Chapelthorpe Medical Centre

Updated 9 August 2016

The practice surgery is located on Standbridge Lane, Wakefield, West Yorkshire. The practice serves a patient population of 12,100 and is a member of NHS Wakefield Clinical Commissioning Group.

The surgery is located in purpose built premises which opened in 2001. The building has two floors and is accessible for those with a disability as the building has a passenger lift installed. There is parking available on the practice site for patients and an independent pharmacy is located next to the practice.

The practice population age profile shows that it is above both the CCG and England averages for those over 65 years old (21% compared to the CCG average of 18% and England average of 17%). Average life expectancy for the practice population is 79 years for males and 83 years for females (CCG average is 77 years and 81 years and the England average is 79 years and 83 years respectively). The practice serves some areas of lower than average deprivation. The practice population is predominantly White British.

The practice provides services under the terms of the Personal Medical Services (PMS) contract. In addition the practice offers a range of enhanced local services including those in relation to:

• Childhood vaccination and immunisation

• Influenza and Pneumococcal immunisation

• Rotavirus and Shingles immunisation

• Dementia support

• Risk profiling and care management

• Support to reduce unplanned admissions.

• Minor surgery

• Learning disability support

• Extended hours access

• Patient participation

As well as these enhanced services the practice also offers additional services such as those supporting long term conditions management including asthma, chronic obstructive pulmonary disease, diabetes, heart disease and hypertension, and physiotherapy.

Attached to the practice or closely working with the practice is a team of community health professionals that includes health visitors, midwives, members of the district nursing team and health trainers.

The practice has seven GP partners (three male, four female), one salaried GP (male), one GP registrar and one Foundation Year 2 doctor. In addition there are four practice nurses (all female), one student nurse (female), three healthcare assistants (all female), one apprentice healthcare assistant (female) and two phlebotomists(both female). Clinical staff are supported by a practice manager, an administration manager, a reception manager, and an administration and reception team. In addition the practice also has the services of pharmacists and physiotherapists on site.

The practice appointments include:

• Pre-bookable appointments six-eight weeks in advance

• On the day/urgent appointments

• Telephone consultations where patients could speak to a GP or nurse to ask advice and if identified obtain an urgent appointment.

• Online via a portal which allowed the patient to contact the practice outlining their condition. Patients then receive contact from the practice such as signposting advice or requesting that they come into the surgery for an appointment.

Appointments can be made in person, via telephone or online.

The practice is open between 8am and 6.30pm Monday to Friday, with extended hours in operation on a Monday and Wednesday up to 8.30pm. Additionally the practice works with others in their local GP network to offer appointments at a nearby surgery from 6.30pm to 8.30pm Monday to Friday and from 9am to 3pm on a Saturday and Sunday.

The practice is accredited as a training practice and supports GP trainees and Foundation Year 2 doctors. Two partners within the practice are GP trainers and a third GP has just been accredited as a trainer. The practice is also active in supporting the training of nurses via placements within the surgery.

Out of hours care is provided by Local Care Direct Limited and is accessed via the practice telephone number or patients can contact NHS 111.

Updated 9 August 2016

Letter from the Chief Inspector of General Practice

We carried out an announced comprehensive inspection at Chapelthorpe Medical Centre on 21 June 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.
• Patients said they found it easy to make an appointment with a named GP and there was continuity of care, with urgent appointments available the same day.
• The practice had good facilities and was well equipped to treat patients and meet their needs.
• There was a clear leadership structure and staff felt supported by management. The practice proactively sought feedback from staff and patients, which it acted on.
• The provider was aware of and complied with the requirements of the duty of candour.

We saw areas of outstanding practice:

• The practice offered online services such as online bookings and prescription ordering. It had recently begun to offer “AskmyGP”, a portal which allowed the patient to contact the practice online outlining their condition. Patients then received contact from the practice such as signposting advice or a request that they come into the surgery for an appointment.

• The practice operated a diabetic clinic delivered in conjunction with a local secondary care provider. The practice also offered specialist care management and enhanced services such as insulin initiation in-house.

There where two areas where the provider should make improvements:

• The practice needed to ensure that all actions identified as a result of a significant event report had been completed and that this had been recorded, and that lessons learned from such events were shared with all relevant staff.

• The practice needed to ensure that appropriate action was taken by staff following patient safety and other alerts.

Professor Steve Field (CBE FRCP FFPH FRCGP) 

Chief Inspector of General Practice

Updated 9 August 2016

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

• GPs and nursing staff had lead roles in chronic disease management such as diabetes, Chronic Obstructive Pulmonary Disease (COPD) and asthma.The practice kept registers of patients with long term conditions and used these to effectively manage treatment packages which included structured examinations, the development of care plans and regular reviews. Whenever possible the practice made every effort to carry out multi-condition appointments for those with more than one long term condition.

• Patients at risk of avoidable hospital admission had an identified named GP and care coordinator in place as well as a personalised care package and review programme.

• The practice operated a diabetic clinic delivered in conjunction with a local secondary care provider. The practice also offered specialist care management and enhanced services such as insulin initiation in-house.

  • In 2015/2016 nine patients received insulin initiation and four received GLP-1(a medication used to treat diabetes) initiation.

  • Performance for diabetes related indicators was either comparable with or better than the national average. For example, 93% of patients on the diabetes register had a record of a foot examination and risk classification being carried out in the preceding 12 months compared to the national average of 88%.

• Longer appointments and home visits were available when needed.

• The practice hosted renal (kidney disease) outreach clinics twice a month for both registered and non registered patients and twice yearly screening clinics for abdominal aortic aneurysm.

Updated 9 August 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.

• Childhood immunisation rates for the vaccinations given were comparable to CCG averages. For example, childhood immunisation rates for the vaccinations given to under two year olds ranged from 94% to 97% (CCG figures ranged from 95% to 98%) and five year olds from 96% to 100% (CCG figures ranged from 92% to 97%).

• The practice’s uptake for the cervical screening programme was 82%, which was comparable to the CCG average of 83% and the national average of 82%. The practice had an effective recall system in place and offered reminders for patients who did not attend for their cervical screening test.

• Appointments were available outside of school hours and the premises were suitable for children and babies.

• The practice carried out eight week mother and baby checks.

• The practice was a c-card distribution centre which gave improved access to contraceptives to young people, chlamydia forms and testing kits were also available from the reception (chlamydia is a common sexually transmitted disease which may not show obvious symptoms).

Updated 9 August 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. For example, t he practice delivered an avoiding unplanned admissions service which provided proactive care management for patients who had complex needs and were at risk of an unplanned hospital admission. Once a patient was identified the practice carried out advanced care planning and three monthly reviews, which involved multi-disciplinary working across health and social care providers. At the time of inspection the practice had 199 patients on their avoiding unplanned admissions register.

• The practice was responsive to the needs of older people, and offered home visits and urgent appointments for those with enhanced needs.

• Staff received regular safeguarding training to assist them to identify and action concerns related to vulnerable older patients.

• The practice delivered weekly clinical sessions to practice patients within three local care homes.

Updated 9 August 2016

The practice is rated as good for the care of working-age people (including those recently retired and students).

• The needs of the working age population, those recently retired and students had been identified and the practice had adjusted the services it offered to ensure these were accessible, flexible and offered continuity of care. For example, the practice participated in the catch up programme for students aged 17 and over for measles, mumps and rubella and meningitis C vaccinations.

• There was the provision for telephone consultations during the day for patients who may not have been able to attend the surgery during the day.

• The practice had extended evening appointments from 6pm to 8.30pm on Monday and Wednesday. In addition it worked with other local GPs and offered appointments from 6.30pm to 8pm Monday to Friday and from 9am to 3pm on Saturday and Sunday. These latter sessions were delivered from a nearby practice.

• The practice was proactive in offering online services as well as a full range of health promotion and screening that reflects the needs for this age group which included healthy living advice and referral to other services such as community mental health.

• The practice offered online services such as online bookings and prescription ordering. It had recently begun to offer “AskmyGP” a portal which allowed the patient to contact the practice online outlining their condition. Patients then received contact from the practice such as signposting advice or requesting that they come into the surgery for an appointment.

Updated 9 August 2016

The practice is rated as good for the care of people experiencing poor mental health (including people with dementia).

• Patients were able to access a local psychological therapies service either via practice referral or self-referral.

• As part of long term condition reviews patients were routinely screened for dementia and asked if they had memory issues. Patients who said they had begun to experience problems were referred within the practice for further investigation and support.

• 99% of patients diagnosed with dementia had had their care reviewed in a face to face meeting in the last 12 months, which is better than the CCG and national averages of 84%. In addition all newly diagnosed dementia patients were offered a first review within six months rather than wait for a first annual review.

• 95% of patients with schizophrenia, bipolar affective disorder and other psychoses had a comprehensive and agreed care plan documented in the patient record which was comparable to the CCG average of 89% and the national average of 88%. The annual review of those patients on the mental health register also included a physical health check.

• The practice was working toward the achievement of dementia friendly status.

Updated 9 August 2016

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

• The practice held a register of patients living in vulnerable circumstances such as those with a learning disability.

• The practice offered longer appointments for patients with a learning disability or the frail elderly with complex needs.

• Patients with a learning disability were offered a health check and annual review.

• The practice regularly worked with other health care professionals in the case management of vulnerable patients and held regular multi-disciplinary team meetings to discuss these patients and their ongoing needs.

• The practice had trained staff to act as care navigators to signpost patients that may be in need of assistance in the community to services that could help and assist them.

• The practice had an electronic information point in the waiting room for patients to utilise to access a range of services which included a directory of local services.

• Staff knew how to recognise signs of abuse in vulnerable adults and children. Staff 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.