Background to this inspection
Updated
20 November 2018
York Street Health Practice is a GP practice. The provider of the practice is Bevan Healthcare CIC, who are a social enterprise, which also provides a GP practice and well-being centre in Bradford. (A social enterprise is a business whose profits are reinvested into their service.) The local team are supported by the organisational structure, which includes Managing, Operations, Finance and Clinical Directors.
York Street Health Practice offers services to people who are homeless or in unstable accommodation and those who have come to the UK as a refugee or to seek asylum. The practice operates from leased premises located at 68 York Street, Leeds LS9 8AA; near to the centre of Leeds. The service website is: www.bevanhealthcare.co.uk
The provider is contracted to provide Alternative Provider Medical Services (APMS) to the registered practice population of approximately 1,515 patients. Patients consisted of 1,224 (81%) male and 291 (19%) female, with 1,278 (84%) of patients being aged 25 to 64 years. There were 20 patients who were aged 65 years and over and 85 patients aged 17 years and under. Due to the nature of the patient population they have an ongoing turnover of patients and register approximately ten new patients per week. At 49%, almost half the patients were classed as homeless; 25% were refugee/asylum seekers; 24% had substance dependency and 19% were alcohol dependent. However, some of the patients were classed as being in more than one of those categories.
The practice clinical team is made up of two male GPs, five female GPs, a male clinical lead nurse/advanced nurse practitioner and two female practice nurses. They are supported by a care navigator, a practice manager and a team of reception/administration staff. Staff at a local level are also supported by a range of staff from an organisational level; such as the quality and development manager and the managing director.
The practice is open from 8am to 6pm Monday to Friday. Face-to-face and telephone consultations are available with a range of clinical staff. When the practice is closed, out-of-hours services can be accessed by calling the NHS 111 service.
The provider is registered with the Care Quality Commission (CQC) to provide regulated activities; treatment of disease, disorder or injury. At the time of inspection, the provider had applied to add diagnostic and screening procedures as a regulated activity.
Bevan Healthcare CIC had taken over as the provider of York Street Health Practice in April 2017. On the day of inspection, they informed us of the challenges they had initially encountered regarding staffing (the majority of reception/administration and managerial staff employed under the previous provider had left the practice). Issues also included computer systems and incorporating new ways of working to provide service delivery.
Updated
20 November 2018
This practice is rated as Good overall. This was the first inspection of this service under the current provider.
The key questions at this inspection are rated as:
Are services safe? – Good
Are services effective? – Good
Are services caring? – Good
Are services responsive? – Good
Are services well-led? – Good
As part of our inspection programme, we carried out an announced comprehensive inspection at York Street Health Practice on 26 September 2018.
At this inspection we found:
- The practice had systems in place to manage risk so that safety incidents were less likely to happen.
- There were systems for reviewing and investigating when things went wrong. The practice learned and shared lessons, identified themes and took action to improve safety in the practice. There was shared learning across the provider’s locations.
- There were comprehensive safeguarding processes in place. Patients who were most at risk were easily identifiable and staff were supported to keep safe.
- There was evidence of good record keeping showing how patients were supported, the care and treatment provided, and what liaison with other services had taken place.
- There was an effective electronic system in place to support staff to identify sepsis.
- Staff were trained in conflict resolution. We saw that the team had developed a range of skills and strategies to assist patients who may be distressed or agitated.
- The practice identified patients who were a carer for another person and support was provided at an individual level. In addition, the practice also identified those patients who had a support worker and liaised with them accordingly.
- The practice had a register of extremely high-risk patients. These patients would be seen opportunistically and "fitted in" without necessarily having an appointment. This list was reviewed in the monthly multidisciplinary meetings. All patients were seen as needed; irrespective of whether they were on the register.
- Outreach work was undertaken with asylum seekers and the homeless to support them to register with the practice.
- Collaborative working was undertaken with another agency to support sex workers to access healthcare.
- The practice had undertaken an analysis of patient deaths to identify if any lessons could be learned. As a result, they had improved the use of the end of life template to record a patients’ wishes and their next of kin.
- There was governance at a local and provider level to support safe and effective management of the practice.
- There was a focus on continuous learning and improvement.
We saw areas of outstanding practice:
- There was evidence to show the practice were one of the lowest prescribers of opioids within the local CCG. Clinicians had worked with patients to support them in reducing their reliance on opioid medication, which had resulted in an overall 40% reduction in prescribing these medicines within a 12-month period.
- The provider operated a ‘street medicine bus’, which was used within Leeds city centre two evenings per week. Staff provided advice, support and signposting for people who accessed the bus. We were given examples where patients had received clinical interventions and urgent referrals to secondary care services.
The areas where the provider should make improvements are:
- Check that all appropriate equipment is calibrated or removed from use until calibration has been completed.
- Review and improve the storage and the accessibility for staff of policies, procedures or any documents/records needed to support safe and effective service delivery.
- Review and improve how prescriptions are recorded when coming into the practice to include serial numbers, in line with their standard operating procedures.
Professor Steve Field CBE FRCP FFPH FRCGPChief Inspector of General Practice
Please refer to the detailed report and the evidence table for further information.