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Inspection Summary


Overall summary & rating

Good

Updated 25 February 2016

Letter from the Chief Inspector of General Practice

We carried out an announced comprehensive inspection at Kippax Hall Surgery on 8 December 2015. 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:

  • There was an open and transparent approach to safety and an effective system was in place for reporting and recording significant events.
  • Risks to patients were assessed and well managed.
  • 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 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 had good facilities and was well equipped to treat and meet the needs of patients.
  • 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.
  • There was a clear leadership structure and staff were supported by management.
  • The provider was aware of and complied with the requirements of the Duty of Candour.

We saw some areas of outstanding practice:

  • The practice had a system of priority booking of appointments for carers and patients who were on the palliative care register.
  • During the times staff acted in the capacity of a chaperone, they wore a tabard and badge citing ‘chaperone’ to enable patients to identify that member of staff was carrying out the role.
  • The practice had developed a visual ‘jobs to do’ board to ensure all tasks were completed in a timely manner and to avoid duplication of work. Morning, afternoon, weekly and monthly tasks were identified. The use of different coloured markers identified when the task had been completed.

Professor Steve Field CBE FRCP FFPH FRCGP

Chief Inspector of General Practice

Inspection areas

Safe

Good

Updated 25 February 2016

The practice is rated as good for providing safe services.

  • There was a system in place for reporting and recording significant events.
  • There was a nominated lead who looked at the reporting mechanisms, safety issues and where improvements could be made in patient safety and experience. Lessons were shared to ensure action was taken to improve safety in the practice.
  • There was a nominated lead for safeguarding children and adults and systems, processes and practices were in place to keep patients and staff safeguarded from abuse.
  • Risks to patients were assessed and well managed.
  • There were processes in place for safe medicines management, which included emergency medicines. A record was kept of what medicines were carried in individual GP’s bags, however, there was no standardisation of those medicines.
  • When staff acted in the capacity of a chaperone, they wore a tabard and badge to enable patients to identify that member of staff was carrying out the role.

Effective

Good

Updated 25 February 2016

The practice is rated as good for providing effective services.

  • Data from the Quality and Outcomes Framework showed patient outcomes were at or above average compared to both local and national figures.
  • Staff assessed needs and delivered care in line with current evidence based guidance.
  • Clinical audits demonstrated quality improvement.
  • Staff had the skills, knowledge and experience to deliver effective care and treatment.
  • There was evidence of appraisals and personal development plans for all staff.
  • Staff worked with multidisciplinary teams to understand and meet the range and complexity of people’s needs. For example, the district nursing and health visiting teams.

Caring

Good

Updated 25 February 2016

The practice is rated as good for providing caring services.

  • Data from the National GP patient survey showed that patients rated the practice higher than others for several aspects of care.
  • Patients we spoke with said they were treated with compassion, dignity and respect and were involved in decisions about their care and treatment.
  • The practice had a system of priority booking of appointments for carers and patients who were on the palliative care register.
  • Information for patients about the services available was easy to understand and accessible.

We saw staff treated patients with kindness, respect and maintained confidentiality

Responsive

Good

Updated 25 February 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 South and East Clinical Commissioning Group (CCG) to secure improvements to services where these were identified.
  • 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.

Well-led

Good

Updated 25 February 2016

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

  • It 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 this.
  • 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. (This is a legal duty on hospital, community and. mental health trusts to inform and apologise to patients if there. have been mistakes in their care that have led to significant harm.) The partners encouraged a culture of openness and honesty. The practice had systems in place for being aware of notifiable safety incidents.
  • 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. For example, with regard to access to the practice by telephone.
  • There was a strong focus on continuous learning and improvement at all levels.
Checks on specific services

People with long term conditions

Good

Updated 25 February 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 chronic disease management and patients at risk of hospital admission were identified as a priority.
  • The House of Care model was used with all patients who had diabetes and chronic obstructive pulmonary disease (a disease of the lungs) and coronary heart disease. This model approach enabled patients to have a more active part in determining their own care and support needs in partnership with clinicians. Individualised care plans for these patients were maintained, which included how to manage an exacerbation and any anticipatory medication which may be required.
  • Early detection of chronic obstructive pulmonary disease was undertaken with all patients aged 35 and over who were known to be either a smoker or ex-smoker.
  • Longer appointments and home visits were available when needed.

Families, children and young people

Good

Updated 25 February 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, ante-natal, post-natal and child health surveillance clinics.
  • Childhood immunisation and cervical screening uptake rates were comparable to other practices in the locality.

Older people

Good

Updated 25 February 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 offered for those patients with enhanced needs.
  • The practice worked closely with other health and social care professionals, such as the district nursing team, to ensure housebound patients received the care 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.

Working age people (including those recently retired and students)

Good

Updated 25 February 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.
  • Early morning appointments were offered on Tuesday, Wednesday and Thursday.
  • 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, cervical screening and health checks for patients between the ages of 16 and 75 who had not seen a GP in the last three years.
  • Non-responders to the national bowel screening programme were proactively followed up by the practice.

People experiencing poor mental health (including people with dementia)

Good

Updated 25 February 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.
  • Advance care planning was undertaken for patients with dementia. All patients who were diagnosed as having dementia had received a face to face review of their condition in the past 12 months. This was higher than the CCG average of 90% and the national average of 84%.
  • Patients who were concerned regarding memory loss or any dementia-like symptoms were encouraged to make an appointment with a clinician.
  • All patients who had a severe mental health problem received an annual review. There was a dedicated member of staff to ensure all patients were invited.
  • There was 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.

People whose circumstances may make them vulnerable

Good

Updated 25 February 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 homeless people, travellers and those with a learning disability.
  • Longer appointments were available for patients as needed.
  • The practice regularly worked with multidisciplinary teams in the case management of vulnerable people. Information was provided on how to access various support groups and voluntary organisations. For example, patients could access support for domestic violence at a neighbouring practice.
  • 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. All external safeguarding meetings were tracked in the practice to ensure they received the minutes.