Archived: The Grange Medicare Ltd: Middleton Park Surgery Also known as Middleton Park Surgery

Updated 28 April 2016

Middleton Park Surgery is part of Grange Medicare Ltd, along with two other practices New Cross Surgery and Swillington Health Practice, all of which are based to the south east of Leeds and are part of Leeds South and East Clinical Commissioning Group.

Middleton Park Surgery is located on the first floor within a three storey purpose built community health centre, which was opened in 2002, and situated in one of the more deprived areas of Leeds. Access is via a lift or stairs. There are nine consulting rooms, a minor surgery room and therapy rooms. There are facilities for baby changing, breast feeding and disabled patients. There is an onsite car park, with marked disabled parking bays. Other community services such as district nursing and health visiting teams are also based in the same building.

There is a patient list size of 5,070 with a higher than national average of patients who are aged between 0 to 40 years. However, they have a lower than average number of patients who are over the age of 40. There is a higher than average unemployment rate of 17%, compared to 8% locally and 5% nationally.

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.)

Middleton Park Surgery is open Monday to Friday 8am to 6.30pm, with the exception of Tuesday when it is open until 8pm. Saturday clinics from 8.30am to 1pm are rotated between this practice and two other Grange Medicare Ltd locations nearby, New Cross Surgery and Swillington Health Practice.

Walk in clinics are also available on Fridays from 9.30am to 12.30pm and 1.30pm to 4.30pm.

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.

There are three male GPs and access to a female GP.  The nursing team consists of an advanced nurse practitioner, two practice nurses, a health care assistant and a phlebotomist. Some of the clinicians rotate across the other two sites at New Cross Surgery and Swillington Health Practice, on set rotas. There is a management support team, headed by a practice manager, and a team of administration and reception staff.

Alternative Provider Medical Services (APMS) 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.

Updated 28 April 2016

Letter from the Chief Inspector of General Practice

We carried out an announced comprehensive inspection at Middleton Park Surgery on 3 March 2016. Overall the practice is rated as good for providing safe, effective, caring, responsive and wel   l- led care for all of the population groups it serves.

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

• 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 an open and transparent approach to safety and an effective system in place for reporting, recording and taking remedial action in relation to significant events. In 2015 the practice had won a local Clinical Commissioning Group award for their excellent use of the electronic reporting system for significant events.

• Risks to patients were assessed and well managed. There were good governance arrangements and appropriate policies in place.
• 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.
• The practice was involved in the House of Care Initiative. This initiative was aimed at encouraging patients with long term conditions to understand their condition and select their own personal health and lifestyle targets.
• The practice had good facilities and was well equipped to treat and meet the needs of patients. There was information on services the practice provided.
• There was a complaints policy and clear information available for patients who wished to make a complaint.
• Patients said they were treated with kindness, dignity, respect and compassion and were involved in decisions about their treatment and care.
• The practice offered extended hours on Tuesday evening and Saturday morning. Urgent appointments were available on the same day as requested and longer appointments were available as needed. Some patients said they found telephone access difficult. However, we saw evidence where the practice had made changes to the telephone system and improvements to access had been made as a result.
• 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 forum.

However, there were areas of practice where the provider should make improvements:

• Ensure all GPs are up to date with level three safeguarding training, in line with intercollegiate guidelines for safeguarding children and young people.
• Ensure mentorship and support is provided for all GPs, especially for those who are recently qualified or recruited.

Professor Steve Field CBE FRCP FFPH FRCGP 

Chief Inspector of General Practice

Updated 28 April 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.
• A care coordinator was employed to support patients who had complex needs and were at a high risk of an unplanned hospital admission. Care plans were in place and regularly reviewed for these patients.
• One of the practice nurses was a specialist diabetic nurse who had been trained to initiate insulin for newly diagnosed patients, this reduced the need for patients to attend secondary care.
• The practice were involved in the House of Care Initiative. This initiative was aimed at encouraging patients with long term conditions to understand their condition and select their own personal health and lifestyle targets.
• 100% of newly diagnosed diabetic patients had been referred to a structured education programme in the last 12 months, compared to 87% locally and 90% nationally.
• 79% of patients diagnosed with asthma had received an asthma review in the 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

Updated 28 April 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 young children and babies 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.
• Childhood immunisation uptake rates were comparable to other local practices.
• Cervical screening, chlamydia screening, sexual health and contraceptive services were provided at the practice.
• 83% of eligible patients had received cervical screening, compared to 75% locally and 82% 74% nationally.

Updated 28 April 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 who were in need.
• 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.

Updated 28 April 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.
• Saturday morning clinics were available, in addition to a walk-in clinic one day per week. Online services and telephone consultations were also available.
• The practice was proactive in offering a full range of health promotion and screening that reflected the needs for this age group. For example, early detection of cardio-vascular disease for patients aged 40 and above, and health checks for patients between the ages of 40 and 75 who had not seen a GP in the last three years.
• Students were registered on a temporary basis and were offered a vaccination programme in line with NHS/public health recommendations.
• New patients checks were offered.

Updated 28 April 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.
• There was access to onsite counselling and psychiatric services, which supported patients who may be anxious attending other areas/services they were unfamiliar with.
• The practice held a register of patients who had poor mental health and an alert was on their electronic record to quickly identify to clinicians where any additional support may be needed.
• 89% of patients diagnosed with dementia had received a face to face review of their care in the last 12 months, which is comparable to the local and national averages.
• 100% of patients who had a severe mental health problem had received an annual review in the past 12 months and had a comprehensive, agreed care plan documented in their record. This was higher than both the local and national average of 88%.
• Staff had a good understanding of how to support patients with mental health needs or dementia.

Updated 28 April 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 an alert placed on their electronic record to raise awareness of potential increased need.
• There was a cohort of patients from the traveller community who were registered with the practice. We saw evidence of joint working relationships with other health and social care agencies to ensure care and support was provided as needed.
• As part of the blood borne virus screening programme, HIV testing was offered to all new patients aged between 16 and 65 and those patients who were thought to be ‘at risk’.
• Longer appointments were available for patients as needed.
• Clinicians regularly worked with multidisciplinary teams in the case management of this population group.
• There was information available for patients on how to access various local support groups and voluntary organisations.
• 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.