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Drs. Vautrey, Bearpark, Cunliffe, Chida, Hayes, Spencer, Hodgson, Izon, Ghirotto & Fineberg Good Also known as Meanwood Group Practice

Inspection Summary


Overall summary & rating

Good

Updated 5 May 2016

Letter from the Chief Inspector of General Practice

We carried out an announced comprehensive inspection at Meanwood Group Practice on 9 March 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:

  • 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.
  • 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 reference group.
  • Information about services and how to complain was available and easy to understand.
  • 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.
  • Staff were supported to attend role specific training and updates. For example; a salaried GP at the practice was being supported through an ENT diploma at the time of our inspection.
  • The practice focused on pursuing hard to reach groups to involve them in diabetic education sessions, this was supported by a specialist dietician.
  • The practice were committed to ensuring information was entered onto the clinical system on the same day as it was received to ensure accurate information was available at all times. There was a system and dedicated time for daily correspondence and results management.
  • The practice used the Leeds Care Record to ensure information regarding health and social care was easily accessible.

We saw areas of outstanding practice:

  • The practice took a proactive approach to monitoring and management of risks to patients. The practice had carried out a risk assessment for each room within the practice and involved all staff members in this process. There was also a dedicated reporting form which staff were required to complete if any hazard was noticed. For example; faulty light switches and trip hazards.

  • The practice had introduced a system of home monitoring for patients with hypertension. This enabled the patient to carry out tests at home, which helped to reduce the stress of undertaking tests in a clinical environment, and supported management of self-care.

  • Additional services were provided at the practice for registered patients and those who were referred from other practices. For example; minor surgery, non-benign gynaecology and an ear nose and throat clinic. These services were overseen by hospital consultants, reducing the number of patients attending hospital appointments and giving patients the choice to access care closer to home.

Professor Steve Field (CBE FRCP FFPH FRCGP) 

Chief Inspector of General Practice

Inspection areas

Safe

Good

Updated 5 May 2016

The practice is rated as good for providing safe services.

  • Risks to patients were assessed and well managed.
  • There was a system in place for reporting and recording significant events.
  • 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.
  • There were processes in place for safe medicines management, which included emergency medicines.
  • The practice was clean and infection prevention and control (IPC) audits were carried out.
  • The provider had implemented an electronic system to ensure communication was available to all staff, this was also used to initiate reminders regarding recording fridge temperatures and stock levels and expiry dates of medication in GP bags.
  • We saw evidence of registration with professional bodies. For example; General Medical Council. However; the provider did not have a system in place to ensure these were checked on an annual basis. We received confirmation from the practice following our inspection that a system had been implemented.
  • We saw evidence of medical indemnity insurance. However the provider did not have a system in place to ensure this was checked on an annual basis. We received confirmation from the practice following our inspection that renewal certificates would now be sent to the managing partner for review.

Effective

Good

Updated 5 May 2016

The practice is rated as good for providing effective services.

  • Data from the Quality and Outcomes Framework showed patient outcomes were 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 community matron, district nursing and health visiting teams.

Caring

Good

Updated 5 May 2016

The practice is rated as good for providing caring services.

  • Data from the National GP patient survey showed that patients rated the practice comparable to others. Patients we spoke with and comments we received were all very positive about the care and service the practice provided. They told us they were treated with compassion, dignity and respect and were involved in decisions about their care and treatment.
  • Information for patients about the services available was easy to understand and accessible.
  • We observed a patient-centred culture and that staff treated patients with kindness, dignity, respect and compassion.

Responsive

Good

Updated 5 May 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 North Clinical Commissioning Group (CCG) to secure improvements to services where these were identified. For example, the practice participated in the Year 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.
  • There was an accessible complaints system. Evidence showed the practice responded quickly to issues raised and learning was shared with staff. Learning from complaints was also shared with stakeholders.
  • The practice focused on pursuing hard to reach groups to involve them in diabetic education sessions, this was supported by a specialist dietician.
  • The practice had a well-established diabetic clinic with a Lead GP and nurse who both specialised in diabetes.
  • The practice had a system to monitor and review patients who were found to have pre-diabetes.

Well-led

Good

Updated 5 May 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.
  • There were governance arrangements which included monitoring and improving quality, identification of risk, policies and procedures to minimise risk and support delivery of quality care.
  • 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.
  • There were systems in place for being aware of notifiable safety incidents and sharing information with staff to ensure appropriate action was taken
  • 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 reference group.

Staff informed us they felt very supported by the GPs and management.

Checks on specific services

People with long term conditions

Good

Updated 5 May 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.
  • Longer appointments and home visits were available when needed.
  • The practice was participating in the Year of Care programme. An initiative aimed to encourage patients with long term conditions to understand their condition and select their own personal targets.
  • The practice focused on pursuing hard to reach groups to involve them in diabetic education sessions, this was supported by a specialist dietician.
  • The practice had a well-established diabetic clinic with a Lead GP and nurse who both specialised in diabetes.
  • The practice had a system to monitor and review patients who were found to have pre-diabetes.

Families, children and young people

Good

Updated 5 May 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.
  • There was a midwife attached to the practice who ran ante-natal and postnatal clinics four days a week.
  • The practice ran childhood immunisation clinics twice a week with Health Visitors present for development checks and baby weighing. This was supported by a recall system for non-attenders resulting in the practice achieving targets in this area.
  • Patients could access a full range of contraceptive services including fitting of implants and emergency contraception.
  • The practice had previously been accredited as a “Young People Friendly” practice with a dedicated nurse leading on young people’s health.
  • All patients registering with the practice were offered the opportunity to have blood borne virus screening.
  • The practice had achieved 89% against the cervical screening domain, this was better than the CCG average of 81% and national 82%.

Older people

Good

Updated 5 May 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 available for those patients with enhanced needs.
  • The practice supported Leeds North Clinical Commissioning Group (CCG) initiatives to reduce the rate of elderly patients’ acute admission to hospital.
  • The practice had a wellbeing co-ordinator who maintained regular contact with patients and identified any additional support required.
  • The practice were co-located with community staff such as Community Matrons, Community Nurses, Speech Therapists, Podiatrist and mental health services, giving staff immediate access to discuss patients requirements.

The practice had established good relationships with third sector organisations that provided social support. For example; Zest for Life and The Royal Voluntary Service.

Working age people (including those recently retired and students)

Good

Updated 5 May 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 was proactive in offering the option to book appointments and request repeat prescriptions online as well as a 24 hour automated telephone service for booking, cancelling, checking and changing appointments.
  • There were a range of appointments available including book on the day and book in advance. In addition, telephone consultations were available from 8am until 11.30am daily for patients who were unable to access the practice for an appointment.
  • The reception desk was open from 7.30am on a daily basis to allow patients to call for repeat prescriptions and book or change appointments.
  • There was a full range of health promotion and screening that reflected the needs for this age group. For example, cervical screening and annual health checks.

People experiencing poor mental health (including people with dementia)

Good

Updated 5 May 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.
  • 92% of patients diagnosed with dementia had received a face to face review of their care in the last 12 months, which was better than the local and national averages
  • The practice had a system in place to check patients at high risk of dementia and had increased detection rates from 59% in April 2014 to 69% as at March 2015.
  • A memory nurse was based at the practice and available to provide support to patients. A memory nurse is a health care professional who supports patients with memory problems, such as those who have dementia. They provide specialist care and advice which is personalised to meet the patient’s needs.
  • The practice employed a wellbeing co-ordinator who worked with patients and signposted to other services. For example; local luncheon clubs, Social Services and Alzheimer’s services.
  • 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 5 May 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 regularly worked with multidisciplinary teams in the case management of this population group.
  • The practice had a system to alert staff to patients with known vulnerabilities or complex needs. For example; when longer appointments were required or the need to see a specific GP.
  • Information was provided on how to access various local support groups and voluntary organisations.
  • Longer appointments were available for patients as needed.
  • 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.
  • People with disabilities could access all areas of the buildings; there was braille signage and a hearing loop in the reception area.
  • Carers were identified and recorded opportunistically by the practice when booking appointments or telephone consultations. Patients who were identified as carers were signposted to Carers Leeds.
  • The practice hosted other services which patients could easily access. For example; weekly sessions from Citizens Advice Bureau and an alcohol worker from Forward Leeds.