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Inspection Summary


Overall summary & rating

Good

Updated 27 September 2016

Letter from the Chief Inspector of General Practice

We carried out an announced comprehensive inspection at Armley Medical Practice on 23 August 2016. 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.
  • Risks to patients were assessed and well managed.
  • Staff assessed patients’ needs and delivered care in line with current evidence based guidance. Staff had been trained to provide them with 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 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 in the main said they found it easy to make an appointment. There was continuity of care. Urgent appointments were available the same day. In addition to pre-booked appointments, ‘sit and wait’ sessions were provided twice a day and these patients were seen by the duty doctor.
  • The practice list size was growing, and additional staff had been recruited to the practice. This meant that increased pressure was being placed on the practice’s facilities, although good use was made of the space available to staff. The facilities were appropriate to treat patients and meet their needs.
  • There was a clear leadership structure and staff felt supported by management. The practice proactively 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.

Professor Steve Field (CBE FRCP FFPH FRCGP) 

Chief Inspector of General Practice

Inspection areas

Safe

Good

Updated 27 September 2016

The practice is rated as good for providing safe services.

  • There was an effective system in place for reporting and recording significant events

  • Lessons were shared to make sure action was taken to improve safety in the practice.

  • When things went wrong patients received reasonable support, truthful information, and a written apology. They were told about any actions to improve processes to prevent the same thing happening again.

  • The practice had clearly defined and embedded systems, processes and practices in place to keep patients safe and safeguarded from abuse.

  • Risks to patients were assessed and well managed.

  • The practice had a number of policies and protocols in place to govern staff activity.

Effective

Good

Updated 27 September 2016

The practice is rated as good for providing effective services.

  • Data from the Quality and Outcomes Framework (QOF) showed patient outcomes were mostly in line with the national average.

  • 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. We saw that salaried GPs did not have the opportunity to complete any pre-appraisal documentation. The practice told us they would review their processes in relation to this.

  • Staff worked with other health care professionals to assess need, plan care and deliver treatment plans to improve outcomes for patients with more complex needs. At the time of our inspection patient records were not always contemporaneously completed following discussion at multidisciplinary meetings. The practice told us they would review their processes in relation to this.

Caring

Good

Updated 27 September 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 others for some aspects of care.

  • Information for patients about the services available was easy to understand and accessible.

  • We saw staff treated patients with kindness and respect, and maintained patient and information confidentiality.

  • The practice gave examples of where they provided personalised, considerate care to patients. For example pre-prepared prompt cards had been developed for a patient whose first language was not English, and who was also hard of hearing.

  • All the CQC patient comment cards we received on the day of the inspection described the practice staff as caring and respectful. Patients we spoke with on the day told us they were involved in decisions about their care and treatment plans.

Responsive

Good

Updated 27 September 2016

The practice is rated as good for providing responsive services.

  • Practice staff reviewed the needs of its local population and engaged with the NHS England Area Team and Leeds West Clinical Commissioning Group (CCG) to secure improvements to services where these were identified. For example the practice was participating in the enhanced care home scheme to improve the care and treatment of patients resident in care homes, and to improve communication between the practice and the care homes. In addition the practice was part of a recently formed 'Mental Health Transformation Programme’ for the locality, seeking to identify available resources for people with mental health difficulties, and improve access to such services.

  • Patients said they found it easy to make an appointment with a GP or nurse and there was continuity of care, with urgent appointments available the same day. In addition to pre-booked appointments, the practice operated ‘sit and wait’ sessions twice daily for people requiring urgent appointments. These patients were seen by the duty doctor.

  • The practice list size was growing, and additional staff had been recruited to the practice. This meant that increased pressure was being placed on the practice’s facilities, although good use was made of the space available to staff. The facilities were appropriate to treat patients and meet their needs.

  • Information about how to complain was available and easy to understand and evidence showed the practice responded quickly to issues raised. Learning from complaints was shared with staff and other stakeholders.

Well-led

Good

Updated 27 September 2016

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

  • The practice provided us with their statement of purpose ahead of the inspection. This described their vision and values as being innovative, supportive, making use of communication, trust and understanding, being professional and accessible. Staff were clear about the vision and their responsibilities in relation to it.

  • 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. The partners and practice manager encouraged a culture of openness and honesty.

    The practice had systems in place for notifiable safety incidents and ensured this information was shared with staff to ensure appropriate action was taken

  • The practice proactively sought feedback from staff and patients, which it acted on. The patient participation group was active.

  • We saw evidence that training, continuous learning and improvement was encouraged at all levels

Checks on specific services

People with long term conditions

Good

Updated 27 September 2016

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

  • Nursing staff had lead roles in chronic disease management and patients at risk of hospital admission were identified as a priority.

  • 90% of patients with diabetes had received a seasonal flu vaccination in the preceding year, compared to 94% locally and 95% nationally.

  • Longer appointments and home visits were available when needed.

  • All these patients had a named GP and a structured annual review to check their health and medicines needs were being met. The practice had recently introduced an annual review in the month of the patient’s birthday, where all conditions were reviewed and any investigations or tests arranged at one appointment.

  • The practice used the ‘Year of Care’ model for a number of long term conditions. These encouraged patients to set their own lifestyle and health objectives when managing their condition.

  • For those patients with the most complex needs, the named GP worked with relevant health and care professionals to deliver a multidisciplinary package of care.

Families, children and young people

Good

Updated 27 September 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. Immunisation rates were in line with national averages for all standard childhood immunisations. The practice told us they had recently changed their processes for re-inviting patients who failed to attend their initial appointments, and this had improved uptake to bring it in line with national averages.

  • Staff told us that children and young people were treated in an age-appropriate way and described examples to demonstrate this.

  • The practice operated a ‘sick child protocol’ which meant that children under one year were always offered a same day appointment.

  • Appointments were available outside of school hours and the premises were suitable for children and babies.

  • Health visitor clinics were held weekly in another part of the building, and coincided with a childhood immunisation clinic.

  • Midwifery clinics were held in the practice twice weekly.

  • Staff provided examples to demonstrate how joint working with health visitors had been effective in sharing information and planning care for children in vulnerable circumstances, or for those with additional needs.

Older people

Good

Updated 27 September 2016

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.

  • The practice was responsive to the needs of older people, and offered home visits and urgent appointments for those with enhanced needs.

  • Before the inspection we sought feedback from two local residential homes for older people who had residents registered at the practice. They both told us they were happy with the standard of care provided to their residents by GPs and practice staff.

  • In conjunction with two other local practices, the practice participated in an enhanced care home scheme. Funding had been received from the CCG to fund a care home nurse and health care assistant, shared by all three practices. These staff visited all care homes on a weekly basis to monitor the health and well-being of the residents, ensure care and treatment plans were appropriate, and provide a link between care home and practice.

  • The practice had a register of older and vulnerable patients at risk of unplanned admission. A care co-ordinator had been appointed who oversaw their care, created care plans which were regularly updated and reviewed by clinicians, and made contact with this group of people at least every six months, or following hospital admission and discharge.

  • A dedicated telephone number was available to this group of patients to access the practice

Working age people (including those recently retired and students)

Good

Updated 27 September 2016

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 acknowledged. The practice was open between 7am and 7pm Monday to Thursday, between 7am and 6pm on Friday, and between 8am and 12 midday on Saturday. This made it easier for working age people to access a convenient appointment time.

  • Patients were able to receive text reminders of appointments. Where test results were normal these were also communicated by text.

  • 77% of eligible women had received a cervical screening test in the preceding five years compared to 79% locally and 82% nationally.

  • The practice was proactive in offering online services as well as a full range of health promotion and screening reflecting the needs for this age group. The practice provided evidence that 1662 patients (12% of the practice list) had registered for online services.

  • The practice offered new patient checks and screening for blood borne viruses was routinely carried out with the patient's permission.

People experiencing poor mental health (including people with dementia)

Good

Updated 27 September 2016

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

  • 83% of patients with schizophrenia and other psychoses had a record of their alcohol consumption completed in the preceding 12 months which is lower than the local and national averages of 89% and 90% respectively.
  • 86% of patients diagnosed with dementia had had their care reviewed in a face to face meeting in the last 12 months, which is higher than the local and national averages of 83% and 84% respectively.
  • The practice regularly worked with multidisciplinary teams in the case management of patients experiencing poor mental health, including those with dementia.

  • The practice participated in a local 'Mental Health Transformation Group’ which sought to identify available resources for people experiencing mental health difficulties, and improve access to services. Staff had received ‘Suicide Awareness and Prevention’ training.

  • One of the GPs was an expert in ‘Mindfulness’ and promoted the practice of mindfulness. For example by visiting a local group for Asian women to promote this approach.

  • Patients were able to access the ‘Patient Empowerment Project’ to help combat social isolation.

  • All staff had been trained as ‘Dementia Friends’.The practice had access to a memory support worker.

  • The practice carried out advance care planning for patients with dementia.

  • The practice had a system in place to follow up patients who had attended accident and emergency or other out of hours services where they may have been experiencing poor mental health.

  • Staff had a good understanding of how to support patients with mental health needs and dementia.

People whose circumstances may make them vulnerable

Good

Updated 27 September 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 those with a learning disability.

  • The practice offered longer appointments for patients with a learning disability.

  • The practice regularly worked with other healthcare professionals in the case management of vulnerable patients.

  • The practice was able to signpost this group of patients to local resources to support their needs.

  • 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.

  • The practice had identified 1% of their patient population as carers, and offered them an annual health check.They were signposted to local organisations such as ‘Carers Leeds’