Craven Road Medical Practice

Updated 23 September 2016

Craven Road Medical Practice has two sites; Craven Road Medical Centre, 60 Craven Road Leeds LS6 2RX and Holly Bank Surgery 1 Shire Oak Street Leeds LS6 2AF. The Craven Road site is situated approximately two miles north of Leeds City Centre. Holly Bank Surgery is situated just over one mile to the west of the Craven Road site. Both sites are modern, purpose built premises, both have full disabled access. Parking is limited at Holly Bank Surgery, but disabled parking spaces are available. The Holly Bank site is situated on the first floor of a purpose built building and access is gained by use of a lift. The building is shared with another GP practice. An independent pharmacy is also situated on the ground floor. Craven Road Surgery has adequate parking space, including disabled parking. All patient consultation rooms are situated on the ground floor at this site. There are currently approximately 11,000 patients on the practice list. A significantly higher than average percentage of patients are in the 20 to 29 year age group. Public Health England National General Practice profile shows the ethnicity of the practice population as predominantly white British, with 11% Asian, 6% Afro-Caribbean with 2% other non-white ethnic groups.

The practice provides Personal Medical Services (PMS) under a locally agreed contract with NHS England. They offer a range of enhanced services such as extended hours access, minor surgery and childhood immunisations.

The practice has six GP partners. Of these, two are male and four female. In addition there are three salaried GPs, one male and two female. At the time of our visit the practice was also supporting two female GP registrars. There is one female advanced nurse practitioner (ANP), five female practice nurses and three female health care assistants (HCAs). The clinical team is supported by a business partner practice manager, deputy practice manager, reception supervisor and a range of administrative, secretarial and reception staff. The practice had recently appointed a human resources manager to supplement the non-clinical team.

The practice catchment area is classed as being within one of the more deprived areas in England. People living in more deprived areas tend to have greater need for health services.

Average life expectancy for patients registered at the practice is 77 years for men and 81 years for women (CCG average is 78 years and 82 years respectively, national average of 79 years and 83 years respectively).

The practice is open between :

• 7am and 7pm Monday to Friday

• 8.30am and 12 midday on Saturday for nurse appointments

• In additionfull weekend cover is provided through the shared resource of locality GP hubs between 8am and 4pm Saturday and Sunday

Weekly clinics are held which include sexual health and contraceptive services, minor surgery, child health surveillance and travel immunisations.

Out of hours care is provided by Local Care Direct which is accessed by calling the surgery telephone number or by calling NHS 111 service.

Updated 23 September 2016

Letter from the Chief Inspector of General Practice

We carried out an announced comprehensive inspection at Craven Road Medical Practice on 9 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. The practice was proactive in reporting prescribing and medicines alerts on the local incident reporting system. An internal system for reporting, disseminating, acting upon and reviewing learning from all significant events was also in place.
• Risks to patients were assessed and well managed. The practice had sought input from a specialist health and safety consultancy, which carried out risk assessments and completed all health and safety policies and protocols.
• Staff assessed patients’ needs and delivered care in line with current evidence based guidance. We saw evidence that new clinical and local guidelines were assessed, reviewed and disseminated in an efficient manner, and that necessary changes to practice were implemented quickly. 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 said they found it easy to make an appointment with a GP, but not necessarily the GP of their choice. Daily walk-in appointments were available with the nurse practitioner at the Craven Road site. Urgent appointments were available the same day and pre-bookable appointments could be made up to four weeks in advance.
• The practice had two sites; Craven Road Medical Centre and Holly Bank Surgery. Both sites had good facilities and were well equipped 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.

We saw areas of outstanding practice:

• The practice provided evidence of how they had effected change in care pathways for secondary care services, which enhanced the effectiveness of management of patients with long term conditions.These changes meant that patients’ conditions were managed safely and effectively, and in line with up to date clinical and medicines management guidelines.

• The practice provided care for asylum seekers and victims of human trafficking in conjunction with local third sector (charitable) support services. The practice gave examples to evidence where outcomes for this group of patients had been improved by support from the practice. For example by ensuring children received the necessary vaccinations and immunisations in a timely way and supporting patients who had experienced extreme mental and physical trauma to rebuild their lives and begin accessing work or education.

Professor Steve Field (CBE FRCP FFPH FRCGP) 

Chief Inspector of General Practice

Updated 23 September 2016

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

• GPs had been identified as clinical leads for managing the care of people with long-term conditions, supported by nursing staff and health care assistants (HCAs). Patients at risk of hospital admission were identified as a priority.

• 77% of patients with diabetes had a recorded cholesterol level which was within normal limits, compared to the CCG and national average of 81%.

• The practice was participating in a local project aimed at identifying those patients at high risk of developing diabetes, and offering proactive diagnosis and treatment.

• The practice had recently appointed a clinical pharmacist to work one day a week with the practice, to review those patients with cerebro-vascular disease and taking anti-coagulant medicines, to rationalise treatment packages for this group of patients.

• Longer appointments and home visits were available when needed.

• The practice made use of the ‘House of Care’ model when working with patients with diabetes, to enable patients to make decisions about their care and treatment. This model was being rolled out to other long term conditions following additional nurse training.

• The practice had access to a health trainer who offered support for people seeking to enhance their health and well-being through increasing their activity levels and reducing their weight.

• All these patients had a named GP and a structured annual review to check their health and medicines needs were being met. 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.

Updated 23 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 relatively high for all standard childhood immunisations.

• Staff told us that children and young people were treated in an age-appropriate way and were recognised as individuals. Children were given priority access to on the day appointments.

• Both sites provided children’s play areas as well as baby changing and breast feeding facilities.

• The practice had recently reinstated monthly meetings with the health visitor to discuss children and families who had more complex needs. Staff gave us examples of when joint working with health visitors had been effective.

• Midwifery clinics were held at the practice for antenatal and postnatal appointments.

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

Updated 23 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.

• The practice had identified 2% of their patients at higher risk of unplanned hospital admissions, and made contact to review their needs following discharge from hospital.

• The practice encouraged patients to attend for bowel and breast cancer screening tests. However, uptake was lower than local and national averages. In the preceding 36 months 63% of eligible women had completed a breast screening test, compared to 69% locally and 72% nationally, and 48% of eligible patients had completed a bowel screening test in the preceding 30 months, compared to 58% locally and nationally. The practice were working with four local practices to try to improve uptake.A cancer screening champion had been appointed in the practice to engage with patients and educate them on the importance of these tests.

• The practice held a register of housebound patients. They provided evidence which showed that 100% of these patients had received a health check in the preceding year.

• The practice worked with ‘Caring Together’ a local organisation which supported older people and helped to combat the isolation and loneliness sometimes associated with later life.

Updated 23 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 identified and the practice had adjusted the services it offered to ensure these were accessible, flexible and offered continuity of care.

• Appointments were available on the day for those patients requiring urgent medical assessment.In addition daily ‘walk- in’ appointments were available at the Craven Road site with a nurse practitioner or GP. Other appointments could be booked up to four weeks in advance

• The practice was open between 7am and 7pm Monday to Friday. In addition, there was access to weekend appointments with a GP provided by the locality hub between 8am and 4pm Saturday and Sunday. The practice offered nurse appointments between 8.30am and 12pm on Saturday at one of their sites for patients who were registered with the practice.

• The practice offered sexual health advice and the full range of contraceptive services, including the fitting of long-acting reversible contraceptives (LARC).

• The practice was proactive in offering online services as well as a full range of health promotion and screening that reflected the needs for this age group. Text reminders were sent to remind patients of their appointment date and time. The practice provided evidence which showed that 1,333 patients (12%) of the patient population had registered for online services.

• The CCG had been successful in obtaining funds from the Prime Minister’s ‘Challenge Fund’ and the practice was exploring ways of using this funding to enhance patient experience through the use of technology; for example by tele-consultation.

• 74% of eligible women had received a cervical screening test in the preceding five years, which was lower than the CCG average of 79% and the national average of 82%.

Updated 23 September 2016

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

• 91% of patients with schizophrenia or other psychoses had a completed comprehensive care plan documented in the preceding 12 months which is comparable with the CCG and national average of 88%.

• 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 CCG average of 83% and the national average of 84%.

• The practice regularly worked with multidisciplinary teams in the case management of patients experiencing poor mental health, including those with dementia.

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

• All staff in the practice had received ‘Dementia Friendly’ training.

• The practice gave patients experiencing poor mental health information about how to access various support groups and voluntary organisations. This included the ‘Patient Empowerment Project’ (PEP) which sought to encourage social inclusion and tackle loneliness and isolation.

• The practice had a system in place to follow up patients who had attended accident and emergency 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.

Updated 23 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 unpaid carers and those with a learning disability. The practice had identified 139 patients (1%) of the practice population as unpaid carers.

• The practice informed vulnerable patients how to access various support groups and voluntary organisations such as ‘Carers Leeds’.

• The practice offered longer appointments of 30 minutes for patients with a learning disability. Health Action Plans had been developed for use with patients with learning disabilities, giving details of personal preferences for health care and detailing medicine requirements.

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

• The practice had access to a benefits adviser to help patients with financial difficulties.

• The practice held a register of housebound patients. They provided evidence that 100% of these patients had received a health check in the preceding year.

• Staff gave examples of when they had provided supporting letters to patients experiencing difficulties such as those facing deportation or homelessness.

• The practice provided care for asylum seekers and victims of human trafficking in conjunction with local third sector support services. The practice had identified a dedicated GP to work with this group of patients. They were able to access same day appointments, up to an hour in length due to the complexity of their needs. Interpreter services were used when necessary during these appointments. The practice gave us examples of how patient outcomes had improved following support from the practice

• 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.