Armley Medical Centre

Updated 27 September 2016

Armley Medical Practice is situated at 95 Town Street Leeds LS12 3HD, which is approximately two miles west of Leeds City Centre. It is housed in a large, modern, purpose built health centre,. The practice is located on the first floor of the building, with lift access. The building is shared with a number of other local services such as physiotherapy and community gynaecology services. Some Leeds Community Healthcare staff are also based in the building. There is an independent pharmacist located on the ground floor. The practice has parking facilities, disabled access and is accessible by public transport.

There are currently approximately 14,200 patients on the practice list. The age profile of the practice shows a significantly higher than average number of people in the 20 to 34 year age group. The Public Health England National General Practice Profile shows the majority of the patient population are of white British origin, with 7% Asian, 2% black and 3% other ethnicities.

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, minor surgery and childhood vaccinations.

The practice has four GP partners, two male and two female. In addition there are three salaried GPs, two female and one male. The practice is a training practice, which means it provides training for qualified doctors wishing to specialise in general practice. Support is also provided for allied health professionals (AHPs) to obtain non-medical prescribing qualifications. On the day of the inspection we received written testimonies from a former GP trainee who described the practice as a supportive learning environment with good educational input. We also received written testimonies from two locum GPs who worked at the practice. They both described the practice as offering thorough induction, and said that as locums they felt part of the team, involved in clinical meetings and able to contribute to practice development.

The practice was involved in developing and managing a practice nurse preceptor programme in 2014/15 to encourage general nurses to enter practice nursing.

The clinical team is completed by one female advanced nurse practitioner (ANP), four female practice nurses, two female health care assistants (HCAs) and one female phlebotomist.

The clinical team is supported by a practice manager, assistant practice manager, reception manager and a range of administrative, secretarial and reception staff.

The practice is classed as being within one of the most deprived areas in England. People living in more deprived areas tend to have greater need for health services.

The average life expectancy for patients at the practice is 75 years for men and 81 years for men, compared to 78 years and 82 years respectively for the CCG average, and 79 years and 83 years respectively for the national average.

The practice is open between 7am and 7pm Monday to Thursday, and between 7am to 6pm Friday. The practice also opens between 8am and 12 midday on Saturday. We were told that from 3 September 2016 the practice would work towards providing seven day access to appointments delivered through the shared resource of a locality’ hub’. Initially access would be on Saturday only.

Weekly clinics are held which include asthma, diabetes and contraceptive services.

Out of hours care is provided by Local Care Direct which is accessed by calling the surgery number or by calling NHS111 service.

Armley Medical Practice was previously inspected by the Care Quality Commission in December 2013. It did not receive a rating at that time.

Updated 27 September 2016

Letter from the Chief Inspector of General Practice

We carried out an announced comprehensive inspection at Armley Medical Practice on 23 August 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 in the main said they found it easy to make an appointment. There was continuity of care. Urgent appointments were available the same day. In addition to pre-booked appointments, ‘sit and wait’ sessions were provided twice a day and these patients were seen by the duty doctor.
• The practice list size was growing, and additional staff had been recruited to the practice. This meant that increased pressure was being placed on the practice’s facilities, although good use was made of the space available to staff. The facilities were appropriate to treat patients and meet their needs.
• There was a clear leadership structure and staff felt supported by 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.

Professor Steve Field (CBE FRCP FFPH FRCGP) 

Chief Inspector of General Practice

Updated 27 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.

• 90% of patients with diabetes had received a seasonal flu vaccination in the preceding year, compared to 94% locally and 95% nationally.

• 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. The practice had recently introduced an annual review in the month of the patient’s birthday, where all conditions were reviewed and any investigations or tests arranged at one appointment.

• The practice used the ‘Year of Care’ model for a number of long term conditions. These encouraged patients to set their own lifestyle and health objectives when managing their condition.

• 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.

Updated 27 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 in line with national averages for all standard childhood immunisations. The practice told us they had recently changed their processes for re-inviting patients who failed to attend their initial appointments, and this had improved uptake to bring it in line with national averages.

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

• The practice operated a ‘sick child protocol’ which meant that children under one year were always offered a same day appointment.

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

• Health visitor clinics were held weekly in another part of the building, and coincided with a childhood immunisation clinic.

• Midwifery clinics were held in the practice twice weekly.

• Staff provided examples to demonstrate how joint working with health visitors had been effective in sharing information and planning care for children in vulnerable circumstances, or for those with additional needs.

Updated 27 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.

• Before the inspection we sought feedback from two local residential homes for older people who had residents registered at the practice. They both told us they were happy with the standard of care provided to their residents by GPs and practice staff.

• In conjunction with two other local practices, the practice participated in an enhanced care home scheme. Funding had been received from the CCG to fund a care home nurse and health care assistant, shared by all three practices. These staff visited all care homes on a weekly basis to monitor the health and well-being of the residents, ensure care and treatment plans were appropriate, and provide a link between care home and practice.

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

• A dedicated telephone number was available to this group of patients to access the practice

Updated 27 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 Thursday, between 7am and 6pm on Friday, and between 8am and 12 midday on Saturday. This made it easier for working age people to access a convenient appointment time.

• Patients were able to receive text reminders of appointments. Where test results were normal these were also communicated by text.

• 77% of eligible women had received a cervical screening test in the preceding five years compared to 79% locally and 82% nationally.

• The practice was proactive in offering online services as well as a full range of health promotion and screening reflecting the needs for this age group. The practice provided evidence that 1662 patients (12% of the practice list) had registered for online services.

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

Updated 27 September 2016

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

• 83% of patients with schizophrenia and other psychoses had a record of their alcohol consumption completed in the preceding 12 months which is lower than the local and national averages of 89% and 90% respectively.
• 86% of patients diagnosed with dementia had had their care reviewed in a face to face meeting in the last 12 months, which is higher than the local and national averages of 83% and 84% respectively.

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

• The practice participated in a local 'Mental Health Transformation Group’ which sought to identify available resources for people experiencing mental health difficulties, and improve access to services. Staff had received ‘Suicide Awareness and Prevention’ training.

• One of the GPs was an expert in ‘Mindfulness’ and promoted the practice of mindfulness. For example by visiting a local group for Asian women to promote this approach.

• Patients were able to access the ‘Patient Empowerment Project’ to help combat social isolation.

• All staff had been trained as ‘Dementia Friends’.The practice had access to a memory support worker.

• The practice carried out advance care planning for patients with dementia.

• The practice had a system in place to follow up patients who had attended accident and emergency or other out of hours services 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.

Updated 27 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 for patients with a learning disability.

• The practice regularly worked with other healthcare professionals in the case management of vulnerable patients.

• The practice was able to signpost this group of patients to local resources to support their needs.

• 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 1% of their patient population as carers, and offered them an annual health check.They were signposted to local organisations such as ‘Carers Leeds’