Lindley Group Practice

Updated 25 November 2016

Lindley Group Practice is a member of the Greater Huddersfield Clinical Commissioning Group (CCG). Personal Medical Services (PMS) are provided under a contract with NHS England. The practice is also registered with the Care Quality Commission (CQC). They offer 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 at a high risk of an unplanned admission and providing additional support as needed.

The practice is situated on the Western outskirts of Huddersfield city centre, at 62 Acre Street, Lindley, Huddersfield HD3 3DY, and is located near to Huddersfield Royal Infirmary and the accident and emergency department. The premises are leased from the acute trust. There is wheelchair access via the front entrance and a disabled toilet on the ground floor. 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. Car parking is available at the rear of the premises and there are spaces allocated for disabled parking near the front entrance. We were informed that due to the proximity of the car park to the hospital, accident and emergency department and outpatient department, some people attending those services often parked in the practice car park, due to it being free of charge. This was causing some problems for patients accessing the practice. The practice had previously approached those services to highlight the issues.

The building had originally been a detached house which was subsequently converted to a GP practice. The internal layout of the building could not be altered for structural reasons. As a result, there were some obstacles for wheelchair users and pushchairs/prams. The practice had identified the issues and discussed their concerns on several occasions with the CCG and were currently putting a business case forward for new premises.

The patient list size is currently 10,297 consisting of 4,801 males and 5,496 females. The ethnic origin of patients is predominantly white British with a small number of patients from mixed ethnic backgrounds. Patient demographics are variable compared to CCG and national averages. For example:

• 49% of patients have a long standing health condition (CCG 55%, national 54%)
• 71% of patients are in paid work or full-time education (CCG and national 61%)
• Less than 1% of patients are unemployed (CCG 7%, national 5%)
• The deprivation score overall is 17%, compared to 21% CCG and nationally

The practice monitors the patient list on a quarterly basis and informed us they have a turnover of patients due to the close proximity of the hospital. Some of the staff who work there register with the practice during their placements. Due to the increasing patient list size and limited capacity within the premises, the practice had made the decision (in consultation with the CCG) to request patients who lived outside of the catchment area to register at a practice nearer to their homes.

There are five GP partners and two salaried GPs (five female, two male). There are two practice nurses and a health care assistant, all of whom are female. The clinicians are supported by a practice manager and a team of administration and reception staff who oversee the day to day running of the practice. In addition there is a female musculoskeletal specialist GP who holds a clinic once a week at the practice.

Lindley Group Practice 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.

The practice is open Monday to Friday 7.30am to 6.30pm (it closes at 6pm on Friday). Appointments can be pre-booked or made on the same day. There are open access clinics available Monday, Wednesday and Friday mornings. 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.) Locally, they have close working links with five nursing homes and a residential setting for patients with learning disabilities. Regular visits are made by the clinicians to these sites.

We were informed by both staff and patients of the concerns regarding the premises due to the increasingly growing patient population.

Updated 25 November 2016

Letter from the Chief Inspector of General Practice

We carried out an announced comprehensive inspection at Lindley Group Practice on 25 October 2016. Overall the practice is rated as good for providing safe, effective, caring, responsive and well-led care for all of the population groups it serves.

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

• Staff had the skills, knowledge and experience to deliver effective care and treatment.
• Patients’ needs were assessed and care was planned and delivered following local and national care pathways and National Institute for Health and Care Excellence (NICE) guidance.
• There was good access to clinicians and patients said they generally found it easy to make an appointment. There was continuity of care and if urgent care was needed patients were seen on the same day as requested. In addition to appointments, the practice provided an open access clinic three mornings a week.
• The practice staff had a good understanding of the needs of their practice population and were flexible in their service delivery to meet patient demands. The practice continually audited patient demand for appointments. Locums were used occasionally to meet increased demand.
• Patients said they were treated with compassion, dignity and respect and they were involved in their care and decisions about their treatment.
• The practice sought views on how improvements could be made to the service, through the use of patient surveys, the NHS Friends and Family Test and engagement with patients and their local community.
• Risks to patients were assessed and well managed.
• The practice had an organised approach to working systems and processes. There was a signatory sheet for all policies to evidence that staff had seen them.
• There were effective safeguarding systems in place to protect patients and staff from abuse.
• The practice promoted a culture of openness and honesty. All staff were encouraged and supported to record any incidents using the electronic reporting system. There was evidence of good investigation, learning and sharing mechanisms in place.
• There was a clear leadership structure, staff were aware of their roles and responsibilities and told us the GPs were accessible and supportive. There was evidence of an inclusive team approach to providing services and care for patients.
• Staff had a ‘mini-meeting’ every working day to discuss any issues or concerns within the practice
• Staff said they were proud to work at the practice and felt they delivered good quality service and care to patients.
• The practice 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.)

Professor Steve Field CBE FRCP FFPH FRCGP

Chief Inspector of General Practice

Updated 25 November 2016

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

• The GPs and practice nurse both supported the management of long term conditions. Annual or six monthly reviews were undertaken to check patients’ health care and treatment needs were being met. There was an effective system for the follow-up of non-compliant patients.
• The practice maintained a register of patients who were a high risk of an unplanned hospital admission. Care plans and support were in place for these patients.
• Clinicians liaised with the community matron regarding care, treatment and support of these patients, particularly those which were housebound.
• There were effective systems in place to support the recall of these patients for influenza and pneumococcal vaccinations.
• Pre-diabetes checks and chronic obstructive pulmonary disease screening were undertaken with those patients who were deemed most at risk of developing these conditions.
• 94% of newly diagnosed diabetic patients had been referred to a structured education programme in the preceding 12 months (CCG average 91%, national average 90%).
• 69% of patients diagnosed with asthma had received an asthma review in the last 12 months (CCG average 78%, national average 75%).
• 98% of patients diagnosed with chronic obstructive pulmonary disease (COPD) had received a review in the last 12 months (CCG average 87%, national average 90%).
• The practice provided a musculoskeletal clinic once a week.

Updated 25 November 2016

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

• 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 were systems in place to identify and follow up children living in disadvantaged circumstances and who were at risk.
• 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. Same day access was available for all children who required medical attention.
• Childhood immunisations were offered in line with the public health immunisation programme.
• Sexual health, contraceptive and cervical screening services were provided at the practice, which included coil fitting and implants.
• The practice promoted cancer screening programmes. For example, 87% of eligible patients had undergone cervical screening (CCG average 85%, national average 82%).

Updated 25 November 2016

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

• Proactive, responsive care was provided to meet the needs of the older people in its population.
• They offered rapid access appointments to those patients with enhanced needs and those who could not access the surgery due to ill health or frailty.
• Medication reviews were undertaken every six months.
• Registers of patients who were aged 75 and above and also the frail elderly were in place to ensure timely care and support were provided.
• The practice worked closely with other health and social care professionals, such as the district nursing team, to ensure housebound patients received the care and support they needed.
• The practice liaised several times a week with local nursing homes, where they had registered patients who resided there.
• At 77%, the uptake rate for influenza immunisation in the over 65s was higher than the CCG target of 75%.

Updated 25 November 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 provided extended hours appointments from 7.30am on weekdays, online booking of appointments and ordering of prescriptions.
• There was an open access clinic three mornings per week.
• During influenza vaccination season, the practice offered Saturday morning flu clinics.
• The practice offered a range of health promotion and screening that reflected the needs for this age group.
• Travel health advice and NHS travel vaccinations were available.

Updated 25 November 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.
• 77% of patients diagnosed with dementia had received a face to face review of their care in the preceding 12 months (CCG average 85%, national average 84%).
• 74% 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 (CCG 90%, national 88%).
• Patients who were at risk of developing dementia were screened and support provided as necessary.
• Staff had received dementia friendly training and could demonstrate a good understanding of how to support patients with dementia or mental health needs.

Updated 25 November 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.
• We saw there was information available on how patients could access various local support groups and voluntary organisations.
• The practice had a register of patients who had a learning disability. There was a named nurse who supported the delivery of annual health reviews of those patients.