Robin Lane Health and Wellbeing Centre Also known as Robin Lane Medical Centre

Updated 13 December 2016

Robin Lane Health and Wellbeing Centre is a member of the Leeds West Clinical Commissioning Group (CCG). Personal Medical Services (PMS) are provided under a contract with NHS England. At the time of inspection Robin Lane had been registered with the Care Quality Commission (CQC) as two separate entities Robin Lane Health Centre – Medical Wing and Robin Lane Health Centre - Charity Wing. At the time of publication of this report the practice have since registered as one entity – Robin Lane Health and Wellbeing Centre. The practice offers a range of enhanced services, which include:

• extended hours access
• improving patient online access
• delivering childhood, influenza and pneumococcal vaccinations
• facilitating timely diagnosis and support for people with dementia
• identification of patients with a learning disability and the offer of annual health checks
• identification of patients who are at a high risk of an unplanned hospital admission, reviewing and coordinating their care needs
• minor surgery
• a glaucoma diagnosis and monitoring service

The practice address is Robin Lane Health and Wellbeing Centre, Robin Lane, Pudsey LS28 7DE. There are good facilities for patients, who also have access to the full range of activities, groups and a café within the wellbeing centre. There is car parking and good transport links. There are plans in place to extend the current premises to include additional consulting rooms and patient/public areas.

The practice currently has a patient list size of 13,200, with higher than average numbers of patients under four years of age and those aged between 25 and 34. The percentage of patients who are in paid work or full time education is 71%, compared to CCG 66% and nationally 61%. Other patient demographics are comparable to CCG and national averages, for example 53% of patients had a long-standing health condition (CCG 51%, nationally 54%).

The partners consist of four GPs (one female, three male) and a non-clinical partner. Other clinical staff includes four salaried GPs (three female, one male), a female GP registrar, three ophthalmologists/specialists, a practice matron, four nurse practitioners, three practice nurses, one care of the elderly nurse, one eye specialist nurse, two practice health care assistants, two eye health care assistants, two eye technicians, one care of the elderly health care assistant, a pharmacist and a phlebotomist. The non-clinical team consist of three managers, three secretaries, one personal assistant, five clerical assistants, six receptionists, one reception technician and two housekeepers.

The practice opening hours are 8am to 8pm Monday to Friday and 9am to 4pm on Saturday. There are early morning appointments available on Wednesday from 7am. In addition there is a walk-in clinic available Monday to Saturday between 8am and 4pm, where patients can ‘sit and wait’ to be seen without the need for an appointment. Telephone consultations are also offered. 

When the practice is closed out-of-hours services are provided by Local Care Direct, which can be accessed via the surgery telephone number or by calling the NHS 111 service.

The practice is a training practice for GP trainees (registrars) and supports graduate doctors, who are in their second year of a foundation programme (FY2), to gain experience in general practice. (This is a transition period of practice between being a student and undertaking more specialised training.) They also provide teaching practice and mentoring for third year medical students, nurse practitioner trainees and sixth form students. The practice also support a volunteer programme of patient volunteers, who deliver over 60 monthly health and wellbeing activities within the wellbeing centre.

The wellbeing centre is an integral part of the practice and can be accessed by patients and other members of the Pudsey community. The concept was initially developed by the practice in partnership with other organisations, such as Leeds City Council, with the aim of supporting the people of Pudsey to “live longer and healthier lives that are full, active and independent”. A café is located within the centre for use both in the day and evening when events or activities are happening. Local groups can use the facilities free of charge and there are a range of event and activities available, such as live music sessions, theatre groups, displays of local art and walking groups. Other local Leeds services use the centre to host support groups, such as carers’ support and counselling.

Updated 13 December 2016

Letter from the Chief Inspector of General Practice

We carried out an announced comprehensive inspection of Robin Lane Health and Wellbeing Centre on 29 June 2016. Overall the practice is rated as outstanding.

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

• There was an open and transparent approach to safety. Staff understood and fulfilled their responsibilities to raise concerns and report incidents and near misses. All opportunities for learning were maximised.
• Risks to patients were assessed and well managed. There was a comprehensive risk register in place (quality assurance document) which identified risks, actions to mitigate the risk and what review arrangements were in place.
• Infection prevention and control was a regular agenda item at the practice meetings.
• All patients had access to extensive facilities and support groups, which were available at the Health and Wellbeing Centre.
• The practice used innovative and proactive methods to improve patient outcomes, working with other local providers to share best practice. For example, the provision of ophthalmology services and the elderly care pathway.
• Patients’ needs were assessed and care was delivered following local and national care pathways and National Institute for Health and Care Excellence (NICE) guidance. Staff had 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.
• Patients had good access to appointments and telephone consultations, which included appointments during extended hours; early morning, evenings and on Saturdays.
• The practice also conducted an annual outreach programme. This was to seek out patients across Leeds who were not currently registered with a GP practice and ensure they received appropriate care, treatment and support.
• There were strong and visible clinical and managerial leadership and governance arrangements in place.
• The practice proactively engaged with their patient population and stakeholders regarding the delivery and development of services.

We saw several areas of outstanding practice:

• The practice had developed a Care of the Elderly pathway, aimed at those patients who were housebound, at a high risk of hospitalisation or residing in a care or nursing home. This pathway had been shared and implemented across other Leeds practices. They had developed an ‘elderly care team’ and as a result the practice could evidence a 23% reduction in unplanned hospital admissions and an 80% reduction in urgent home visits for this population group.
• There was a walk-in service for all routine or urgent health matters, which ran from 8am to 4pm Monday to Saturday each week. There was evidence to support that there had been an overall reduction in A&E attendance by 10% and an overall reduced demand for appointments in the usual bookable clinics by 26%.
• The practice had developed the health and wellbeing centre where patients and members of the local community could attend. Facilities included an onsite café, arts events, a variety of support groups and over 60 free volunteer run activities.
• The practice promoted sharing and learning and linked with a number of organisations in this country and around the world to use best practice to develop their services. This was evidenced in the number of organisations who had approached the practice to share their innovative approach to primary care, such as the smartphone app, elderly care pathway and the formation of the health and wellbeing centre.

Professor Steve Field CBE FRCP FFPH FRCGP 

Chief Inspector of General Practice

Updated 13 December 2016

The practice is rated as outstanding for the care of people with long term conditions.

• Nursing staff had lead roles in the management of long term conditions.
• In line with best practice, six monthly or annual reviews were undertaken to check patients’ health care and treatment needs were being met. For example: 92% of newly diagnosed diabetic patients had been referred to a structured education programme in the preceding 12 months (CCG average 88%, national average 90%); 100% of patients with diabetes had received an influenza vaccination (CCG and national average 94%)
• The practice pharmacist undertook a review of patients’ medication to support optimisation and compliance.
• A register was maintained of those patients who were a high risk of an unplanned hospital admission. Individual care plans and support were in place for these patients.
• The practice offered phlebotomy (blood tests) ambulatory blood pressure monitoring, spirometry and electrocardiogram (ECG) for patients as appropriate.
• There was a glaucoma diagnosis and monitoring service held in the practice.
• Patients were signposted to the health and wellbeing centre to access a range of activities suitable for patients with long term conditions. These included walking, exercise and lifestyle support groups.

Updated 13 December 2016

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.
• The practice had recently reviewed its patient registration process to include a children’s safeguarding screening process.
• Staff told us children and young people were treated in an age-appropriate way and were recognised as individuals and we saw evidence to confirm this.
• Appointments were available outside of school hours, on Saturdays and there a daily walk-in service, where priority was given to children and babies.
• The premises were suitable for children with a dedicated waiting area for children and parents and baby changing facilities.
• Two members of the clinical staff had extensive children’s and adolescent mental health backgrounds and supported patients as needed.
• We saw evidence of monthly meetings between the health visitor and lead GP for safeguarding, to discuss vulnerable children and those with complex needs.
• The practice worked with midwives to support ante-natal and post-natal care.
• Uptake rates for all standard childhood immunisations were between 97% and 99%.
• At 79% the practice uptake for the cervical screening programme was in line with the CCG average of 75% and the national average of 82%.
• The practice offered a sexual health clinic on Thursday afternoons. In addition there was a walk-in sexual health clinic available between 8am and 4pm on Saturdays. Nurses who were trained in sexual health and adolescent mental health supported the clinics.
• Patients had access to a breastfeeding support group and parent and toddler group based at the health centre.
• Teenagers were supported to use the smart app to access the practice, message a clinician or download health advice and information.

Updated 13 December 2016

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

• The practice offered proactive, responsive and personalised care to meet the needs of the older people in its population. Home visits, longer or urgent appointments were available for those in need.
• The practice had developed a Care of the Elderly pathway, aimed at those patients who were housebound, at a high risk of hospitalisation or residing in a care or nursing home. There was an ‘elderly care team’ in place and as a result the practice could evidence a 23% reduction in unplanned hospital admissions and an 80% reduction in urgent home visits for this population group.
• Patients were encouraged to attend the health and wellbeing centre and participate in the many events and activities being run there. For example, a weekly chair based exercise group run by one of the practice health care assistants.
• As part of the volunteer programme initiated by the practice, patients were supported with managing other aspects of life, such as using new technology including mobile phones and computer.

Updated 13 December 2016

The practice is rated as outstanding for the care of working age people (including those recently retired and students).

• The needs of these patients had been identified and the practice had adjusted the services it offered to ensure these were accessible, flexible and offered continuity of care. The practice provided extended hours Monday to Saturday. Patients had access to the walk-in centre without the need to make an appointment.

• Telephone consultations and online services were available. This helped to improve access to the practice for this group of patients. The practice had 5,479 patients registered for online access which was 41% of the practice population. 
• Patients of working age and students were encouraged and supported to use the smart app to access the practice, message a clinician or download health advice/information.
• The practice offered students MMR and Men C vaccinations. Students who were staying in the area for less than three months were supported to temporarily register with the practice.
• Sexual health services were offered which included contraceptive implants, coil fittings and chlamydia screening.
• Travel health advice and vaccinations were available.
• The practice offered free mindfulness classes for patients, which were accessible at the health and wellbeing centre.

Updated 13 December 2016

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

• The practice regularly worked with multidisciplinary teams in the case management of people in this population group, for example the local mental health team.
• They 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 or dementia.
• Patients and/or their carer were given information on how to access various support groups and voluntary organisations.
• Data showed that 83% of patients diagnosed with dementia and 90% of patients who had a complex mental health problem, such as schizophrenia, bipolar affective disorder and other psychoses, had received a review of their care in the preceding 12 months. These were both in line with the CCG and national averages of 83% and 88% respectively.
• Health champions were available in the practice to support patients in this group.
• There were a variety of groups and activities available, such as art workshops, community choir and a ‘singing for the brain’ group.

Updated 13 December 2016

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

• Staff knew how to recognise signs of abuse in children, young people and adults whose circumstances may make them vulnerable. They 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 held a register of patients living in vulnerable circumstances including those who had a learning disability and patients who acted in the capacity of a carer.
• The practice regularly worked with other health care professionals in the case management of vulnerable patients. Vulnerable patients were supported to access various support groups and voluntary organisations
• The practice had a dedicated lead GP for those patients with a learning disability, who was responsible for ensuring that annual reviews were conducted. An alert was placed on the patient’s electronic record so that staff and clinicians were aware of their vulnerability and potential increased patient requirement.
• The reception staff were trained to proactively identify patients who appeared to be distressed and alert a clinician as needed.
• Carers were offered a health check and influenza vaccination and were encouraged to participate in the Carers Leeds yellow card scheme. The practice facilitated a carers’ support group which was held on a monthly basis. Details were displayed in the practice and also on their website.
• The practice signposted those patients who were lonely or isolated to other supportive services. The practice had previously hosted Christmas Day dinners for this group of patients.
• Through a public health campaign, the practice operated an annual Leeds wide outreach programme for those patients who were not currently registered with a GP practice. These patients were supported to register with the practice and referred to other health and social services as appropriate.