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Allerton Medical Centre Good

Inspection Summary


Overall summary & rating

Good

Updated 1 June 2016

Letter from the Chief Inspector of General Practice

We carried out an announced comprehensive inspection at Allerton Medical Centre on 12 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 decisions about their care and treatment.
  • Patients were positive about access to the service. They 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.
  • The practice sought patient views on 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.
  • There was a complaints policy and clear information available for patients who wished to make a complaint.
  • Information regarding the services provided by the practice was readily available for patients.
  • The practice had good facilities and was well equipped to treat and meet the needs of patients.
  • There was a dedicated telephone line to support timely access to the practice by secondary care, mental health teams and care homes.
  • 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 the care and treatment of patients.)
  • The partners encouraged a culture of openness and honesty, which was reflected in their 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 promoted an all inclusive approach amongst staff.
  • The ethos of the practice was to provide good quality services and care for their patients.

Professor Steve Field CBE FRCP FFPH FRCGP 

Chief Inspector of General Practice

Inspection areas

Safe

Good

Updated 1 June 2016

The practice is rated as good for providing safe services.

  • Risks to patients were assessed and well managed
  • There was a nominated lead and systems in place for the reporting and recording of significant events. Lessons were shared to ensure action was taken to improve safety in the practice. All staff were encouraged and supported to record any incidents using the electronic reporting system.
  • There was a nominated lead for safeguarding children and adults. Systems were in place to keep patients and staff safeguarded from abuse.
  • There were processes in place for safe medicines management.
  • 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.
  • Staff had access to policies and procedures through the practice electronic document system.

Effective

Good

Updated 1 June 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 current evidence based guidance.
  • Weekly meetings were held between the clinicians to discuss patient care and complex cases.
  • Staff worked with other health and social care professionals, such as the community matron, district nursing and health visiting teams, to meet the range and complexity of patients’ needs.
  • Clinical audits were undertaken which could demonstrate quality improvement.
  • Data from the Quality and Outcomes Framework showed patient outcomes were at or above average compared to both local Clinical Commissioning Group (CCG) and national (England) figures.
  • Staff had annual appraisals, which enabled areas of development to be identified.

Caring

Good

Updated 1 June 2016

The practice is rated as good for providing caring services.

  • The practice had a patient-centred culture and we observed that staff treated patients with kindness, dignity, respect and compassion.
  • Information regarding the services provided by the practice was readily available for patients.
  • Data from the national GP patient survey showed that patient satisfaction rates for the practice were higher than other practices within the CCG.
  • Patients we spoke with and comments we received were all extremely positive about the care and service the practice provided. They told us they were treated with compassion, dignity and respect and were involved in decisions about their care and treatment.

Responsive

Good

Updated 1 June 2016

The practice is rated as good for providing responsive services.

  • The practice reviewed the needs of its local population and engaged with the NHS England Area Team and Leeds North CCG to secure improvements to services where these were identified.
  • National GP patient survey responses and patients we spoke with said they found it easy to make an appointment.
  • All urgent care patients were seen on the same day as requested.
  • The practice had good facilities and was well equipped to treat patients and meet their needs.
  • There was an accessible complaints system. Evidence showed the practice responded quickly to issues raised and learning was shared with staff. Learning from complaints was shared with staff.

Well-led

Good

Updated 1 June 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.
  • There were governance arrangements which included monitoring and improving quality, the identification of risk, policies and procedures to minimise risk and support delivery of quality care.
  • The provider was aware of and complied with the requirements of the duty of candour.
  • The partners encouraged a culture of openness and honesty.
  • There were systems in place for reporting notifiable safety incidents and sharing information with staff to ensure appropriate action was taken
  • Staff were encouraged to raise concerns, provide feedback or suggest ideas regarding the delivery of services. The practice proactively sought feedback from patients through the use of patient surveys, the NHS Friends and Family Test and the patient participation group.
  • Staff informed us they felt very supported by the GPs and practice management.
  • The ethos of the practice was to provide good quality services and care for their patients.
Checks on specific services

People with long term conditions

Good

Updated 1 June 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.
  • Longer appointments and home visits were available when needed.
  • Patients who were identified most at risk of hospital admission were identified as a priority.

  • The practice had recently commenced using an approach called the House of Care for patients who had diabetes. This approach enabled patients to have a more active part in determining their own care and support needs.
  • 88% of newly diagnosed diabetic patients had been referred to a structured education programme in the last 12 month, compared to 87% locally and 90% nationally.
  • 88% of patients diagnosed with asthma had received an asthma review in the last 12 months, compared to 75% locally and nationally.
  • 96% of patients diagnosed with chronic obstructive pulmonary disease (COPD) had received a review in the last 12 months, compared to 88% locally and 90% nationally.
  • Medication reviews were undertaken with this group of patients, to ensure medicine optimisation and effectiveness.
  • The practice had in-house electrocardiogram (ECG), ambulatory blood pressure, spirometry and phlebotomy services, to prevent patients from unnecessary attendance at secondary care.

Families, children and young people

Good

Updated 1 June 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.
  • The practice participated in the C-Card Scheme; which supported young people under the age of 25 access to free condoms.
  • 83% of eligible patients had received cervical screening, compared to 82% locally and nationally.
  • Appointments were available with both male and female GPs.

Older people

Good

Updated 1 June 2016

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

  • The practice provided proactive, responsive and personalised care to meet the needs of the older people in its population.
  • Home visits and urgent appointments were available for those patients in need.
  • Longer appointments were provided for those patients with complex needs.
  • 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.
  • The practice had patients who were resident in two local care homes. All these patients had care plans in place.
  • Patients who were lonely or isolated were signposted to other services.

Working age people (including those recently retired and students)

Good

Updated 1 June 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.
  • Extended hours appointments from 7am were available three mornings per week.
  • Telephone consultations were available.
  • Patients were sent text reminders when an appointment was booked.
  • The practice was proactive in offering online services, such as the ordering of repeat prescriptions.
  • Health checks were offered to patients aged between 40 and 75 who had not seen a GP in the last three years.
  • Screening for early detection of chronic obstructive pulmonary disease (a disease of the lungs) was available for patients aged 40 and above who were known to be smokers or ex-smokers.

People experiencing poor mental health (including people with dementia)

Good

Updated 1 June 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 carers were given information on how to access various support groups and voluntary organisations, such as Carers Leeds.
  • The practice had identified patients who were carers in order to ensure appropriate support was provided as needed.
  • With their consent, dementia screening was undertaken opportunistically with appropriate patients and those who presented with memory impairment.
  • 82% of patients diagnosed with dementia had received a face to face review of their care in the last 12 months, which was comparable to the local and national averages.
  • 92% of patients with a severe mental health problem had a comprehensive, agreed care plan documented in their record, in the preceding 12 months, compared to both the local and national average of 88%.
  • Staff had a good understanding of how to support patients who had mental health needs or dementia.
  • The practice actively recalled patients who had mental health issues and were on depo-provera injections for contraception purposes.

People whose circumstances may make them vulnerable

Good

Updated 1 June 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.
  • The practice had close links with two care homes for patients who had learning disabilities. These patients had an annual review of their health needs.
  • 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 on their patient list, who were on a child protection plan (this is a plan which identifies how health and social care professionals will help to keep a child safe).
  • Information on how to access various local support groups and voluntary organisations was available and patients were signposted to these services as needed.
  • The practice undertook Alcohol Use Disorders Identification Test Consumption (Audit C) screening on appropriate patients, and referred them to alcohol misuse services as identified.
  • 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’.