Mulberry Street Medical Practice Also known as Pudsey Health Centre

Updated 30 August 2016

Dr Ross and Partners (Pudsey Health Centre) is situated in Pudsey, Leeds LS28 7XP. Pudsey is a small town six miles to the west of Leeds city centre. There are currently 7304 patients on the practice list. The majority of their patient group is of white British origin. The practice provides Personal Medical Services (PMS) under a contract with NHS England. They offer a range of enhanced services such as childhood vaccinations and immunisations and minor surgery.

The practice has six GP partners, three of whom are women and three men. There are two female practice nurses and one female health care assistant (HCA). The clinical team is supported by a practice manager, assistant practice manager and a range of reception, secretarial and administrative staff.

The practice is a training practice, which means it provides training and support for qualified doctors wishing to specialise in general practice. At the time of our visit one male GP registrar was working at the practice.

The practice catchment area is classed as being within the group of the fifth least deprived areas in England.

The age/sex profile of the practice is in line with national averages. Average life expectancies for patients is 78 years for men and 82 years for women. (England average 79 years and 83 years respectively).

The practice is open between 7am and 7pm Monday to Friday.

Weekly clinics are held which include diabetic, asthma and kidney reviews; cervical smear clinics and childhood immunisation clinics.

The practice has limited parking spaces available on site, but a public car park adjacent to the practice provides parking facilities. The practice is accessible by public transport.

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

Updated 30 August 2016

Letter from the Chief Inspector of General Practice

We carried out an announced comprehensive inspection at Dr Ross and Partners (Pudsey Health Centre) 12 July 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 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, although not necessarily the GP of their choice. Urgent appointments were available to pre-book or on the same day. Each day one GP on call was able to accommodate urgent and unexpected patient need, and to offer non urgent same day appointments.
• The practice had facilities which were appropriate to treat patients and meet their needs.
• There was a clear leadership structure and staff felt supported by management and the practice manager. 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 identified one area of outstanding practice:

• The practice had developed a ‘dementia care pack’ for patients diagnosed with dementia. This provided information relating to national and local support services for patients and their families and carers; as well as helpful information relating to the medical and social features of dementia.

There are areas where the provider should make improvement. The practice should:

• Develop a system to update patient records following all multidisciplinary meetings. During the inspection the practice told us they had plans in place to carry this out.

• Consider means of masking patient:clinician conversations being overheard from one of the clinical rooms.

Professor Steve Field (CBE FRCP FFPH FRCGP) 

Chief Inspector of General Practice

Updated 30 August 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.

• 95% of patients with diabetes, on the register had received a flu vaccination in the preceding year compared to the national average of 94%.

• Patients identified as being at risk of developing diabetes (pre-diabetes) were provided with a ‘diabetes pack’ which enabled them to monitor their own lifestyle and family risk factors, and gave advice on healthy eating, exercise and other lifestyle factors to help reduce the risk of developing diabetes.

• The practice had purchased 150 blood pressure monitoring devices to enable patients to track their blood pressure recordings at home.

• The practice was working with four local practices to improve outcomes for patients with chronic obstructive pulmonary disease (COPD) where they were obese or where they acted in the role of unpaid carer.

• Longer appointments and home visits were available when needed. Patients attending for review of their long term condition had 30 minute appointments, which included ten minutes with the health care assistant, practice nurse and GP respectively.

• 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. The practice had employed a pharmacist to support GPs in managing patients' medicine needs

• The practice participated in the ‘House of Care’ model which encouraged patients to set their lifestyle and health objectives when managing their diabetes.

• A number of other care planning templates were in use for other long term conditions, such as asthma and coronary heart disease

Updated 30 August 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 or who had a high number of failed appointments. 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 described examples to demonstrate this.

• The practice was open between 7am and 7pm to allow appointments to be made available outside of school hours and the premises were suitable for children and babies. The practice building provided good facilities for baby changing and breast feeding mothers.

• Staff provided examples to demonstrate how joint working with health visitors had been effective in sharing information and planning care for children with more complex needs.

Updated 30 August 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 elderly and frail elderly patients who were at risk of unplanned hospital admission, and offered support and monitoring to this group of patients. The practice had employed a clinical care co-ordinator who oversaw this group of patients. Following hospital admission and discharge these patients were contacted, a care plan was issued, and patients were signposted to local services to try to reduce the chances of future admission to hospital.

• 74% of eligible women had received a breast screening examination in the preceding three years, which was higher than the CCG average of 69% and the national average of 72%.

• 59% of eligible patients had been screened for bowel cancer in the preceding 30 months which was in line with CCG and national averages of 58%.

Updated 30 August 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.

• 83% of eligible women had a cervical screening check recorded in the preceding five years compared to the national average of 82%.

• The practice was proactive in offering online services as well as a full range of health promotion and screening reflecting the needs of this age group.

• The practice provided data which indicated that 1435 patients (20 % of the patient population) had registered for online services.

• The practice used social media to engage with patients and the wider community, and provided free wi-fi on site to meet the needs of this group of patients.

Updated 30 August 2016

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

• 97% of patients with schizophrenia or other psychoses had completed a face to face review in the preceding 12 months compared to the national average of 89%.

• 78% 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 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.

• Staff had received ‘dementia friendly’ training.

• The practice had developed a’ dementia care pack’ which provided patients with crucial information relating to their condition and useful contact details of appropriate support agencies. This enabled patients and their carers to proactively plan and manage their condition.

• 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 could self refer to access support from the local ‘Patient Empowerment Project’ (PEP).

Updated 30 August 2016

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

• The practice had identified 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.

• 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.

• The practice had identified 2% of their patient population as unpaid carers, and offered additional support and signposting services to this group of  people.