Archived: Fieldhead Surgery

Updated 7 October 2016

Fieldhead Surgery is registered with the Care Quality Commission (CQC) and is a member of the Leeds West Clinical Commissioning Group (CCG). General Medical Services (GMS) are provided under a contract with NHS England. They offer a range of enhanced services, which include:

• extended hours access
• improving patient 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
• identification of patients who are at a high risk of an unplanned hospital admission, reviewing and coordinating their care needs

The practice address is 65 New Road Side, Leeds LS18 4JY. This is located in the Horsforth area of Leeds, which is in the south west of Leeds city cente. The building is owned by the GP partners and is a converted two storey house. It is situated on a main road with local shops and pharmacy nearby. There is no dedicated car park, however, on street parking is available. There is one reception area with two patient waiting areas on each of the two floors. The first floor is accessed by stairs. We were informed patients who have mobility difficulties are seen in a downstairs consulting room. There was limited disabled access, however, we were informed staff were aware of their disabled patients and supported them accordingly.

At the time of our inspection we were informed of the building issues and what actions the practice had taken. They had previously submitted a business case to obtain funding to refurbish and extend the premises and were currently awaiting the outcome. We were also informed that many of their patients had sent letters both to the practice and CCG supporting the modernisation of the premises.

The practice currently has a patient list size of 5,202 which is predominantly white British. The practice catchment area is classed as being within one of the lesser deprived areas in England. The patient demographics deviate from local CCG and national averages in some areas. For example:

• They have a slightly higher number of patients aged 65 and older, compared to other practices locally and nationally.
• The percentage of patients who are in paid work or full time education is 71% (CCG 66%, nationally 61%). Less than 1% of patients are unemployed (CCG and nationally 5%).
• There are lower numbers of patients who have a long standing health condition, 38% (CCG 51%, nationally 54%).

The partners consist of three GPs (one female, two male) and a female practice manager. Other clinical staff includes two other GPs, two practice nurses, a pharmacist and a health care assistant; all of whom are female. There is also a male health care assistant. Clinicians are supported by a team of reception, administration and secretarial staff who are managed by a site supervisor.

The practice is open as follows:

Monday, Tuesday 7am to 7pm

Wednesday 8am to 8pm

Thursday, Friday 8am to 7pm

In addition, the practice worked with other local GP practices, ‘a hub’, to provide weekend appointments. These were provided at Headingly Medical Centre (approximately three miles away) on Saturday and Sunday 8am to 4pm.

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.)

The practice supports graduate doctors, who are in their second year of a foundation programme (FY2), to gain experience in general practice. (This is a transition period of practice between being a student and undertaking more specialised training.)

Fieldhead Surgery has ‘sister’ practices based at Craven Road Surgery, 60 Craven Road Leeds LS6 2RX and Holly Bank Medical Centre, 1 Shire Oak Street Leeds LS6 2AF. These are registered separately with CQC. The GPs and practice manager are partners for all sites and both clinical and non-clinical staff rotate between the sites. They share the same policies and procedural systems. Patients from Fieldhead Surgery can access Craven Road Surgery for minor operation procedures. The practice manager is based at Craven Road Surgery and the site supervisor is based at Fieldhead Surgery.

Updated 7 October 2016

Letter from the Chief Inspector of General Practice

We carried out an announced comprehensive inspection at Fieldhead Surgery on 2 September 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:

• 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. Staff had been trained to provide them with the skills, knowledge and experience to deliver effective care and treatment.
• Staff were proactive in promoting and offering cancer screening for bowel, breast and cervical and could evidence higher than average uptake rates, compared to CCG and national figures.
• Patients had good access to appointments, which included extended hours early morning, evening and on Saturdays and Sundays. The practice could evidence a low usage of out of hours care as a result.
• 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 were treated with compassion, dignity and respect and they were involved in their care and decisions about their treatment. National GP patient survey results showed patient satisfaction rates for the majority of the questions were higher than both the local CCG and national rates.
• Views were sought 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.
• 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.
• There were effective safeguarding systems in place to protect patients and staff from abuse. There was evidence of shared learning with a wider team.
• 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 an open and transparent approach to safety. 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 was proactive in reporting prescribing and medicines alerts on the local incident reporting system.
• The provider was aware of and 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.)

We saw an area of outstanding practice:

• The practice provided evidence of how they had effected change in diabetes care pathways for secondary care services, in line with up to date clinical and medicines management guidelines. For example, following input from the practice, insulin prescribing guidelines had been changed and adopted locally for patients discharged from secondary care. This had supported a consistent approach in the management of those patients across both secondary and primary care services within Leeds.

Professor Steve Field CBE FRCP FFPH FRCGP 

Chief Inspector of General Practice

Updated 7 October 2016

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

• 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.
• Longer appointments were available as needed.
• The practice delivered care and support for patients who had diabetes using an approach called the House of Care. This approach enabled patients to have a more active part in determining their own needs in partnership with clinicians. This model of care was being rolled out to other long term conditions, following additional nurse training.
• 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 89%, national average 90%)
• 92% of newly diagnosed diabetic patients had been referred to a structured education programme in the preceding 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%)
• There was an effective system in place for the recall and review of patients who were prescribed Amber drugs. (Amber drugs are prescribed medicines which require the patient to be closely monitored in line with specific guidelines.)
• The practice had recently appointed a clinical pharmacist to work one day a week. Part of their role was to review patients, with cerebro-vascular disease who were prescribed anti-coagulant medicines, to ensure effective prescribing was being undertaken.

Updated 7 October 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.
• Staff told us children and young people were treated in an age-appropriate way and were recognised as individuals.
• Patients under the age of 18 who could benefit from additional support for their emotional and mental wellbeing were referred to Leeds MindMate; which was a CCG funded support service.
• Appointments were available outside of school hours, including evening and weekends. Children were given priority access to on the day appointments.
• We saw evidence of monthly meetings between the health visitor and lead GP for safeguarding, to discuss vulnerable children and those with complex needs. The health visitor was informed of all new children under the age of five who registered with the practice.
• The practice worked with midwives to support ante-natal and post-natal care.
• Uptake rates for all standard childhood immunisations were between 98% and 100%.
• Sexual health, contraceptive and cervical screening services were provided at the practice.
• 86% of eligible patients had received cervical screening in the preceding five years (CCG average 79% and national average 82%).

Updated 7 October 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. Six monthly health reviews were offered for these patients and all had a named GP.
• Any patient who had not attended the practice in the preceding 12 months was also invited for a health check.
• Patients who were on four or more medicines had an alert on their record. This was to ensure six monthly reviews were undertaken by a clinician.
• 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.
• Patients were signposted to other local services for additional support. For example, Caring Together a local organisation which supported older people and helped them to combat the isolation and loneliness sometimes associated with later life.

Updated 7 October 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 appointments from 7am to 8pm, telephone consultations, online booking of appointments and ordering of prescriptions. In addition weekend appointments were available at a nearby practice through a local agreement.
• 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 45 and 74 who did not have a pre-existing condition.
• The practice offered sexual health advice and a full range of contraceptive services, including the fitting and removal of long-acting reversible contraceptives (LARC).
• Travel health advice and vaccinations were available.

Updated 7 October 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.
• 90% of patients diagnosed with dementia and 96% 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 83% and 88% respectively.
• Staff had received dementia friendly training and good demonstrate a good understanding of how to support patients with dementia or mental health needs.
• Patients who were at risk of developing dementia were screened and support provided as necessary.
• There was information available for patients on how to access various support groups and voluntary organisations. Patients were signposted to 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.

Updated 7 October 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.
• Patients were signposted to other agencies for additional care and support as needed. We saw there were notices displayed in the patient waiting area informing patients how they could access various local support groups and voluntary organisations.
• The practice held a register of patients living in vulnerable circumstances including those who had a learning disability and patients who act in the capacity of a carer.
• Carers were offered a health check and influenza vaccination and were encouraged to participate in the Carers Leeds yellow card scheme.
• Patients who had a learning disability were offered longer appointments and an annual health check. 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.