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Inspection Summary


Overall summary & rating

Good

Updated 12 September 2016

Letter from the Chief Inspector of General Practice

We carried out an announced comprehensive inspection at Gibson Lane Practice on 2 August 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 a clear leadership structure, staff were aware of their roles and responsibilities and told us the GPs were accessible and supportive. There was evidence of an all-inclusive team approach for providing services and care for patients.
  • Staff had the skills, knowledge and experience to deliver effective care and treatment.
  • 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.
  • Patients had good access to appointments over three locations, which included extended hours early morning, in an evening and on Saturdays. There was continuity of care and if urgent care was needed patients were seen on the same day as requested.
  • Information regarding the services provided by the practice and how to make a complaint was readily available for patients.
  • The practice sought views 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. They were leading on a locality wide patient participation group with regard to the delivery of enhanced services such as patient liaison, extended access and healthy lifestyle support.
  • There were safe and effective systems in place, which included the management of medicines, patient care and safeguarding.
  • The practice had an organised and effective approach to infection prevention and control which was in line with recommended guidance. This was evidenced in their policies, audits and training of staff.
  • The practice promoted a culture of openness and honesty. There was a nominated lead for dealing with significant events. 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 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.)

Professor Steve Field CBE FRCP FFPH FRCGP 

Chief Inspector of General Practice

Inspection areas

Safe

Good

Updated 12 September 2016

The practice is rated as good for providing safe services.

  • Risks to patients were assessed and well managed.
  • There were systems in place for reporting and recording significant events and near misses. There was a nominated lead who ensured all incidents were recorded on the electronic reporting system and could evidence a very organised approach. There was evidence of investigation, actions taken to improve safety in the practice and shared learning with staff.
  • 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 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), who demonstrated an organised and knowledgeable approach with respect to IPC guidance. They undertook regular IPC audits, raised awareness and ensured staff were up to date with training.
  • The practice employed a pharmacist to support safe prescribing and medicines management.

Effective

Good

Updated 12 September 2016

The practice is rated as good for providing effective services.

  • Data from the Quality and Outcomes Framework (QOF) showed patient outcomes were at or above average compared to local and national averages.
  • The practice could evidence they were the second lowest within Leeds South and East Clinical Commissioning Group (CCG) practices, for accident and emergency (A&E) attendances (27% below), for the period April 2015 to March 2016. We were informed how patients were supported to avoid an unplanned hospital admission and also how ‘frequent attenders’ to A&E were followed up.
  • Services were provided to support the needs of the practice population, such as screening and vaccination programmes, health promotion and preventative care.
  • The practice could evidence high uptake rates for cancer screening, such as cervical, breast and bowel; which at 67% was the highest in the CCG (average 54%).
  • The practice were supported by a pharmacist twice a week, to ensure effective and appropriate prescribing was undertaken. This could be evidenced as Gibson Lane Practice was one of the few practices in the CCG who had achieved a prescribing budget underspend.
  • There was evidence of working with other health and social care professionals, such as the community matron and palliative care team, to meet the range and complexity of patients’ needs.
  • End of life care was delivered in a compassionate and coordinated way.
  • 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 examples where clinicians used the latest NICE guidance when managing the care of patients.
  • All staff received annual appraisals and had up to date training.
  • We saw evidence of clinical audits which could demonstrate quality improvement.

Caring

Good

Updated 12 September 2016

The practice is rated as good for providing caring services.

  • Data from the National GP Patient Survey showed patients rated the practice comparable to 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.
  • Carers were identified and support provided as needed.
  • There was a variety of health information available for patients, relevant to the practice population, in formats they could understand.

Responsive

Good

Updated 12 September 2016

The practice is rated as good for providing responsive services.

  • The practice worked with Leeds South and East Clinical Commissioning Group (CCG) and other local practices to review the services provided, based on the needs of their population.
  • The practice had good facilities and was well equipped to treat patients and meet their needs. There was a well-developed website which was easy to navigate and provided health information and links to other relevant organisations.
  • Patients had access to appointments and services over three locations. Pre-bookable, same day and online appointments were offered. They also provided extended hours appointments early morning, evening and on Saturdays, telephone consultations and text message reminders.
  • 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.
  • National GP patient survey responses regarding access were variable. For example, 60% of respondents said they could easily get through to the practice by telephone and 96% said the last appointment they got was convenient.
  • 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 12 September 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 practice 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. They had an annual ‘away day’ where staff got together to discuss key issues and future developments of the practice.
  • 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. These included the identification of risk, with policies and systems in place to minimise risk.
  • We saw evidence of formal minutes for meetings, such as practice, multidisciplinary, palliative care and safeguarding.

  • The practice proactively sought feedback through engagement with patients and their local community. They were leading on a locality wide patient participation group with regard to the delivery of enhanced services such as patient liaison, extended access and healthy lifestyle support.
  • They were an accredited research practice and also offered teaching and training for medical students and qualified doctors training to be GPs.
Checks on specific services

People with long term conditions

Good

Updated 12 September 2016

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

  • The practice maintained a register of those patients who were a high risk of an unplanned hospital admission. Each identified patient had a care coordinator and a care plan in place.
  • The practice had a same day access policy for those patients who experienced a deterioration in their condition. Longer appointments were also available as needed.

  • The practice delivered care and support for some patients using an NHS approach called the Year of Care (YoC). YoC supports and enables patients to be involved in their own care, by providing a more personalised approach and supporting self-management. It was currently used with patients who had chronic obstructive pulmonary disease (COPD), cardiovascular disease and diabetes.
  • 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 88%, national average 90%)
  • 73% of patients diagnosed with asthma had received a review in the last 12 months (CCG and national average 75%)
  • 100% of newly diagnosed diabetic patients had been referred to a structured education programme in the preceding 12 months (CCG average 87%, national average 90%)

Families, children and young people

Good

Updated 12 September 2016

The practice is rated as good for the care of families, children and young people.

  • 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.
  • There were systems in place to identify and follow up children living in disadvantaged circumstances and who were at risk.
  • 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. Same day access was available for all children under the age of five.
  • Childhood immunisations were offered in line with the public health programme. Uptake rates for all children aged eight weeks to 5 years were between 97% and 100%.
  • Sexual health, contraceptive and cervical screening services were provided at the practice. In the preceding five years 84% of eligible patients had received cervical screening (CCG and national average 82%).

Older people

Good

Updated 12 September 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. Health checks were offered for all these patients and all had a named GP.
  • 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.
  • The practice had patients who resided in a nearby care home. The GP attended regularly one day a week to support the care and treatment of those patients. Ad hoc visits were also undertaken as needed.

Working age people (including those recently retired and students)

Good

Updated 12 September 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. Patients had access to appointments and services over three locations.
  • The practice offered pre-bookable, same day and online appointments. They also provided extended hours appointments early morning, evening and on Saturdays, telephone consultations and text message reminders. Prescriptions could be ordered online and collection arranged from a nominated pharmacy.

  • 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 40 and 74 who did not have a pre-existing condition.
  • Travel health advice and vaccinations were available. The practice was also a designated Yellow Fever vaccination centre.

People experiencing poor mental health (including people with dementia)

Good

Updated 12 September 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.
  • Data showed that 98% of patients diagnosed with dementia and 98% 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 88%.
  • All staff had received dementia friendly training and could demonstrate a good understanding of how to support patients.

People whose circumstances may make them vulnerable

Good

Updated 12 September 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.
  • We saw there was information available on how patients could access various local support groups and voluntary organisations.
  • Patients were signposted to other agencies for additional care and support as needed.
  • The practice had developed a user friendly pre-health check questionnaire booklet for use with patients who had a learning disability, which included pictures to aid understanding. The booklet also been shared with local learning difficulties and disabilities services.