Archived: Dr Leonard Jacob

Updated 24 December 2015

The Dr Leonard Jacob practice, also known as Thryberg Surgery, is situated within a terraced property in Wath on Dearne, Rotherham.

The practice provides General Medical Services (GMS) for 1,500 patients in the NHS Rotherham Clinical Commissioning Group (CCG) area.

There is one male GP, a practice manager, practice nurse, senior receptionist and receptionist.

The practice reception hours are 8.30am to 6.30, surgery hours are 9am to 11am and 4.30pm to 6pm, Monday to Friday.

Out of hours services are provided by Care UK. The practice telephone transfers patients to this service when the practice is closed. A walk-in centre is available at Rotherham Community Health Centre

The practice is registered to provide the following regulated activities; maternity and midwifery services; surgical procedures, diagnostic and screening procedures and treatment of disease, disorder or injury.

Updated 24 December 2015

Letter from the Chief Inspector of General Practice

We carried out an announced comprehensive inspection at Dr Leonard Jacob on 10 November 2015. Overall the practice is rated as good.

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

• There was an open and transparent approach to safety and an effective system in place for reporting and recording significant events.
• Not all risks to patients were assessed and well managed in relation to health and safety matters and recruitment.
• Staff assessed patients’ needs and delivered care in line with current evidence based 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 they were involved in their care and decisions about their treatment.
• Information about how to complain was not readily available.
• Patients said they found it easy to make an appointment with a named GP and that there was continuity of care, with urgent appointments available the same day.
• The practice had good facilities and was well equipped to treat patients and meet their needs.
• There was a clear leadership structure and staff felt supported by management. The practice sought feedback from staff and patients, which it acted on.
• The provider was aware of and complied with the requirements of the Duty of Candour.

We saw one area of outstanding practice:

• The practice was proactive in ensuring patients received vaccinations and health screening and demonstrated high rates of uptake. For example, the practice’s uptake for the cervical screening programme in 2014/15 was 96%, which was significantly higher than the local Clinical Commissioning Group (CCG) average of 82.5% and the national average of 81.8%. Childhood immunisation rates for the vaccinations given were significantly higher than CCG and national averages. For example, they had achieved 100% of childhood immunisation rates for the vaccinations given to under two and under five year olds. Flu vaccination rates for 2013/14 for the over 65s were 77.78% and at risk groups 70.12%. These were also above national averages. The practice had achieved a 98% response rate for health checks for patients aged 40 years plus compared to local CCG rates of 70%.

The areas where the provider must make improvement are:

• An infection prevention and control (IPC) risk assessment had not been completed and there were shortfalls in the management of IPC.
• Records of the vaccine storage fridge temperatures did not record reasons for the increase in temperature above the recommended limits and the actions taken to ensure the quality and effectiveness of medicines.
• The recruitment policy and procedure did not include requirements for references and DBS checks and appropriate recruitment checks had not been undertaken prior to employment.

• The fire risk assessment did not identify all areas of risk and fire escape routes were not fully marked with signs to indicate the exit route.

The areas where the provider should make improvement are:

• Procedures should be reviewed to ensure the GP has signed the Patient Group Directions (PGD) to allow nurses to administer medicines.
• The lack of provision of oxygen on the premises for use in an emergency situation should be reviewed.
• Records were not maintained to evidence all the training the staff had completed.
• Oxygen was not available for use in emergency situations.
• Curtains were not provided in all consulting rooms to maintain patients’ privacy and dignity during examinations, investigations and treatments.

• Information about the complaints procedure was not displayed in the practice.

Professor Steve Field CBE FRCP FFPH FRCGP 

Chief Inspector of General Practice

Updated 24 December 2015

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

• Nursing staff had the lead role in chronic disease management and patients at risk of hospital admission were identified as a priority. Longer appointments and home visits were available when needed.
• All these patients had a structured annual review to check that their health and medicines needs were being met. For those people with the most complex needs, the GP worked with relevant health and care professionals to deliver a multidisciplinary package of care.

Updated 24 December 2015

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.
• The practice was proactive in ensuring patients received vaccinations and health screening and demonstrated high rates of uptake. For example, the practice’s uptake for the cervical screening programme in 2014/15 was 96%, which was significantly higher than the CCG average of 82.5% and the national average of 81.8%. Childhood immunisation rates for the vaccinations given were significantly higher than CCG and national averages. For example, the practice had achieved 100% of childhood immunisation rates for the vaccinations given to under two and under five year olds.
• Appointments were available outside of school hours and the premises were suitable for children and babies.

• We saw good examples of joint working with midwives, health visitors and school nurses.

Updated 24 December 2015

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.
• It was responsive to the needs of older people, and offered home visits and urgent appointments for those with enhanced needs.
• The practice was proactive in ensuring patients received vaccinations and health screening and demonstrated high rates of uptake. Flu vaccination rates for 2013/14 for the over 65s were 77.78% and at risk groups 70.12%. These were above national averages.

Updated 24 December 2015

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 practice had achieved a 98% response rate for health checks for patients aged 40 years plus compared to local CCG rates of 70%.

Updated 24 December 2015

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

• 100% of people diagnosed with dementia had had their care reviewed in a face to face meeting in the last 12 months.
• The practice regularly worked with multi-disciplinary teams in the case management of people experiencing poor mental health, including those living with dementia.
• It carried out advance care planning for patients living with dementia.
• The practice had told patients experiencing poor mental health about how to access various support groups and voluntary organisations.
• It 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 people with mental health needs and dementia.

Updated 24 December 2015

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 those with a learning disability.
• It offered longer appointments for people with a learning disability.
• The practice regularly worked with multi-disciplinary teams in the case management of vulnerable people.
• It had told vulnerable patients about how to access various support groups and voluntary organisations.
• 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.