Garforth Medical Practice

Updated 17 March 2016

Garforth Medical Practice is situated on Church Lane, Garforth on the eastern outskirts of Leeds and is part of the Leeds South and East CCG. The main surgery is situated in one of the lesser deprived areas of Leeds, being located in modern premises which has parking and disabled access. There are toilet facilities and a low rise reception counter for disabled access. The reception has a hearing loop in situ and the patient call system is visual, although staff will call those patients who have a visual impairment. There is a separate building across a short pathway where the majority of the management and administration team are located.

In addition there are two smaller branch surgeries at Elmwood Lane, Barwick-in-Elmet and Jessamine Cottage, Aberford; both of which have a small dispensary. Patients can access any of the surgeries and staff rotate between them. All policies and procedures are the same across all the sites. All three locations are registered with CQC under one registration and were all visited as part of the inspection.

There are six GP partners (three female, three male) and four salaried GPs (all female). The nursing team consists of one female advanced nurse practitioner (ANP), a trainee male ANP, a practice nurse manager, seven practice nurses and four health care assistants (all of whom are female). The clinical team is supported by a practice manager, an assistant practice manager and a large team of reception and administrative staff. In addition there are four dispensing staff who work across the two dispensaries.

The practice is an advanced training practice. They are accredited to train qualified doctors to become GPs and to support undergraduate medical students, with clinical practice and theory teaching sessions. They also support the training and mentoring of nursing students and physician associates. The GP trainer was also acting as a mentor for local practices who were going through the process of becoming training practices.

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

The practice has a patient list size of 13,197, consisting of 99% white British. There are a higher than national average percentage of patients who are aged 65 and over (22% compared to 17% nationally) and 62% of patients have a long standing health condition (compared to 54% nationally).

The practice opening hours are:

Garforth Medical Practice: 8am to 8pm Monday, 7.15am to 6pm Tuesday and 8am to 6pm Wednesday, Thursday, Friday.

Elmwood Surgery: 8.30am to 5.30pm Monday, 8.30am to 12 midday Tuesday and 8.30am to 5pm Wednesday, Thursday and Friday. They are also open the third Saturday in the month between 8.30am and 11.30am for pre-booked appointments only.

Jessamine Cottage Surgery: 8.15am to 12.15pm Monday to Friday.

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

General Medical Services (GMS) are provided under a contract with NHS England. Garforth Medical Practice is registered to provide the following regulated activities; maternity and midwifery services, surgical procedures, diagnostic and screening procedures and treatment of disease, disorder or injury. They also offer a range of enhanced services such as extended hours, minor surgery, influenza, pneumococcal and childhood immunisations.

Updated 17 March 2016

Letter from the Chief Inspector of General Practice

We carried out an announced comprehensive inspection at Garforth Medical Practice on 15 December 2015. 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:

• There was an open and transparent approach to safety and an effective system was in place for reporting and recording significant events.
• The provider was aware of and complied with the requirements of the Duty of Candour. (Duty of Candour means health care professionals have a legal duty to be open and honest with patients when something goes wrong with their treatment or care which causes, or has the potential to, cause harm.) 
• Risks to patients were assessed and well managed.
• 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.
• Patients said they were treated with compassion, dignity and respect and were involved in care and decisions about their treatment.
• Urgent appointments were available on the same day as requested.
• The practice had good facilities and was well equipped to treat and meet the needs of patients.
• The practice sought patient views 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 and staff were supported by management.
• The ethos of the practice was to provide quality patient centred care.

We saw several areas of outstanding practice:

• All vaccines had labels on which identified the date they had arrived in the practice, for audit purposes. We were informed this was common practice across all three locations and was undertaken by the nursing staff. This also supported stock rotation and prevention of waste.

• The practice worked with a local further education college to ensure students who registered with the practice were given a ‘new starter’ pack, which contained information about the practice, contact details, what services were available and relevant health advice.

• The practice took a positive approach to staff development, for example nursing staff were given two to four hours of development time each week. This time was protected for individual professional learning and development. Staff told us how they appreciated this time and felt valued by the practice.

Professor Steve Field CBE FRCP FFPH FRCGP 

Chief Inspector of General Practice

Updated 17 March 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 nurses had lead roles in chronic disease management and patients who were at risk of an unplanned hospital admission were identified as a priority.
• The practice delivered care for patients using an approach called The House of Care. It was used with all patients who had diabetes, cardio-vascular disease or chronic obstructive pulmonary disease (a disease of the lungs). This approach enabled patients to have a more active part in determining their own care and support needs in partnership with clinicians. The practice had been an early adopter of this approach.
• Monthly reviews were undertaken of patients who were seen as being at risk. Information and care was shared with members of the multidisciplinary team.
• The practice used the palliative care Gold Standard Framework (a systematic evidence based approach) to provide end of life care for patients.
• Longer appointments and home visits were available for patients when needed.

Updated 17 March 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 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.
• Childhood immunisation and cervical screening uptake rates were comparable to other practices in the locality.

Updated 17 March 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 who needed them. 
• The practice worked closely with other health and social care professionals, such as the local neighbourhood team and district nurses, to ensure housebound patients received the care they needed.
• Home visits were provided by the health care assistant for those frail and elderly patients who required blood tests. Follow ups were provided by a nurse or GP.
• Patients who were resident in care homes and had a high risk of an unplanned hospital were visited weekly by the advanced nurse practitioner.
• Patients who were elderly or frail were reviewed by a clinician following a hospital discharge.

Updated 17 March 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 earlier and late evening appointments on specific days of the week. Telephone apppointments and triage were also available.
• 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.

• The practice worked with a local further education dance college to ensure students who registered with the practice were given a ‘new starter’ pack, which contained information about the practice, contact details, what services were available and relevant health advice.

Updated 17 March 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, such as the local mental health team, in the case management of people in this population group. Patients and/or their carer were given information on how to access various support groups and voluntary organisations.
• 78% of patients who were diagnosed as having dementia had received a face to face review of their condition in the past 12 months; compared to the CCG average of 82% and the national average of 84%. 
• There was a system in place to follow up patients who had attended accident and emergency (A&E) where they may have been experiencing poor mental health.
• Staff had a good understanding of how to support people with mental health needs and dementia, with most staff having received training to become a dementia friend.
• Patients known to have memory problems were contacted on the day of their appointment as a reminder.
• The practice hosted a mental health services led memory clinic.
• Risk registers were in place to identify those patients who had poor mental health or dementia.

Updated 17 March 2016

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

• The practice held risk registers for patients whose circumstances may make them vulnerable, for example persons of no fixed abode or children in need.
• The practice regularly worked with multidisciplinary teams in the case management of vulnerable people. Information was provided on how to access various support groups and voluntary organisations.
• 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.
• Longer appointments were available for patients as needed.