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Inspection Summary


Overall summary & rating

Good

Updated 7 October 2016

Letter from the Chief Inspector of General Practice

We carried out an announced comprehensive inspection at Fieldhead Surgery on 2 September 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 local and national care pathways and National Institute for Health and Care Excellence (NICE) guidance. Staff had been trained to provide them with the skills, knowledge and experience to deliver effective care and treatment.
  • Staff were proactive in promoting and offering cancer screening for bowel, breast and cervical and could evidence higher than average uptake rates, compared to CCG and national figures.
  • Patients had good access to appointments, which included extended hours early morning, evening and on Saturdays and Sundays. The practice could evidence a low usage of out of hours care as a result.
  • Information about services and how to complain was available and easy to understand. Improvements were made to the quality of care as a result of complaints and concerns.
  • Patients said they were treated with compassion, dignity and respect and they were involved in their care and decisions about their treatment. National GP patient survey results showed patient satisfaction rates for the majority of the questions were higher than both the local CCG and national rates.
  • Views were sought 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 sought input from a specialist health and safety consultancy, which carried out risk assessments and completed all health and safety policies and protocols.
  • There were effective safeguarding systems in place to protect patients and staff from abuse. There was evidence of shared learning with a wider team.
  • 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 an open and transparent 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. The practice was proactive in reporting prescribing and medicines alerts on the local incident reporting system.
  • The provider 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.)

We saw an area of outstanding practice:

  • The practice provided evidence of how they had effected change in diabetes care pathways for secondary care services, in line with up to date clinical and medicines management guidelines. For example, following input from the practice, insulin prescribing guidelines had been changed and adopted locally for patients discharged from secondary care. This had supported a consistent approach in the management of those patients across both secondary and primary care services within Leeds.

Professor Steve Field CBE FRCP FFPH FRCGP 

Chief Inspector of General Practice

Inspection areas

Safe

Good

Updated 7 October 2016

The practice is rated as good for providing safe services.

  • Risks to patients were assessed and well managed. The practice had sought input from a specialist health and safety consultancy, which carried out risk assessments and completed all health and safety policies and protocols.
  • There was an open and transparent 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. The practice was proactive in reporting prescribing and medicines alerts on the local incident reporting system.
  • 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. We saw evidence that a risk assessment had been undertaken with regard to which medicines GPs should keep in their bags, for use in an emergency (in line with up to date guidance).
  • The practice employed a clinical pharmacist who supported safe and effective prescribing.
  • 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). Regular IPC audits and checks of the building were undertaken.

Effective

Good

Updated 7 October 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 evidence where clinicians undertook monthly reviews of NICE guidance and identified any actions the practice needed to take in respect of these.
  • The practice provided evidence of how they had effected change in diabetes care pathways for secondary care services; in line with up to date clinical and medicines management guidelines. 
  • 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.
  • Services were provided to support the needs of the practice population, such as screening and vaccination programmes, health promotion and preventative care.
  • Staff were proactive in promoting and offering cancer screening for bowel, breast and cervical and could evidence higher than average uptake rates, compared to CCG and national figures. For example, cervical screening was 86% (CCG 79%, national 82%).
  • Patients who were at risk of developing either chronic obstructive pulmonary disease or diabetes were invited for screening and healthy lifestyle advice.
  • The practice had access to a health trainer who offered support for people seeking to enhance their health and well-being through increasing their activity levels and reducing their weight.
  • Data from the Quality and Outcomes Framework (QOF) showed patient outcomes were good compared to local and national averages.

Caring

Good

Updated 7 October 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.
  • There was a carers’ register and all carers were referred to Carers Leeds for additional support and advice suitable for their individual needs.
  • We were given examples of where staff had ‘gone the extra mile’ for patients. For example, collecting a prescription and taking it to a patient who was unable to access the surgery and was in acute need of treatment.

Responsive

Good

Updated 7 October 2016

The practice is rated as good for providing responsive services.

  • The practice worked with Leeds West Clinical Commissioning Group (CCG) and other local practices to review the needs of their population. For example, they participated in local quality improvement projects such as the local prescribing initiative. We were shown evidence that this had streamlined the prescribing patterns for antibiotic prescribing. 

  • 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 CCG and national practices. For example, 96% of respondents said they could easily get through to the practice by telephone (CCG 77%, national 73%).

  • The practice offered pre-bookable, same day and online appointments. They also provided extended hours appointments every weekday, telephone consultations and text message reminders. Patients had good access to appointments, which included extended hours early morning, evening and at the weekend. The practice could evidence a low usage of out of hours care as a result.
  • 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, for example housebound patients or those with complex conditions.
  • There was an accessible complaints system. Evidence showed the practice responded quickly to issues raised and learning was shared with staff.
  • The practice took account of the needs and preferences of patients with life-limiting progressive conditions, including people with dementia or a condition other than cancer.

Well-led

Good

Updated 7 October 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 policies and systems to identify and minimise risk.
  • The practice had a very organised approach to working systems and processes, which was evidenced in their policies and checks relating to safe care. Such as reviewing NICE guidance and recorded equipment and vaccine fridge temperature checks.
  • We saw evidence of formal minutes for meetings, such as practice, multidisciplinary, palliative care and safeguarding.
  • The GP partners 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. There was an active patient participation group of 40 members, who were encouraged to vocalise ideas and suggestions to improve service delivery.
  • The CCG had been successful in obtaining funds from the Prime Minister’s ‘Challenge Fund’ and the practice was exploring ways of using this funding to enhance patient experience through the use of technology; for example using tele-consultation.
  • Staff at all levels were encouraged to develop their skills and progress in their roles.
  • The practice supported graduate doctors, who were in their second year of a foundation programme (FY2), to gain experience in general practice. (This is a transition period of practice between being a student and undertaking more specialised training.)
Checks on specific services

People with long term conditions

Good

Updated 7 October 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.
  • Longer appointments were available as needed.
  • The practice delivered care and support for patients who had diabetes using an approach called the House of Care. This approach enabled patients to have a more active part in determining their own needs in partnership with clinicians. This model of care was being rolled out to other long term conditions, following additional nurse training.
  • In line with best practice, six monthly or annual reviews were undertaken to check patients’ health care and treatment needs were being met.
  • 94% of patients diagnosed with COPD had received a review in the last 12 months (CCG average 89%, national average 90%)
  • 92% of newly diagnosed diabetic patients had been referred to a structured education programme in the preceding 12 months (CCG average 88%, national average 90%)
  • 73% of patients diagnosed with asthma had received a review in the last 12 months (CCG and national average 75%)
  • There was an effective system in place for the recall and review of patients who were prescribed Amber drugs. (Amber drugs are prescribed medicines which require the patient to be closely monitored in line with specific guidelines.)
  • The practice had recently appointed a clinical pharmacist to work one day a week. Part of their role was to review patients, with cerebro-vascular disease who were prescribed anti-coagulant medicines, to ensure effective prescribing was being undertaken.

Families, children and young people

Good

Updated 7 October 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.
  • Staff told us children and young people were treated in an age-appropriate way and were recognised as individuals.
  • Patients under the age of 18 who could benefit from additional support for their emotional and mental wellbeing were referred to Leeds MindMate; which was a CCG funded support service.
  • Appointments were available outside of school hours, including evening and weekends. Children were given priority access to on the day appointments.
  • We saw evidence of monthly meetings between the health visitor and lead GP for safeguarding, to discuss vulnerable children and those with complex needs. The health visitor was informed of all new children under the age of five who registered with the practice.
  • The practice worked with midwives to support ante-natal and post-natal care.
  • Uptake rates for all standard childhood immunisations were between 98% and 100%.
  • Sexual health, contraceptive and cervical screening services were provided at the practice.
  • 86% of eligible patients had received cervical screening in the preceding five years (CCG average 79% and national average 82%).

Older people

Good

Updated 7 October 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. Six monthly health reviews were offered for these patients and all had a named GP.
  • Any patient who had not attended the practice in the preceding 12 months was also invited for a health check.
  • Patients who were on four or more medicines had an alert on their record. This was to ensure six monthly reviews were undertaken by a clinician.
  • 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.
  • Patients were signposted to other local services for additional support. For example, Caring Together a local organisation which supported older people and helped them to combat the isolation and loneliness sometimes associated with later life.

Working age people (including those recently retired and students)

Good

Updated 7 October 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 7am to 8pm, telephone consultations, online booking of appointments and ordering of prescriptions. In addition weekend appointments were available at a nearby practice through a local agreement.
  • 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 45 and 74 who did not have a pre-existing condition.
  • The practice offered sexual health advice and a full range of contraceptive services, including the fitting and removal of long-acting reversible contraceptives (LARC).
  • Travel health advice and vaccinations were available.

People experiencing poor mental health (including people with dementia)

Good

Updated 7 October 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.
  • 90% of patients diagnosed with dementia and 96% 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 higher than the CCG and national averages of 83% and 88% respectively.
  • Staff had received dementia friendly training and good demonstrate a good understanding of how to support patients with dementia or mental health needs.
  • Patients who were at risk of developing dementia were screened and support provided as necessary.
  • There was information available for patients on how to access various support groups and voluntary organisations. Patients were signposted to the Patient Empowerment Project (PEP) which sought to encourage social inclusion and tackle loneliness and isolation.
  • 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.

People whose circumstances may make them vulnerable

Good

Updated 7 October 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.
  • Patients were signposted to other agencies for additional care and support as needed. We saw there were notices displayed in the patient waiting area informing patients how they could access various local support groups and voluntary organisations.
  • The practice held a register of patients living in vulnerable circumstances including those who had a learning disability and patients who act in the capacity of a carer.
  • Carers were offered a health check and influenza vaccination and were encouraged to participate in the Carers Leeds yellow card scheme.
  • Patients who had a learning disability were offered longer appointments and an annual health check. Health Action Plans had been developed for use with patients with learning disabilities, giving details of personal preferences for health care and detailing medicine requirements.