Chapeltown Family Surgery

Updated 28 September 2016

Chapeltown Family Surgery is located in Chapeltown Health Centre, Spencer Place, Leeds, West Yorkshire, LS7 4BB. The practice is part of the Leeds North Clinical Commissioning Group.

The practice serves a population of approximately 4894 patients and the service is provided by two GP partners (one male and one female). The partners are supported by a female salaried GP, two practice nurses a health care assistant and a pharmacist. The clinical staff are supported by an experienced team of administration staff.

The practice is an inner city practice classed as being in the one of the most deprived areas in England.

Patients can access a number of clinics for example; asthma and diabetes and baby clinics and the practice offers services such as childhood vaccinations and cervical smears.

The practice is open from 8.30am to 6pm Monday to Friday, with surgeries running from 8.30am until 11am and 2.30pm until 5pm.

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.

Services are provided under a General Medical Services contract. This is the contract held between the practice and NHS Commissioners. They also offer a range of enhanced services such as influenza, pneumococcal and childhood immunisations.

The practice has good working relationships with local health, social and third sector services to support provision of care for its patients. The third sector includes a very diverse range of organisations including voluntary and community groups.

Updated 28 September 2016

Letter from the Chief Inspector of General Practice

We carried out an announced comprehensive inspection at Chapeltown Family Surgery on 5 May 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.
• The provider was aware of and complied with the requirements of the duty of candour.

We saw one area of outstanding practice:

• The practice had identified low uptake of bowel cancer screening due to cultural beliefs and had appointed a bowel cancer champion to increase this. The bowel cancer champion used various methods to engage with patients including involvement of a local radio station. GPs and reception staff linked with the local community and Clinical Commissioning Groups and the practice had appeared in the local press and handed out leaflets at a local place of worship. The practice had also taken part in a citywide bowel screening programme, this involved appearing in a Youtube video which was broadcast in a large shopping centre. As a result of work undertaken by the practice, bowel cancer screening uptake had increased from 33% to 52%, this represented a 50% increase.

The areas where the provider should make improvement are:

• Should implement systems to audit checks on emergency drugs to avoid expiry dates being overlooked.

Professor Steve Field (CBE FRCP FFPH FRCGP) 

Chief Inspector of General Practice

Updated 28 September 2016

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

• All these patients had a structured review to check that their health and medicines needs were being met. This review was undertaken on an annual basis or more often when required.
• The practice nurses had lead roles in the management of long term conditions.
• The practice worked closely with the community matron in the management of housebound patients who had complex long term conditions, to ensure they received the care and support they needed.
• Medication reviews were undertaken on a regular basis by the GPs at the practice, with input from the local medicines optimisation pharmacist.
• The practice worked with other practices in the locality and had recruited a Diabetic Specialist Nurse to support the increasing diabetic and improve care across the Chapeltown area.
• The practice employed a practice based pharmacist to support polypharmacy patients patients (Polypharmacy is a term used to refer to patients who have been prescribed four or more medications).
• 90% of patients with diabetes, on the register, had a record of a foot examination and risk classification; CCG average 86%, England average 88%.
• 97% of patients with diabetes, on the register, had received an influenza immunisation in the preceding 12 months; CCG average 95%, England average 94%.
• The practice referred all appropriate patients to the’ Better for Me’ programme. This was a programme run by the community matron and district nursing team who worked with patients to achieve better self management of their long term conditions.

Updated 28 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.
• Patients and staff told us children and young people were treated in an age-appropriate way and were recognised as individuals.
• Appointments were available outside of school hours. All children who required an urgent appointment were seen on the same day as requested.

• The practice hosted a dedicated baby clinic, working closely with health visitors and midwifes.
• The practice worked with the Chapeltown and Harehills Extended Support Service, which included local counsellors, police and school teams, to share information on local services and early years parenting programmes.

• Cervical screening, sexual health and contraceptive services were provided at the practice.
• 94% of eligible patients had received cervical screening (CCG and England average 82%).

Updated 28 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.
• The practice maintained a register of patients above the age of 75 and offered annual health checks.
• All patients aged 65 and over had a named GP.
• The practice were participating in the ‘Avoiding Unplanned Admission’s Scheme which helped reduce avoidable unplanned admissions for vulnerable patients who are at high risk of hospital admission. Dedicated GP led clinics were held to review these patients.
• Patients were signposted to other services for access to additional support, particularly for those who were isolated or lonely.

Updated 28 September 2016

The practice is rated as good 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 offered a telephone triage service to enable patients to access a clinician for review.
• The practice was proactive in offering online services as well as a full range of health promotion and screening that reflected the needs for this age group.
• Health checks were offered to patients aged between 40 and 74 who had not seen a GP in the last three years.
• The practice used the NHS e-Referral Service system to help patients to access appointments around work commitments.

Updated 28 September 2016

The practice is rated as good 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. Patients and/or their carers were given information on how to access various support groups and voluntary organisations, such as’ Carers Leeds’.
• 85% of patients who had a complex mental health problem, such as schizophrenia, bipolar affective disorder and other psychoses, had a comprehensive, agreed care plan documented in their record in the preceding 12 months (CCG average 90% and England average of 88%).
• Staff could demonstrate they had a good understanding of how to support patients with mental health needs.
• Staff within the practice had received Dementia Friends training. This gave them a greater understanding of how to support patients with dementia and their carers.
• The clinicians in the practice were aware of and referred to local mental health services as appropriate.

Updated 28 September 2016

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

• Patients who had a learning disability had an annual review of their health needs and a health action plan in place.
• 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.
• We saw information displayed in the practice about various local support groups and voluntary organisations, which patients could access as needed.
• The practice hosted a weekly session with an alcohol and drug advisor to support patients who had issues or dependency.