Archived: The Gables Surgery

Updated 24 November 2016

The Gables Surgery is situated in Pudsey, Leeds LS28 9AP. It is housed in a modern, purpose built single storey building. There are currently 4,496 patients on the practice list. The National General Practice Profile shows the ethnicity of the practice as predominantly white British, with 2% mixed ethnicity, 3% Asian and 1% other non-white 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 opening hours, childhood immunisations and minor surgery.

The practice has three GPs, two of whom are male and one female. There are three female practice nurses and one female health care assistant. The clinical team is supported by a practice manager and a range of long serving administrative and reception staff.

The practice catchment area is within the fourth more deprived decile in England. People living in deprived areas tend to have greater need for health services.

The practice age profile is in line with national averages. Average life expectancy for patients at the practice is 78 years for men and 83 years for women, which is in line with the national average of 79 years and 83 years respectively.

The practice is open from 8am to 8pm Monday to Wednesday, and from 8am to 6pm Thursday and Friday. The practice has a reciprocal agreement with a local practice, where patients from their practice can be seen between 6pm and 8pm on Thursday and Friday.

Weekly clinics are held which include coronary heart disease (CHD), diabetes and travel vaccination clinics.

When the practice is closed patients can access out of hours care by calling the NHS 111 service.

Updated 24 November 2016

Letter from the Chief Inspector of General Practice

We carried out an announced comprehensive inspection at The Gables Surgery on 31 October 2016. Overall the practice is rated as good.

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

• There was a system in place for reporting and recording significant events. All the staff we spoke with were aware of the process.
• Current evidence based guidance was accessible by clinical staff. 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. 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 and there was continuity of care, with urgent appointments available the same day. Some patients told us it was more difficult to access a female GP.
• The practice had good facilities and was well equipped to treat patients and meet their needs.
• There was a leadership structure and staff told us they felt supported by management. We saw that some policies and protocols were not updated in a timely manner. The storage of practice policies was not consistent. Some were available on the practice computer system, whilst others were only available in paper form.
• Newly recruited staff completed a health screening questionnaire. We saw that clinical staff were screened for hepatitis B immunity. Screening for immunity against other diseases such as chicken pox was not carried out.
• The practice sought feedback from staff and patients, which it acted on.
• The practice had recently moved into new purpose built premises. Staff told us that as a result of the move, and the need for meetings pertaining to new build issues, staff and clinical meetings were convened less frequently.
• The provider was aware of and complied with the requirements of the duty of candour.

The areas where the provider should make improvements are:

• Establish a clear timetable of regular minuted meetings, including clinical meetings.

• Review and update policies and procedures in a timely way; and standardise the storage systems for these.

• Develop systems to establish staff immunity against measles mumps and rubella and chicken pox (varicella) in line with Public Health England guidelines.

Professor Steve Field (CBE FRCP FFPH FRCGP) 

Chief Inspector of General Practice

Updated 24 November 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 chronic obstructive pulmonary disorder (COPD) had had a review by a health professional within the last 12 months, which included an assessment of breathlessness, compared to the CCG average of 88% and the national average of 90%. COPD is a term to cover a range of non-reversible lung conditions which impair normal breathing.

• The practice, as part of a locality ‘hub’ had adopted a case finding exercise to identify those patients at risk of COPD, such as those patients who were smokers. These patients were then able to access smoke stop advice, be referred to a pulmonary rehabilitation service, or receive regular monitoring by practice staff.

• 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.

Updated 24 November 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.

• Staff told us that children were always prioritised for appointments. During the inspection we saw that a child who was very unwell was seen promptly and an ambulance was called to transport the child to accident and emergency.

• Staff gave examples of when they had treated children and young people in an age appropriate way.

• 89% of eligible women had a cervical screening test completed in the preceding five years compared to the local and national figures of 79% and 82% respectively.

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

• The practice held regular meetings with health visitors, where children and families with additional needs were discussed, and their records updated. Antenatal and postnatal services were provided in-house by the community midwife.

Updated 24 November 2016

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

• The practice offered 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 visiting the practice we sought feedback from a nursing home whose residents were registered at the practice. They told us relationships had recently improved with the practice. They were overall satisfied with the service provided by doctors, nurses and reception staff at the practice.

• The practice had appointed a clinical care co-ordinator who oversaw the care of patients over 75 years. She made contact following any hospital or out of hours attendance, and updated their care planning needs.

• The practice carried out annual health checks on patients over 75 years. We saw evidence that out of 66 eligible patients, 48 had had their health check carried out within the previous 12 months.

Updated 24 November 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 8am and 8pm Monday to Wednesday, and between 8am and 6pm Thursday and Friday. Patients were able to access appointments at a nearby practice on Thursday and Friday between 6pm and 8pm.

• The practice promoted online access. We saw that 728 patients (17% of the practice population) had registered for this service.

• The practice provided smoking cessation and weight management services in-house. The ‘Healthy Living’ team visited the practice on a regular basis and were able to offer patients advice on healthy lifestyle choices.

• The practice participated in the ‘Pharmacy First’ scheme which enabled patients to access treatment for a range of minor illnesses from the pharmacist without the need to consult with a GP.

• Text message reminders were sent following booking of appointments.

Updated 24 November 2016

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

• 94% of patients diagnosed with dementia had had their care reviewed in a face to face meeting in the last 12 months, which was higher than the local and national averages of 87% and 84% respectively.
• 93% of patients with schizophrenia or other psychoses had a recording of their alcohol consumption completed in the last 12 months compared to the local and national averages of 86% and 90% respectively.
• The practice worked with multi-disciplinary teams when appropriate to effectively manage the care of patients experiencing poor mental health, including those with dementia.
• The practice carried out advance care planning for patients with dementia.
• The practice was able to provide patients experiencing poor mental health with information relating to local support groups and voluntary organisations.
• Staff had a good understanding of how to support patients with mental health needs and dementia.

Updated 24 November 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 worked with other health care professionals, such as the mental health team when appropriate to manage the care of vulnerable patients.
• The practice was able to provide vulnerable patients with information relating to local support groups and voluntary organisations.
• Staff gave examples which demonstrated their understanding of 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 48 people (1% of the practice population) as unpaid carers.