Hillfoot Surgery

Updated 2 November 2016

Hillfoot Surgery is situated at Owlcotes Road, Pudsey, Leeds LS28 7QR. It is located approximately eight miles to the west of Leeds City Centre, and four miles to the east of Bradford City Centre. The practice is housed in a two storey building and has been occupied by the practice since 1991. All patient consulting rooms are on the ground floor and are accessible by those people using a wheelchair. The practice has car parking facilities on site as well as on street parking. The national general practice profile shows that 22% of the patient group are of Asian origin, with 2% mixed ethnicity, 1% black and 2% other non-white ethnicity. There are currently 7,008 patients on the practice list. 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 opening, online patient access services and childhood vaccinations and immunisation.

The practice is training and teaching practice, which means it, supports the specialist training of qualified doctors wishing to practice as GPs as well as medical students wishing to gain experience of working in general practice. There are currently four GP partners, two male and two female and two salaried GPs, both female. At the time of our inspection a male registrar (trainee GP) was also working at the practice. The clinical team is completed by two female practice nurses and two female health care assistants (HCAs). Supporting the clinical team is a practice business manager, deputy practice manager, office manager as well as a range of administrative, reception and secretarial staff.

The practice is located in one of the less deprived areas in England. The practice profile shows the age range/sex of patients is similar to the national average. Average life expectancy for patients registered at the practice is 84 years for women and 78 years for men. CCG average is 82 years and 78 years respectively, and national average is 83 years and 79 years respectively.

The practice is open between 7.30am and 7.30pm Monday to Friday.

Weekly clinics are held which include asthma, diabetes and smoking cessation.

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

Hillfoot Surgery has not been inspected previously by the Care Quality Commission.

Updated 2 November 2016

Letter from the Chief Inspector of General Practice

We carried out an announced comprehensive inspection at Hillfoot Surgery on 27 September 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 and an effective system in place for reporting and recording significant events.

• Risks to patients were assessed and well managed.

• Staff assessed patients’ needs and delivered care in line with current evidence based guidance. 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 comment on care was available in the patient information leaflet. We saw that information on how to complain was not clearly displayed in the patient areas. We saw evidence that improvements were made to the quality of care as a result of complaints and concerns.

• The appointment system had recently been changed to accommodate patients’ needs. People told us access to appointments was improving, though not necessarily with the GP of their choice. Telephone triage was offered, and urgent appointments were available the same day.

• The practice was open between 7.30am and 7.30pm Monday to Friday. The premises were well equipped and appropriate for treating patients and meeting their needs.

• There was a clear leadership structure and staff felt supported by GP partners and 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.

  The provider should:

• Take steps to improve the provision of information on how to complain in the patient areas in the practice and on the practice website.

Professor Steve Field (CBE FRCP FFPH FRCGP) 

Chief Inspector of General Practice

Updated 2 November 2016

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

• Nursing staff had lead roles in chronic disease management and patients at risk of hospital admission were identified as a priority.

• 77% of patients with diabetes, on the register had a recorded blood pressure completed in the preceding 12 months, compared to the CCG and national average of 78%.

• Longer appointments and home visits were available when needed.

• All these patients had a named GP and a structured annual review carried out in the month of their birthday 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.

• The practice participated in the ‘Year of Care’ model which encouraged patients to set their own lifestyle and health objectives when managing their asthma, diabetes or chronic obstructive pulmonary disease (COPD).

• Health care assistants had been trained to carry out foot health checks for patients with diabetes to reduce the need to attend other appointments such as podiatry appointments on a routine basis.

Updated 2 November 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. The practice staff liaised with the health visiting team to monitor attendance at A&E by babies and young children. Immunisation rates were relatively high for all standard childhood immunisations.

• Patients told us that children and young people were treated in an age-appropriate way and described examples to demonstrate this.

• 76% of eligible women had received a cervical screening test in the preceding five years compared to the CCG average of 79% and national average of 82%.

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

• Staff gave examples of when joint working with health visitors had been effective in sharing information and planning care for children with more complex needs.

Updated 2 November 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 their 2% of elderly and frail patients as well as other patients who were at risk of unplanned hospital admission. They had appointed a clinical care co-ordinator who monitored hospital admission and discharge and attendance at out of hours services. Telephone contact was made following discharge from hospital where their needs were assessed and care plans updated to address any new needs.

• Before the inspection we sought feedback from a residential home for older people who had eight residents registered at the practice. Staff there told us they were happy with the service provided by the GPs and other staff at the practice.

Updated 2 November 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 acknowledged, and the practice had adjusted the services it offered to ensure these were accessible, flexible and offered continuity of care.

• The practice was open between 7.30am and 7.30 pm Monday to Friday to provide opportunities for working age patients to access appointments at a time convenient to them.

• The practice provided evidence which showed that 2,183 people (31% of the practice population) had registered for access to online services. This service had been promoted by reception staff, who were offered incentives, by way of additional annual leave allowance when targets had been reached.

• We saw the practice provided a full range of health promotion material relevant to this age group.

• The practice participated in the ‘Pharmacy First’ scheme which enabled pharmacists to prescribe and dispense a number of medicines to treat minor illnesses.

• The practice made use of text reminders advising patients of their appointment date and time. They told us they had reduced the number of patients failing to attend their appointments by 20% since its introduction in July 2015.

• The practice provided evidence that 95% of eligible patients had received an NHS health check in the preceding year, which exceeded their target of 75%.

Updated 2 November 2016

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

• 73% of patients diagnosed with dementia had had their care reviewed in a face to face meeting in the last 12 months, which was lower than the local and national averages of 89% and 90% respectively. The practice was addressing this shortfall by the appointment of a lead GP for mental health, and by offering telephone reminders for care planning appointments

• 93% of patients with schizophrenia or other psychoses had their alcohol consumption recorded in the preceding 12 months which was higher than the local and national averages of 89% and 90% respectively.

• 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.

• The practice gave patients experiencing poor mental health information about how to access various support groups and voluntary organisations.

• 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.

• Patients experiencing emotional difficulties were able to access support from the local ‘Patient Empowerment Project’ (PEP).

Updated 2 November 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 those with a learning disability.
• The practice offered longer appointments for patients with a learning disability.
• The practice regularly worked with other health care professionals in the case management of vulnerable patients.
• The practice informed vulnerable patients how to access various support groups and voluntary organisations, such as ‘Forward Leeds’, a local alcohol and drug support service.
• The practice hosted weekly cognitive behavioural therapy (CBT) sessions weekly to help patients living with chronic pain.
• Staff knew how to recognise signs of abuse in vulnerable adults and children. Staff were aware of their responsibilities and described good examples where appropriate action had been taken in response to safeguarding concerns. They showed they were aware of information sharing, documentation of safeguarding concerns and how to contact relevant agencies in normal working hours and out of hours.
• The practice had identified 70 patients (1% of their practice population) as unpaid carers. This group of patients was offered additional support, such as an annual health check, seasonal flu vaccination and signposting to local support services, such as ‘Carers Leeds’.