Performance for diabetes related indicators was better than the national average. For example the percentage of patients on the diabetes register, with a record of a foot examination and risk classification within the preceding 12 months (01/04/2014 to 31/03/2015) was 97% compared to the England average of 88%.
  • The percentage of patients with asthma, on the register, who have had an asthma review in the preceding 12 months that includes an assessment of asthma control using the 3 RCP questions. (01/04/2014 to 31/03/2015) was 78% compared to the England average of 75%.
  • Longer appointments and home visits were available when needed.
  • 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.
  • The practice had effective systems in place for LTC reviews including reviews for those patients not taking medicines. The practice evidenced they actively tried to increase the uptake of annual reviews. For example for those patients with asthma who were identified as not attending for an annual review then these were encouraged by offering them a telephone review.
  • Patients had individualised care plans for chronic obstructive pulmonary disease (COPD) and asthma.

Families, children and young people

Good

Updated 1 July 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 A&E attendances.
  • Immunisation rates were relatively high for all standard childhood immunisations.
  • 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.
  • The practice’s uptake for the cervical screening programme was 80% which was high when compared to the CCG average of 78% and the national average of 74%.
  • Appointments were available outside of school hours and the premises were suitable for children and babies.
  • We saw positive examples of joint working with midwives and health visitors.

Older people

Good

Updated 1 July 2016

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. 4% of the practice population had a proactive care plan which was above the 2% national target. Most of these patients were older people.

Working age people (including those recently retired and students)

Good

Updated 1 July 2016

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 National Cancer Intelligence Network (NCIN) data published in March 2015 showed a high uptake of females aged 50-70 years screened for breast cancer in last 36 months. This was 81% compared to the England average of 72%. Patients between the age of 60-69 years screened for bowel cancer in the last 30 months was high when compared to the England average. This was 68% compared to the England average of 58%.

People experiencing poor mental health (including people with dementia)

Good

Updated 1 July 2016

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

  • Performance for mental health related indicators was better than the national average. For example the percentage of patients with schizophrenia, bipolar affective disorder and other psychoses who have a comprehensive, agreed care plan documented in the record, in the preceding 12 months (01/04/2014 to 31/03/2015) was 95% compared to the England average of 88%. The percentage of patients diagnosed with dementia whose care has been reviewed in a face-to-face review in the preceding 12 months (01/04/2014 to 31/03/2015) was 93% compared to the England average of 84%.
  • 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.
  • The practice had recently been involved in two mental health research projects; the outcomes of which were having a positive benefit to the patients involved.

People whose circumstances may make them vulnerable

Good

Updated 1 July 2016

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 carers and those with a learning disability.
  • The practice hosted weekly services from Carers Resource and until recently the Red Cross that the practice could refer into.
  • The practice offered longer appointments for patients assessed as needing them.
  • The practice regularly worked with other health care professionals in the case management of vulnerable patients. We were provided with many examples of significant multi-agency working to try and support and improve the outcomes for patients. For example the practice had worked with up to 50 agencies in respect of one patient and now had an agreed plan in place for this patient that was benefitting the patient and the agencies and services the patient was involved with.
  • The practice informed vulnerable patients about how to access various support groups and voluntary organisations and offered them support when they were of no fixed abode. For example one patient used the practice has their home address.
  • 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.