Dr Moxon & Partners (Burton Croft Surgery) Also known as Burton Croft Surgery

Updated 11 January 2017

Dr Moxon and Partners (Burton Croft Surgery) and is located at St Michaels Court, Headingley, LS6 2AF. Headingley is a suburb of Leeds, West Yorkshire and is approximately two miles out of the city centre. The practice is situated within a purpose built building on the second floor with lift access, disabled facilities and car parking available.

The practice provides services for 11,008 patients and is situated within the Leeds West Clinical Commissioning group (CCG) and is contracted to provide primary medical services under the terms of a personal medical services (PMS) contract. This is a contract between general practices and NHS England for delivering services to the local community.

They offer a range of enhanced services such as extended hours provision, childhood immunisations and facilitating timely diagnosis and support for people with dementia.

There is a slightly lower than average number of patients aged 14 and under and there are more patients aged between 20 and 29 than the England average. The practice also supports a higher than average number of older people. The national general practice profile shows that the practice population is predominantly white British with 14% of the practice population from a south Asian, mixed background, black or non-white ethnic group. Whilst the diversity of the Leeds West area is changing, white British remains the largest ethnic group.

The practice has seven GP partners, four of whom are female and three are male, with one male salaried GP. The practice also employs one advanced nurse practitioner (ANP) five part time practice nurses, a part time care homes nurse, a practice matron and two health care assistants (HCAs) who are all female. The clinical team is supported by a practice manager and a team of administrative staff.

The practice catchment area is classed as being within one of the 20% least deprived areas in England with slightly higher than average numbers of patients in employment.

The practice reception is open between 7.45am to 8pm Monday to Thursday and between 7.30am to 6.30pm on a Friday. Appointments are from 8am to 7.50pm Monday to Thursday and from 8am to 6pm on a Friday. Additional extended hours appointments are offered between 8am and 4pm on a Saturday and Sunday at the surgery as part of a Federation of local practices.

When the surgery is closed patients are advised of the NHS 111 service for non –urgent medical advice and are directed to a local out of hours provider.

Burton Croft Surgery is a training practice which supports GP Trainees (fully qualified doctors in training to become GPs). They are also involved in the training of medical students, dental students and nurses.

Updated 11 January 2017

Letter from the Chief Inspector of General Practice

We carried out an announced comprehensive inspection at Dr Moxon and Partners (Burton Croft Surgery) on 17 November 2016. Overall the practice is rated as Outstanding.

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

• Staff understood and fulfilled their responsibilities to raise concerns and report incidents and near misses. There was a genuinely open culture in which all safety concerns raised by staff and people who use services were highly valued as integral to learning and improvement. We saw a formal meeting for the review and discussion of medicines, good practice guidelines and safety alerts. This ‘Learning Meeting’ ensured that information was disseminated to the right people in a timely manner.
• Data from the most recent National GP Patient Survey showed that 95% of patients would recommend the surgery to someone new to the area and 99% of patients said the last appointment they got was convenient.
• The practice gathered feedback from patients and it had a very engaged and proactive patient participation group (PPG), who liaised closely with staff and influenced practice development. Changes were made to the way it delivered services as a consequence of feedback from patients and the PPG.
• Feedback from patients about their care was consistently and strongly positive. The PPG had carried out a survey of 500 patients in January 2016 with a response rate of 74%, 99% of patients said their overall experience of the surgery was positive and they were treated with care and respect.
• Nursing staff carried out “spot checks” of each other competencies, for example, when conducting blood tests or administering vaccinations to ensure that their practice met national guidance and good practice.
• We saw comprehensive safe systems and processes that promoted good quality, safe care for patients.
• The practice had a clear pro-active vision which had quality and safety as its top priority. The strategy to deliver this vision had been produced with stakeholders and was regularly reviewed with them and the staff team.
• The practice had strong and visible clinical and managerial leadership and governance arrangements.
• We saw a culture of audit that was strongly embedded into the day to day management of the practice.
• Patients with palliative care needs were well supported at the practice. A GP at the practice had undertaken additional qualifications in this area and supported a local hospice. He disseminated good practice to the team regularly at multidisciplinary meetings. Patients were also reviewed with specialist community staff.
• The reception team had implemented a twice daily ‘huddle’ to review tasks, workloads and respond to urgent matters. This was a focussed, documented discussion that improved patient safety by ensuring the workload was continually reviewed, well managed and organised.
• Patients who had complex needs were supported to receive coordinated care and we observed innovative and efficient ways of delivering joined up care for patients. For example, we saw a patient recall system whereby coded letters were sent to patients asking them to attend for reviews. This code was then used by the reception team to ensure that the correct length of appointment was allocated, reducing the need for the patient to explain their condition and allowing a review of multiple issues to take place at the same time.

We saw areas of outstanding practice including:

• The practice had employed a Matron and a part time Care Homes Nurse to review and proactively support the care of approximately 170 older people living in care homes registered with the practice and also other patients living in their own homes. The matron conducted a daily review of unplanned admissions, accident and emergency (A&E) attendances and hospital discharges. These patients were then reviewed by the matron, lead health professional or the GP as appropriate. As a result, the practice could evidence they were 38% lower than the national average for A&E attendances and 28% lower than the national average for unplanned hospital admissions. An unplanned admissions audit was undertaken quarterly.

Professor Steve Field (CBE FRCP FFPH FRCGP) 

Chief Inspector of General Practice

Updated 11 January 2017

The practice is rated as outstanding 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. The practice matron conducted a daily review of unplanned admissions, A&E attendances and hospital discharges. These patients were then reviewed by the matron, lead health professional or the GP as appropriate.
• We observed a patient recall system whereby coded letters were sent to patients asking them to attend for long term condition (LTC) reviews. This code was then used by the reception team to ensure that the correct length of appointment was allocated, reducing the need for the patient to explain their condition and allowing a review of multiple issues to take place at the same time.
• The percentage of patients newly diagnosed with diabetes, who had a record of being referred to a structured education programme within nine months after entry on to the diabetes register was 94%, compared to the CCG average of 89% and the England average of 92%.
• Between February 2015 and February 2016, the practice had screened over 1,900 patients at risk of pre-diabetes and identified 564 patients who were eligible for annual review. Patients were referred to an intensive lifestyle and behaviour change programme as appropriate.
• Longer appointments and home visits were available when needed or on request. Appointments for the review of LTC were up to 45 minutes in duration and were tailored to suit individual patient needs.
• 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.
• Two GPs and the matron had undertaken additional training to enable the initiation of New Oral Anticoagulants (NOAC) drugs for patients with atrial fibrillation (AF), a condition which causes an irregular heartbeat. The practice were currently auditing patient records to identify those at risk.

Updated 11 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 a high number of A&E attendances. 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 were recognised as individuals, and we saw evidence to confirm this. For example, following an audit, a Fraser/ Gillick competency template had been produced to support young people under 16 who were attending for contraception. (The Gillick competency and Fraser guidelines help to balance children’s rights and wishes with the responsibility to keep children safe from harm).
• The percentage of women aged 25 or over whose notes recorded that a cervical screening test has been performed in the preceding 5 years was 78% compared to the CCG average of 79% and the England average of 81%.
• Appointments were available outside of school hours and the premises were suitable for children and babies. We were told that children who were ill would be prioritised during the walk in service if necessary.
• We saw positive examples of joint working with midwives, health visitors and school nurses.
• The practice offers a weekly sports injuries clinic to review issues relating to sports or exercise. Patients could also be referred to physiotherapy services within the building.
• A full range of contraceptive options were offered to patients and practice reception staff had undertaken additional training in sexual health to encourage the early detection of sexually transmitted infections.

Updated 11 January 2017

The practice is rated as outstanding 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 participated in the Leeds West CCG Care Homes Scheme alongside other practices in the area. They had identified 1.4% of its population as residing in a care home compared to the CCG average of 0.3% A practice matron had been employed to proactively support those registered patients who lived in local care homes each week to review their needs. The homes were also supported by a dedicated care homes practice nurse, who monitored and managed long term conditions. GPs would visit when required.
• The practice had higher than average numbers of patients who were 85 years and over. They were responsive to the needs of this age group. Home visits and urgent appointments were offered for those with enhanced needs including those with long term conditions.
• The matron worked closely with the palliative care team to support end of life care planning in conjunction with care home staff, the patient and their families. This included planning for the preferred place of death, or care if a patient’s condition deteriorated. The practice held regular Gold Standard palliative care meetings. A GP at the practice had undertaken additional qualifications in this area and worked regular sessions at a local hospice.
• We also viewed evidence of unplanned admissions and “do not attempt cardio pulmonary resuscitation” care plans completed for relevant patients. The matron would spend time with relatives and the patient to produce these.

Updated 11 January 2017

The practice is rated as outstanding 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.
• Patients could be seen until 8pm Monday to Thursday and between 8am and 4pm on a Saturday and Sunday. Early morning appointments were also available.
• The practice held a walk- in service every morning which allowed access to on the day appointments between 8am and 10.30am. This was evaluated highly by patients and we were told all patients attending this service would be seen.
• During Freshers’ week the practice would attend a local halls of residence to encourage new students to register.
• The practice was proactive in offering online services as well as a full range of health promotion and screening that reflects the needs for this age group. Patients could also request telephone appointments or consult with the practice via email.

Updated 11 January 2017

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

• Overall performance for mental health related indicators was better than CCG and England averages. For example, the percentage of patients with schizophrenia, bipolar affective disorder and other psychoses who had a comprehensive care plan documented in their notes in the preceding 12 months was 92%, which was better than the CCG average of 85% and the England average of 89%. Data also showed that 91% of the same patient group had their alcohol consumption recorded compared to the CCG average of 86% and the England average of 89%.
• Data showed that 83% of patients diagnosed with dementia had received a review of their care in a face to face meeting in the last 12 months, which was comparable to the CCG average of 87% and the England average of 84%.
• 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. Several nursing staff had completed dementia specific training and used a dementia screening tool and template to identify patients at risk. Ad hoc assessments would be conducted if a patients’ behaviour caused concern during the consultation.
• We saw that care plans were in place for patients with dementia and mental health issues. Plans were also in place for patients at risk of an unplanned admission.
• The practice had told patients experiencing poor mental health about how to access various support groups and voluntary organisations.
• Staff had a good understanding of how to support patients with mental health needs and dementia. Physical health checks were being undertaken for patients with serious mental illness.

Updated 11 January 2017

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

• The practice held a register of patients living in vulnerable circumstances including homeless people, and those with a learning disability.
• The practice offered longer appointments for patients with a learning disability and for patients who might request these.
• The practice regularly worked with other health care professionals in the case management of vulnerable patients. We saw that care plans were in place for those who were at risk of an unplanned admission.
• The practice informed vulnerable patients including carers, about how to access various support groups and voluntary organisations.
• The practice matron conducted a daily review of accident and emergency attendances and hospital discharges. These patients were then reviewed by the matron, lead health professional or the GP as appropriate.
• Staff knew how to recognise signs of abuse in vulnerable adults and children and all staff had attended training relevant to their role. Staff were clear about their responsibilities regarding information sharing, documentation of safeguarding concerns and how to contact relevant agencies in normal working hours and out of hours.