Archived: The Medical Centre Also known as Dr S Laybourn and Partners

Updated 9 September 2016

The Medical Centre is a member of the Leeds South and East Clinical Commissioning Group (CCG). General Medical Services (GMS) are provided under a contract with NHS England. The practice is registered to provide the following regulated activities; maternity and midwifery services, family planning, diagnostic and screening procedures and treatment of disease, disorder or injury. They also offer a range of enhanced services, which include:

• improving online access for patients
• delivering childhood, influenza and pneumococcal vaccinations
• facilitating timely diagnosis and support for people with dementia
• identification of patients who are at a high risk of an avoidable unplanned hospital admission

The practice is located in a two storey semi-detached dwelling, which had been converted from a house to a medical centre. Patient consulting rooms are on two floors and access is by a stairway. Patients who have difficulty in climbing stairs are seen in a downstairs consulting room. There are limited car parking facilities on site but there is nearby street parking.

The Medical Centre also has another practice at 846 York Road, Leeds LS14 6DX, which is approximately two miles away. This location has been registered separately with the CQC. Although both locations were inspected at the same time, separate reports will be published. The two locations share the same patient list, policies and procedures and Quality and Outcomes Framework data. Both clinical and administrative staff rotate between both sites and have access to the practice computer system. The provider has been advised to deregister the Rookwood Avenue site as a separate location with the CQC.

The practice currently has 8,899 patients split evenly over both locations. The Rookwood Avenue site patient population has a higher level of deprivation than those who access the York Road location. The patient population is made up of predominantly British, although a number of patients are from other ethnic origins, such as Asia, Africa and Eastern Europe.

There are six GP partners (three male, three female), four practice nurses and a health care assistant; all of whom are female. The clinicians are supported by a practice manager and an experienced team of administration and reception staff.

The Medical Centre, 143 Rookwood Avenue, Leeds LS9 0NL is open Monday to Friday 8.15am to 6pm with the exception of Thursday when it closes at 12 midday. GP appointments are as follows:

Monday, Tuesday, Wednesday and Friday 8.30am to 10.40am, 1pm to 2pm and 3.30pm to 5.40pm

Thursday 8.30am to 10.40am.

However, the practice state these times can vary due to fluctuation in demand.

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 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, community, tenants’ and residents’ groups.)

The Medical Centre is a teaching and training practice. They are accredited to train qualified doctors to become GPs (registrars) and to support undergraduate medical students with clinical practice and theory teaching sessions.

Updated 9 September 2016

Letter from the Chief Inspector of General Practice

We carried out an announced comprehensive inspection at The Medical Centre on 12 and 13 July 2016. Overall the practice is rated as good for providing effective, caring, responsive and well-led care. However, it requires improvement for safe.

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

• Patients’ needs were assessed and care was planned and delivered following best practice guidance. Staff had the skills, knowledge and experience to deliver effective care and treatment. Newly employed staff were supported in their learning and development needs.
• The practice had good facilities and was well equipped to treat and meet the needs of patients. Information regarding the services provided by the practice was available for patients.
• Overall, risks to patients were assessed and well managed. There were good governance arrangements and appropriate policies in place. However, not all staff acted in line with the cold chain procedures.
• The practice was aware of and complied with the requirements of the duty of candour. (The duty of candour is a set of specific legal requirements that providers of services must follow when things go wrong with care and treatment.)
• The partners promoted a culture of openness and honesty and there was a ‘being open’ policy in place, which was reflected in their approach to safety. All staff were encouraged and supported to record any incidents using the electronic reporting system. However, the abnormalities in the vaccine fridge temperatures had not been reported and acted upon.
• There was a complaints policy and clear information available for patients who wished to make a complaint.
• There was evidence of good investigation, learning and sharing mechanisms being in place with regard to reported significant events and complaints.
• Patients said they were treated with compassion, dignity and respect and were involved in care and decisions about their treatment.
• The majority of patients were positive about access to the service. They said they found it generally easy to make an appointment, there was continuity of care and urgent appointments were available on the same day as requested.
• The practice sought patient views on how improvements could be made to the service, through the use of patient surveys, the NHS Friends and Family Test and the patient participation group.
• There was a clear leadership structure in place. Staff were aware of their roles and responsibilities and told us that the GPs and manager were accessible and supportive.

There was an area where the provider must make an improvement:

• The practice must ensure staff understand and follow the policy and procedures for the management of the vaccine fridge temperatures and the cold chain process.

There were also areas where the provider should make improvements:

• Notify the Care Quality Commission of changes to their registration in a timely manner, particularly in relation to changes in GP partners.
• Review and improve the arrangements in place to monitor what actions are undertaken in response to national and regional safety alerts.

Professor Steve Field CBE FRCP FFPH FRCGP

Chief Inspector of General Practice

Updated 9 September 2016

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

• All these patients had a named GP and a structured annual review to check that their health and medicines needs were being met.
• 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.
• The practice participated in the Year of Care programme. This approach supported patients to understand their condition and have a more active part in determining their own care and support needs in partnership with clinicians. It was currently being used with all patients who had diabetes, chronic obstructive pulmonary disease (COPD) and ischaemic heart disease (IHD).
• There was a system in place to monitor and review patients who were found to have pre-diabetes.
• Holistic reviews were undertaken to avoid the need for patients to have multiple appointments
• 94% of newly diagnosed diabetic patients had been referred to a structured education programme in the preceding 12 months (CCG average 87%, national average 90%).
• 71% of patients diagnosed with asthma had received an asthma review in the last 12 months (CCG and national averages of 75%).
• 81% of patients diagnosed with chronic obstructive pulmonary disease (COPD) had received a review in the last 12 months (CCG average 88%, national average 90%).

Updated 9 September 2016

The practice is rated as good for the care of families, children and young people.

• 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 and the premises were suitable for children and babies. All children who required an urgent appointment were seen on the same day as requested.
• The practice worked with midwives, health visitors and school nurses to support the needs of this population group. For example, the provision of ante-natal, post-natal and child health surveillance clinics.
• There was a dedicated child immunisation co-ordinator to promote uptake of all standard childhood immunisations.
• Cervical screening, sexual health and contraceptive services were provided at the practice.
• There was a dedicated cervical screening co-ordinator who dealt with the recall and follow up of patients. The latest data showed that 98% of eligible patients had received cervical screening, which was considerably higher than the CCG and national averages of 82%.
• Appointments were available with both male and female GPs.
• Reviews were undertaken of children who failed to attend a practice or hospital appointment and those who attended accident and emergency (A&E).

Updated 9 September 2016

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

• The practice provided proactive, responsive and personalised care to meet the needs of the older people in its population. Home visits and urgent appointments were available for those patients in need.
• All elderly patients had a named GP.
• The practice worked closely with other health and social care professionals, such as the district nursing team, community matron and memory services, to ensure housebound and elderly patients received the care and support they needed.
• Care plans were in place for those patients who were considered to have a high risk of an unplanned hospital admission and patients were reviewed as needed.
• Health checks were offered for all patients over the age of 75 who had not seen a clinician in the previous 12 months.
• Patients were signposted to other services for access to additional support, particularly for those who were isolated or lonely.

Updated 9 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.
• There was access to text messaging and online services to request repeat prescriptions and make appointments
• The practice was proactive in offering a full range of health promotion and screening that reflected the needs for this age group. For example, early detection of chronic obstructive pulmonary disease (a disease of the lungs) for patients aged 35 and above who were known to be smokers or ex-smokers.
• Health checks were offered to patients aged between 40 and 74 who had not seen a GP in the last three years.

Updated 9 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 carer were given information on how to access various support groups and voluntary organisations, such as Mindmate and Carers Leeds.
• 91% 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 and national averages of 88%).
• 92% of patients diagnosed with dementia had received a face to face review of their care in the preceding 12 months (CCG average 88%, national average 84%).
• Staff could demonstrate they had a good understanding of how to support patients with mental health needs or dementia.
• Those patients who had dementia and did not attend an appointment were contacted by the practice.

Updated 9 September 2016

The practice is rated as good for the care of people whose 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.
• There was a register of patients who had a safeguarding concern.
• The practice could evidence the number of children who were on a child protection plan (this is a plan which identifies how health and social care professionals will help to keep a child safe).
• Patients who had a learning disability received an annual review of their health needs and a health action plan was put in place. Carers of these patients were also encouraged to attend, were offered a health review and signposted to other services as needed.
• There was an alert on the record of those patients who were known to be vulnerable or have complex needs to identify the need for a longer appointment.