Laurel Bank Surgery

Updated 25 January 2017

The practice operates from a surgery which is located at 216b Kirkstall Lane, Leeds, West Yorkshire LS6 3DS. The practice serves a patient population of around 7,200 patients and is a member of NHS Leeds West Clinical Commissioning Group.

The surgery is situated in a detached building and is of older construction being built around 1900. The surgery is located over two floors and is accessible for those with a physical disability. There is limited parking available on the site for patients, the site is also shared with another GP practice.

The practice population age profile shows that it is below both the CCG and England averages for numbers of patients aged under 18 years old (12% compared to the CCG average of 19% and England average of 21%) and for patients aged over 65 years old (9% compared to the CCG average of 14% and England average of 17%). The majority of patients are therefore of working age and a large proportion of these (around 35% of the patient list) are students attending the nearby universities. Average life expectancy for the practice population is 77 years for males and 82 years for females (CCG average is 78 years and 82 years and the England average is 79 years and 83 years respectively). The practice population shows some diversity in ethnic origin with 89% of recorded patients being White, 3% being Asian, 2% being Black and 3% classified as Other/Mixed.

The practice provides services under the terms of the General Medical Services (GMS) contract. In addition the practice offers a range of enhanced local services including those in relation to:

• Childhood vaccination and immunisation

• Influenza and Pneumococcal immunisation

• Rotavirus and Shingles immunisation

• Meningitis vaccination

• Extended hours access

• Dementia support

• Learning disability support

• Risk profiling and case management

• Support to reduce unplanned admissions

• Improving patient online access

• Minor surgery

• Patient participation

• Out of area in hours care provision

• Alcohol review

As well as these enhanced services the practice also offers additional services such as those supporting long term conditions management including asthma, diabetes, heart disease and hypertension, joint injections and smoking cessation.

Attached to the practice, or closely working with the practice, is a team of community health professionals that includes the community matron, health visitors, midwives, members of the district nursing team and a memory support worker.

The practice has three GP partners (two male, one female), two salaried GPs (both female), and two GP registrars (both female). In addition there are three nurses, one health care assistant and one phlebotomist (all female). Clinical staff are supported by a practice manager, a deputy manager (who also acts as the phlebotomist) and an administration and reception team. In addition the practice also has the services of CCG employed pharmacist allocated to them for half a day a week.

The practice appointments include:

• On the day appointments

• Pre-bookable appointments

• Telephone consultations

• Home visits

Appointments can be made in person, via the telephone or online.

The practice was open between 8am and 8pm Monday to Thursday and 7am to 7pm on Friday. As a result of working with other practices locally, patients were also able to access appointments delivered at a nearby practice from 8am to 4pm on a Saturday and Sunday.

The practice is accredited as a training practice and also acts as a teaching practice for a local university and supports and hosts GP trainees and Year Three medical students respectively. In addition the practice hosts and supports student nurses undergoing training.

Out of hours care is provided by Local Care Direct Limited and is accessed via the practice telephone number or patients can contact NHS 111.

Updated 25 January 2017

Letter from the Chief Inspector of General Practice

We carried out an announced comprehensive inspection at Laurel Bank Surgery on 10 November 2016. Overall the practice is rated as outstanding.

Our key findings across all the areas we inspected were as follows:

• The practice had developed an open, blame-free culture with regard to the identification and notification of significant events and incidents. A thorough analysis of the events was carried out and these were discussed at the daily and monthly clinical team meetings. The GP trainer kept a log of historical significant events which they used with GP registrars as a training aid.

• The practice used innovative and proactive methods to improve patient outcomes, working with other local providers to share best practice. They participated in a number of Clinical Commissioning Group (CCG) led initiatives which delivered integrated care and improved service co-ordination.

• The practice had a proactive view to wider service improvement and co-operated with other bodies which required GP practice input. For example, they had worked with the Department of Work and Pensions to develop and trial new online systems to support terminally ill patients accessing appropriate benefits in a timely way.

• Audit and compliance assessment was a fundamental part of the culture of the practice. A programme of audits had been developed based on patient safety alerts, effective prescribing, guidance updates and any issues highlighted within the practice. Over the previous 12 months the practice had carried out 46 audits.

• Feedback from patients about their care was consistently positive and above local and national averages.

• The practice worked closely with other organisations and with the local community in planning how services were provided to ensure that they meet patients’ needs. For example, the practice worked with others locally to provide weekend appointment access, this service being delivered at a nearby surgery.

• The practice delivered care to specific vulnerable groups which included those with a learning disability.

• The practice implemented suggestions for improvements and had made changes to the way it delivered services as a consequence of feedback from patients and from the patient participation group.
• The practice had a vision which had quality and safety as its top priority. The practice had developed a clear strategic approach which was supported by a business plan and practice improvement plan and used these to deliver this vision.
• The practice had a strong commitment to training and told us that training formed a key part of the culture of the organisation and that this ensured the delivery of knowledgeable, informed and effective patient care.
• The practice had strong and visible clinical and managerial leadership and governance arrangements.

We saw two areas of outstanding practice:

• The practice had adopted a systematic approach to service improvement and had developed a practice improvement plan (PIP). The PIP identified key areas where it was demonstrated that improvement was required. These areas were identified from patient surveys and feedback, performance reports, public health reports, audits and risk assessments. The PIP was maintained by the practice manager, however all staff were involved in its development and in supplying content. The PIP was also used to track and report on progress and its content was discussed at team meetings. As an example, the practice had identified cervical screening as a subject area and included actions to increase screening in the PIP. At the time of inspection screening rates had improved from 76% to 81% from 2014/2015 to 2015/2016.

• The practice provided services for residents of a local bail hostel for recently released ex-offenders. The practice had to cope with a rapid turnover of patients from the hostel, many of whose residents had pre-existing or developing health conditions.

However there was an area where the provider should make improvement:

• Review the immunity status of staff in relation to measles, mumps, rubella and chickenpox in order to assure themselves that their staff are adequately protected in line with the latest guidance.

Professor Steve Field (CBE FRCP FFPH FRCGP) 

Chief Inspector of General Practice

Updated 25 January 2017

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

• GPs and nursing staff had lead roles in chronic disease management. In line with other work such as avoiding unplanned admissions and via the work of the clinical care co-ordinator patients at risk of hospital admission were identified as a priority.

• Outcomes for patients with long term conditions were either comparable to or better than local and national averages. For example, 92% of patients on the diabetes register had which was above the CCG average of 88% and the national average of 89%.

• Patients with a long term condition had named support and regular structured reviews to check their health and medicines needs were being met. For those patients with the most complex needs, clinicians worked with relevant health and care professionals to deliver a multidisciplinary package of care.

• To meet the challenges posed by long term conditions the practice had plans to implement the “House of Care” model (this takes a whole systems approach to the management of long term conditions and aims to make the patient central to care).

• The practice kept up to date with national guidance in relation to long term conditions. For example, it had discussed and examined guidance in relation to atrial fibrillation management (atrial fibrillation is an irregular heartbeat that can lead to blood clots, stroke, heart failure and other heart-related complications) and devised and implemented an action plan to drive this forward. This work had been subject to subsequent clinical audit.   

Updated 25 January 2017

The practice is rated as outstanding 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 missed key appointments and health checks.

• Immunisation rates were relatively high for all standard childhood immunisations and comparable to national averages.

• We were told by the practice, and we saw evidence on the day, that children and young people were treated in an age-appropriate way and were recognised as individuals.

• The practice encouraged the uptake of the cervical screening programme and offered evening smear clinics, and had sought to raise awareness amongst target groups. They had also refreshed the patient cervical screening list and had removed “ghost” patients who were no longer living in the area supported by the practice or students from other countries who may have returned home. As a result of this activity screening uptake had risen from 76% in 2014/2015 to 81% in 2015/2016.

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

• The practice hosted twice weekly antenatal clinics which were provided by community midwives.

• Staff accessed and referred children and young people with emotional problems to a local online portal where they could receive advice and support.

• The practice had a baby-changing station and a quiet area which was suitable for nursing mothers. 

Updated 25 January 2017

The practice is rated as outstanding for the care of older people.

• The practice was responsive to the needs of older people, and offered home visits, urgent appointments for those with enhanced needs, and longer contact time with clinicians if this was required.

• The practice offered proactive, personalised care to meet the needs of the older people in its population. For example, they delivered an avoiding unplanned admissions service which provided proactive care management for patients who had complex needs and were at risk of an unplanned hospital admission. To facilitate effective communication the practice had given by-pass telephone numbers to all patients/carers involved with this service. At the time of inspection the practice had 127 patients (around 2% of the practice list) on their avoiding unplanned admissions register.

• The practice had appointed a nurse to act as a clinical care co-ordinator to work with other agencies in the identification and support of vulnerable older patients.As well as care planning this included referral to other bodies and improved liaison with carers and family members.

• The practice provided routine visits to local residential care homes where they had registered patients. As a result of these interventions and support, since August 2015, local practices who participated in the delivery of care home visits to a total of 50 homes could evidence an overall 5% reduction in accident and emergency attendance and a 4% reduction in unplanned hospital admissions.

Updated 25 January 2017

The practice is rated as outstanding for the care of working-age people (including those recently retired and students).

• The needs of this population group had been identified and the practice had adjusted the services it offered to ensure these were accessible, flexible and offered continuity of care. There was extended hours access and also access to weekend services.

• Patients could access in-house services such as family planning clinics, minor surgery and joint injections.

• The practice was proactive in offering online services which included appointment booking, repeat prescriptions and medical records.

• The practice provided dedicated support and specific services for its large student population (around 35% of registered patients).

• The practice accepted out of area registrations for patients who for example may work in the area but live out of the catchment area.

Updated 25 January 2017

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

• Performance for mental health related indicators showed performance generally above CCG and national averages. For example: 100% of patients with schizophrenia, bipolar affective disorder and other psychoses who had a comprehensive care plan documented in the record, in the preceding 12 months compared to a CCG average of 85% and a national average of 89%.

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

• The practice carried out advance care planning for patients with dementia and had an active relationship with the local dementia team.

• The practice told patients experiencing poor mental health how to access various support groups and voluntary organisations specific to their needs, as well as promoting wider public health services such as smoking cessation, weight management and exercise opportunities.

• GPs were able to demonstrate a clear understanding of consent and decision-making requirements of legislation and guidance, including the Mental Capacity Act 2005.

• A GP partner held the MRCPsych (Member of the Royal College of Psychiatrists); a qualification awarded to physicians who have completed the prescribed training requirements and membership examinations mandated by the Royal College of Psychiatrists. This additional training gave them a more detailed and specific understanding of mental health, and was particularly useful to the large student population and vulnerable adults such as patients from the bail hostel.  

Updated 25 January 2017

The practice is rated as outstanding for the care of people whose circumstances may make them vulnerable.

• The practice held a register of patients living in vulnerable circumstances which included those with a learning disability and the frail elderly with complex needs. These patients were offered additional support which included health checks and reviews, enhanced care planning and access to longer appointments.

• The practice provided services for residents of a local bail hostel for recently released ex-offenders. The practice had to cope with a rapid turnover of patients from the hostel, many of whose residents had pre-existing or developing health conditions.

• The practice regularly worked with other health care professionals in the case management of vulnerable patients. For example, the practice held monthly multidisciplinary team meetings with partners such as the community matron, social workers, memory support worker and palliative care nurses which the needs of such patients were discussed.

• The practice informed vulnerable patients about how to access various support groups and voluntary organisations.

• 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.