Dr RI Addlestone, Dr N Mourmouris & Dr GE Orme

Updated 12 February 2020

Dr RI Addlestone, Dr N Mourmouris and Dr GE Orme is located at Thornton Medical Centre, 15 Green Lane, Wortley, Leeds, West Yorkshire, LS12 1JE. The practice has on-site parking, with dedicated spaces for those with mobility issues, good transport links and there is a pharmacy located nearby.

The provider is registered with CQC to deliver the following Regulated Activities:

• Diagnostic and screening
• Family planning
• Surgical procedures
• Treatment of disease, disorder or injury

Dr Addlestone, Dr N Mourmouris and Dr G E Orme is situated in the NHS Leeds Clinical Commissioning Group and provides services to approximately 9,551 patients under the terms of a General Medical Services (GMS) contract. This is a contract between general practices and NHS England for delivering service to the local community.

The service is provided by a partnership consisting of three GP partners (two male and one female). The partners are supported by two salaried GPs (both female), one advanced practitioner (female), three practice nurses (female), one health care assistant (female) and a phlebotomist (male). The practice also employed a long term advanced nurse practitioner locum.

The practice is a teaching and training practice, which means it provides training for fully qualified doctors wishing to specialise in general practice. The practice also provided student nurse training, however at the time of our inspection this was temporarily on hold until the new members of the nursing team had been fully integrated into the team.

The practice is part of the Armley Primary Care Network (PCN). A PCN is a group of practices that work together and with other stakeholders to meet the needs of their local population.

The National General Practice Profile states that 88% of the practice population is from a White British or Irish origin and a further 6% from an Asian background. The remainder of the population is originating from black, mixed or other non-white ethnic groups.

The practice is open from 8am until 6pm on Monday, Wednesday, Thursday and Friday and from 7am until 6pm on Tuesday.

Patients can also access weekend appointments at a local practice as part of the locality extended access service.

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

When we returned we checked and saw that the ratings from the previous inspection were displayed as required in the practice and on the website.

Updated 12 February 2020

We carried out an inspection of this service due to the length of time since the last inspection. Following our review of the information available to us, including information provided by the practice, we focused our inspection on the following key questions:

• Are services effective?
• Are services well- Led?

We based our judgement of the quality of care at this service on a combination of:

• what we found when we inspected
• information from our ongoing monitoring of data about services and
• information from the provider, patients, the public and other organisations.

We have rated this practice as good overall and good for all population groups.

We found that:

• The practice provided care in a way that kept patients safe and protected them from avoidable harm.
• Patients received effective care and treatment that met their needs.
• The practice organised and delivered services to meet patients’ needs. Patients could access care and treatment in a timely way.
• The practice was committed to continuous learning and development.
• We received positive comments from staff and patients regarding the service that was provided.

Whilst we found no breaches of regulations, the provider should:

• Continue to review and improve their processes in relation to Quality and Outcomes Framework (QoF) exception reporting to provide the optimum care for their patients.
• Continue to take steps to improve uptake of cervical screening.
• Monitor new cancer cases which have resulted from a two week urgent referral.

Details of our findings and the evidence supporting our ratings are set out in the evidence tables.

Dr Rosie Benneyworth BM BS BMedSci MRCGP

Chief Inspector of Primary Medical Services and Integrated Care

Updated 23 September 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.

• 81% of patients with diabetes, on the register, had a recorded cholesterol reading which was within normal limits completed in the preceding 12 months which was the same as the CCG and national average of 81%

• Longer appointments and home visits were available when needed.

• 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 adopted the ‘Year of Care’ model for several long term conditions. These encouraged patients to set their own lifestyle and health objectives to manage their condition.

• The practice participated in the local pre-diabetes project, aimed at early diagnosis and treatment for patients at risk of developing this condition... They showed us data which indicated that of 74 people invited for an initial pre-diabetic screening, 14% had been found to have pre-diabetes indicators and 8% had diabetes. Of this group of patients, those who were clinically obese, or who were newly diagnosed diabetics were able to access a 12 week course at a commercial weight loss programme to support them with weight loss if appropriate

• The practice had obtained funding to run a ‘self-management’ course to help patients to deal with their long term condition. We saw that 98 patients had completed the course, and saw evaluation which evidenced that most of the participants felt an improvement in relation to positive and active engagements in life, emotional well-being and ability to navigate the range of health services available to them...

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.

• The practice described examples of where they had ‘gone the extra mile’ to identify and support children in vulnerable circumstances; for example, children at risk of trafficking.

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

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

• Staff gave several examples to describe how joint working with health visitors, school nurses and other agencies, such as family centres, had been effective in sharing information and improving care planning for children in vulnerable circumstances, or for those with more complex needs.

• The practice made contact with all new mothers, providing a ‘new baby’ pack, encouraging parents to register the baby with the practice, and providing details of appointments for new baby medicals and immunisations.

• The practice described how they had obtained funding to provide a ‘childhood minor illness’ session at the local family centre. We saw evaluation from this session which showed that that parents’ confidence and knowledge had improved as a result of attending the group. The practice had plans to continue to offer such sessions in conjunction with health visitor pregnancy support groups.

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.

• In conjunction with two other local practices the practice participated in an enhanced care home scheme. A CCG funded care home nurse and health care assistant, shared by all three practices, visited all care homes in the area on a weekly basis to monitor the health and well-being of the residents. They ensured care and treatment plans were in place and appropriate, and liaised with the practice on a weekly basis.

• The practice told us that prior to this scheme being initiated, they had appointed a nurse employed by the practice to oversee and monitor the care of patients in residential and care homes for older people. They showed us data which indicated that the number of patients able to end their lives at their place of choice had increased from 20% in 2004 to 70% in 2016.

• Before we visited the practice we sought feedback from one residential home for older people and one nursing home for older people.Both told us they received a high quality service from the practice, with easy access to home visits by the GPs and a responsive and friendly service from the practice. One of the homes remarked that there were sometimes delays in receiving the prescriptions requested.Both told us the enhanced care home scheme was having a big impact in terms of improving patient care.

• The practice had a register of older and vulnerable patients at risk of unplanned hospital admission. A care co-ordinator had been appointed who oversaw their care, and created care plans which were regularly reviewed and updated by clinicians. She made contact with this group of patients at least every six months, or following hospital admission and discharge.

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

• The practice provided access to a range of health promotion material appropriate to this age group.

• 83% of eligible women had received a cervical screening test in the preceding five years which was higher than the CCG average of 79% and national average of 82%.

• The practice was proactive in offering online services. They showed us evidence to suggest that 1976 patients (22% of the patient population) had registered for online services.

• Patients were able to make use of self-monitoring of blood pressure, weight and body mass index by means of equipment which was available in the patient waiting area.

• The practice offered new patient checks and screening for blood borne viruses was carried out with the patient’s permission.

Updated 23 September 2016

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

• 92% of patients with schizophrenia or other psychoses had a comprehensive documented care plan completed within the preceding 12 months, which was higher than the local and national average of 88%.
• 74% 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 local and national averages of 83% and 86% respectively.

• The practice regularly worked with multi-disciplinary 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.

• We saw evidence that evaluation from the ‘Rise High’ project showed a reduced level of anxiety and depression reported by those who had received support from the project.

• 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.

• The practice had obtained funds to contribute to ‘mindfulness resilience skills’ groups which ran from the local children’s centre. We saw evaluation from these groups which indicated that between 85% and 100% attendees described feeling better about themselves, more able to cope and less stressed than before they attended the course. Mindfulness is a type of meditation which focuses on slowing breathing and focusing thoughts on the precise thoughts, feelings and sensations during the period spent in meditation.

• Patients were able to access support from the local community centre to help manage their mental health, including those issues associated with alcohol or drug misuse.

• Patients experiencing emotional difficulties were able to self-refer to access support from the locally provided ‘Patient Empowerment Project’ (PEP).

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 those with a learning disability.

• The practice offered longer appointments of 20 minutes, 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 worked closely with multi-agency teams, including third sector (charitable) organisations to improve outcomes for this group of patients. Some of their patients had benefited from a locally provided multi-agency ‘Rise High’ project which provided support and advice, with issues such as managing debt and tackling other vulnerability factors. This project worked with people living in four nearby high risk flats. Of the 46 people who were seen during the course of the project, 58% were patients at Thornton Medical Practice. Evaluation at the end of the project showed an improvement in people’s ability to perform their usual duties, and their ability to manage their self-care needs.

• The practice had identified 202 patients (2%) of the practice list as carers. This group of patients were offered an annual health check and seasonal flu vaccination. They were also signposted to local support services, such as ‘Carers Leeds’.

• The practice hosted local authority debt management services who offered a regular clinic at the surgery.