The Roundhay Road Surgery

Updated 16 August 2016

The Roundhay Road Surgery is a member of the Leeds South and East Clinical Commissioning Group (CCG). Personal Medical Services (PMS) are provided under a contract with NHS England. The practice is registered with the Care Quality Commission (CQC) to provide the following regulated activities: diagnostic and screening procedures and treatment of disease, disorder or injury. They also offer a range of enhanced services, which include:

• extended hours access
• improving online access
• delivering childhood, influenza and pneumococcal vaccinations
• facilitating timely diagnosis and support for people with dementia
• identification of patients with a learning disability and the offer of annual health checks

The practice is located in an area of high deprivation within the Harehills district, being in close proximity to Leeds city cente and St James Hospital. The practice operates from a leased three storey Victorian terraced property, situated on a main road. There are consulting rooms on both the ground and first floor which are accessed by stairs. Patients with mobility difficulties are seen in the ground floor rooms. There is disabled access and a small number of car parking spaces at the front and additional nearby on-street parking. We were informed of the difficulties the current premises presented in developing further services for patients. The GPs acknowledged the premises needed to be updated but were constricted by circumstances out of their control. We were informed they were in talks with both the landlord and the CCG to look at how they could make improvements to the building or relocate to modernised premises.

Over the past two years, there had been an increase of 300 patients onto the practice list. This was due, in the main, to the closure of local practices. The practice currently has a patient list size of 3,531 made up of approximately 82% from an Asian origin (mainly Bangladesh and Pakistan), 8% Eastern European and 10% British. They have a higher than CCG and national average number of patients aged 45 years or younger, but a lower average of patients aged 65 years and older. The unemployment status of patients is 18%, compared to 8% locally and 5% nationally. However, at 66%, there is a higher than CCG (59%) and national (61%) average number of patiens who are in paid employment or full time education.

We were informed that none of their elderly patients resided in nursing/care homes. This was due, in the main, to the culture of Asian families providing care and support of their elderly relatives within their own homes. However, there were some registered patients who resided in a nearby sheltered housing facility. The practice had good links with the staff who worked there and would be alerted to any concerns.

There are two GP partners, one female and one male. Nursing staff consist of two practice nurses and a health care assistant; all of whom are female. There is a practice manager, a data management lead and a team of administration and reception staff who oversee the day to day running of the practice.

The practice is open Monday to Friday 8am to 6pm, with extended hours on Tuesday from 6pm to 8pm. Gp appointments are available:

Monday, Thursday, Friday 9am to 11.30am and 2pm to 6pm

Tuesday 9am to 11.30am and 2pm to 7.30pm

Wednesday 9am to 11.30 am and 12.30pm to 5.30pm

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.

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.) We were informed of the close working relationships they had with the local community and nearby Roundhay Road Community Centre.

Updated 16 August 2016

Letter from the Chief Inspector of General Practice

We carried out an announced comprehensive inspection at The Roundhay Road Surgery on 29 June 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:

• The practice staff had a very good understanding of the needs of their practice population and were flexible in their service delivery to meet patient demands; such as providing additional GP appointments when required.
• Many of the staff were multilingual which supported effective communication with their patients.
• 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 to 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 said they found it generally easy to make an appointment. 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 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.)
• The practice promoted a culture of openness and honesty. There was a nominated lead who had a very organised approach 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.
• Risks to patients were assessed and well managed.
• There were safeguarding systems in place to protect patients and staff from abuse.
• 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 engagement with patients and their local community.

We saw some areas of outstanding practice:

• The practice facilitated an annual ‘healthy eating’ open day to provide information for patients on how to grow, eat and cook food more healthily; particularly Asian cuisine in relation to diabetes. Anecdotal and photographic evidence showed these events were well attended.
• At the suggestion of the patient participation group, the practice had set up a weekly pilates class. This had been ongoing for the past two years and both patients and staff had access to the classes. As a result of positive feedback and attendance classes had increased to twice a week.
• There were dedicated staff ‘champions’ for cancer screening, immunisation programmes and long term condition (LTC) reviews. (Practices with disproportionately high ethnic minority populations are usually associated with low uptake rates.) They contacted patients and provided information. Often staff were able to speak to the patient in their own language to aid understanding. As a result, uptake for LTC reviews, screening and immunisations were higher than CCG and national averages. 

Professor Steve Field (CBE FRCP FFPH FRCGP) 

Chief Inspector of General Practice

Updated 16 August 2016

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

• The practice nurses had lead roles in the management of long term conditions, supported by the GPs. Six monthly or annual reviews were undertaken to check patients’ health care and treatment needs were being met.
• The practice maintained a register of patients who were a high risk of an unplanned hospital admission. Care plans and support were in place for these patients. They were also given priority same day appointments.The practice verbally informed us this had supported a reduction in the number of A&E admissions. However, written evidence was not available at the time of our inspection.
• The practice had a same day access policy for those patients who experienced a deterioration in their condition. Longer apppointments were also available as needed.

• The practice delivered care and support for some patients using an approach called the Year of Care. This approach enabled patients to have a more active part in determining their own needs in partnership with clinicians. It was currently used with patients who had asthma, chronic obstructive pulmonary disease (COPD), diabetes or coronary heart disease (CHD).
• Patients who had COPD were given a self-management plan and a prescription to enable quick access to medicines in case of an acute exacerbation of their symptoms (anticipatory prescribing).
• 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%).
• 88% of patients diagnosed with asthma had received an asthma review in the last 12 months (CCG and national averages of 75%).
• 92% of patients diagnosed with chronic obstructive pulmonary disease (COPD) had received a review in the last 12 months (CCG average 88%, national average 90%).

Updated 16 August 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, in 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 of abuse.
• 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 acces was available for all children under the age of five.
• At between 98% and 100%, immunisation uptake rates were higher than CCG and national rates for all standard childhood immunisations.
• Sexual health, contraceptive and cervical screening services were provided at the practice.
• 90% of eligible patients had received cervical screening (CCG and national average 82%).

Updated 16 August 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.
• Medication reviews were undertaken every six months.
• 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.
• The practice could evidence a good understanding of their elderly patients, how they were cared for, their family environment and cultural needs. Due to the Asian culture, many elderly patients resided with or were cared for by their families and the practice had good relationships with these to ensure the needs of all concerned were met.
• 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 a good working relationship with the staff who worked in a nearby sheltered housing facility. If the staff had any concerns about the patients who resided there, they would alert the practice, who acted on them accordingly.

Updated 16 August 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 provided extended hours appointments one day a week, telephone consultations, online booking of appointments and ordering of prescriptions.
• The practice offered a range of health promotion and screening that reflected the needs for 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.
• 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.

Updated 16 August 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.
• 100% of patients diagnosed with dementia and 94% 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.
• Patients who were at risk of developing dementia were screened and support provided as necessary.
• Staff had a good understanding of how to support patients with mental health needs or dementia.

Updated 16 August 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.

• As part of the blood borne virus screening programme, Hepatitis B and Hepatatis C testing were offered to all new patients aged between 16 and 65. Testing was also offered to those patients who were thought to be ‘at risk’. The practice also offered latent tuberculosis screening.
• The practice could identify patients who were at risk of female genital mutilation (FGM), forced marriage or radicalisation and provided additional support as needed.