The Garden Surgery

Updated 25 May 2016

The Garden Surgery is a member of Leeds South and East Clinical Commissioning Group (CCG) and is situated in one of the top 100 most deprived areas in Yorkshire. The Garden Surgery is located on the second floor of a purpose built health centre, which also houses a separate GP practice and various community health services. There are facilities for people with disabilities and access to the practice is via a lift or stairway. All patient areas are on the same level. There are car parking facilities available on site. 

The practice has a patient list size of 5,866 with a higher than national average of patients who have a long standing health condition; 66% compared to 56% locally and 54% nationally. Approximately 79% of patients are of white British origin, with the remaining percentage made up of different ethnic origins. There are a total of 27 different languages spoken by the patient population. 

There are three GP partners, two male and one female, and a salaried female GP. The practice also employs the services of a long term male GP locum, which supports the continuity of care for patients. The clinical team also consists of one advanced nurse practitioner, two practice nurses, two health care assistants and a pharmacist; all of whom are female. The clinicians are supported by a practice manager and a team of administration and reception staff.

The practice is open between 8am to 6pm Monday to Friday. GP appointments are available 8.30am to 11.30am and 3pm to 5.30pm Monday to Friday. Saturday morning appointments were available from November 2015 to March 2016 under the Winter Pressure Scheme. 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.

Personal Medical Services (PMS) are provided under a contract with NHS England. The practice is registered to provide the following regulated activities; maternity and midwifery services, family planning, diagnostic and screening 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 very diverse range of organisations including voluntary, community, tenants’ and residents’ groups.) The practice also has close links with three local residential nursing/care homes, where patients who are mainly frail elderly reside.

The Garden Surgery is a teaching and training practice and are accredited to train Foundation year doctors and trainee GPs. 

We were informed both by the practice and Leeds South and East CCG of the supervision and support which had been provided by the practice to another GP practice over a period of eight months. This had resulted in additional work in the provision of clinical input for patients at that practice and the submission of reports to NHS England. Emergency on-call and home visiting services had also been provided by The Garden Surgery over a period of six months. 

Updated 25 May 2016

Letter from the Chief Inspector of General Practice

We carried out an announced comprehensive inspection at The Garden Surgery on 5 April 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:

• Patients’ needs were assessed and care was planned and delivered following best practice guidance. Staff had the skills, knowledge and experience to deliver effective care and treatment.
• Patients said they were treated with compassion, dignity and respect and were involved in care and decisions about their treatment.
• Patients said they found it easy to make an appointment, there was continuity of care and urgent appointments were available on the same day as requested.
• Longer appointments were given to those patients who needed them.
• Information regarding the services provided by the practice was available for patients.
• The practice had good facilities and was well equipped to treat and meet the needs of patients.
• There was a complaints policy and clear information available for patients who wished to make a complaint.
• The practice sought patient views how improvements could be made to the service, through the use of patient surveys, the NHS Friends and Family Test and the patient participation group.
• Risks to patients were assessed and well managed. There were good governance arrangements and appropriate policies in place.
• The practice was aware of and 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.)
• There was a culture of openness and honesty, which was reflected in the approach to safety. 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.
• There was a clear leadership structure and a stable workforce in place. Staff were aware of their roles and responsibilities and told us the GPs and manager were accessible and supportive.
• The practice ethos was to deliver good quality patient-centred care.

We saw two areas of outstanding practice:

• The practice employed their own pharmacist to assist with medication reviews, medicine optimisation and audits.
• The practice contracted the services of an independent consultant who periodically reviewed clinical performance data and reports to support improvements in service delivery and patient care

However, there was one area where the provider should make an improvement:

• The practice needs to reduce the probability of accidental interruption of the electrical supply to vaccine fridges. 

Professor Steve Field CBE FRCP FFPH FRCGP 

Chief Inspector of General Practice

Updated 25 May 2016

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

• All these patients had a named GP and a structured annual review to check that their health and medicines needs were being met. The practice nurses had lead roles in the management of long term conditions. A holistic review was undertaken for patients who had multiple conditions, to avoid the need for several appointments.
• Patients were signposted to the Leeds Better for Me programme, which provided advice and support to improve self-management of their condition.
• Patients who were identified most at risk of hospital admission were identified as a priority.

• The practice delivered care for patients using an approach called the Year of Care. This approach enabled patients to have a more active part in determining their own care and support needs in partnership with clinicians and a pharmacist. It was used with all patients who had diabetes, asthma, chronic obstructive pulmonary disease (a disease of the lungs) or cardiovascular disease..
• Longer appointments and home visits were available when needed.

Updated 25 May 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 provision of ante-natal, post-natal and child health surveillance clinics.
• Immunisation uptake rates were high for all standard childhood immunisations, achieving up to 100% for many vaccinations.
• Sexual health, contraceptive and cervical screening services were provided at the practice.
• 76% of eligible patients had received cervical screening, compared to 82% both locally and nationally.
• Appointments were available with both male and female GPs.

Updated 25 May 2016

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

• The practice provided proactive, responsive and person-centred 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 other health and social care professionals, such as the district nursing and local neighbourhood teams, 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.
• Health checks were offered for all patients over the age of 75 who had not seen a clinician in the previous 12 months.

• Named GPs attended on a weekly basis at three local residential nursing/care homes, where they had registered patients, to provide care, support and medication reviews.
• The practice participated in the End of Life project in conjunction with a local hospice, to manage patients who were not expected to live beyond two weeks and had no reversible conditions. The project provided a homely setting for patients and families to prepare for end of life in a 'home from home' environment. 

Updated 25 May 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.

• Telephone triage was available to assess whether the patient needed to be seen face to face or could be treated/given advice without the need for an appointment.
• 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. For example, early detection of chronic obstructive pulmonary disease for patients aged 40 and above who were known to be smokers or ex-smokers.
• Health checks were offered to patients aged between 40 and 74 who had not seen a GP in the last three years.

Updated 25 May 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.
• 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.
• Advance care planning was undertaken with patients who had dementia, 75% of whom had received a face to face review of their care in the last 12 months which was comparable to the local and national averages.
• 65% of patients who had a complex mental health problem, such as schizophrenia, bipolar affective disorder and other psychoses had received an annual review in the past 12 months and had a comprehensive, agreed care plan documented in their record. This was lower than both the local and national averages.

Updated 25 May 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 and regularly worked with multidisciplinary teams in the case management of this population group.
• 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.
• The practice could evidence children who were currently on a child protection plan (this is a plan which identifies how health and social care professionals will help to keep a child safe).
• There were 22 children who were on the autistic spectrum disorder and were coded on their electronic record. The practice tailored consultations to meet the needs of these children and their parents/carers.
• Information was provided on how to access various local support groups and voluntary organisations.
• As part of the blood borne virus screening programme, HIV, Hepatitis B and C testing were offered to all new patients aged between 16 and 65. Testing was also offered to those patients who were thought to be ‘at risk’.