The Paddock Surgery

Updated 7 November 2016

The Paddock Surgery provides primary medical services to 5,718 patients, whose catchment area includes Thornhill, Thornhill Lees, Saville Town, Whitley, Briestfield and Middlestown, under a General Medical Services (GMS) contract with NHS England. The practice is a member of the North Kirklees Clinical Commissioning Group and the Dewsbury and Thornhill cluster group of GP practices.

• The practice is located in modern purpose built single storey premises at Chapel Lane, Thornhill, Dewsbury, WF12 0DH close to Thornhill Lees primary school. There is disabled access and a large public car park next to the premises.
• There are three GP partners (two male and one female), a female practice nurse, a female healthcare assistant and a female phlebotomist. The clinical team is supported by a practice manager and a team of administrative staff.
• The practice is open between 8.30am and 6.30pm Monday to Friday. The surgery operates a walk-in session each morning between the hours of 8.30am and 10.30am where patients can be guaranteed to see a GP.

Routine appointments are available:

• Monday to Friday from 4pm until 6pm with the doctors
• Monday to Friday from 8.40am until 6pm with the nurse and health care assistant.
• Tuesday to Friday from 8.40am until 1.30pm with the Phlebotomist
• Telephone consultations are also available every day after the doctors have finished morning surgery.
• When the practice is closed calls are transferred to the NHS 111 service who will triage the call and pass the details to Local Care Direct who is the out -of-hours provider for North Kirklees. This includes from 8am and 8.30am and 6pm to 6.30pm.

The area is on fourth decile on the scale of deprivation. Data showed that 7% of patients are from black, minority ethnic populations.

Updated 7 November 2016

Letter from the Chief Inspector of General Practice

We carried out an announced comprehensive inspection at The Paddock Surgery on 8 September 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 one area of outstanding practice:

• The GP partners offered a small scale acupuncture service for patients with musculoskeletal complaints. An evaluation of this service showed that 74% of respondents said the treatment was very or fairly effective and 52% of patients felt able to reduce their medication as a result of the treatment.

The areas where the provider should make improvement are:

• Review the arrangements for the storage and checking of emergency equipment and medicines.
• Consider expanding incident and significant event reporting to include near misses and minor administrative errors.
• Review how they label clinical waste bags in line with current legislation and guidance.

Professor Steve Field (CBE FRCP FFPH FRCGP) 

Chief Inspector of General Practice

Updated 7 November 2016

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

• Nursing staff had lead roles in chronic disease management and patients at risk of hospital admission were identified as a priority. Where appropriate, patients were referred to the community matron, diabetic, respiratory and heart failure specialist nurses to provide care closer to home.
• The GPs and nurses initiated diabetic treatment. Seventy nine percent of patients with diabetes had a record of a foot examination and risk classification in the preceding 12 months (CCG average 89%, national average 88%).
• Nursing staff showed us how they provided patients with long term conditions, such as diabetes, the results of checks, care planning information and encouraged them to set health goals.
• Longer appointments and home visits were available when needed.
• All these patients had a named GP and a structured annual review to check their health and medicines needs were being met. For those patients with the most complex needs, the named GP worked with relevant health and care professionals to deliver a multidisciplinary package of care.
• The practice maintained a register of patients at risk of unplanned hospital admission. Staff worked with community healthcare services to plan care. Patients were contacted after hospital discharge to check on their wellbeing and address ongoing needs.
• Clinical staff carried out urgent home visits and annual reviews for housebound patients as required.

Updated 7 November 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.
• Immunisation rates were relatively high for all standard childhood immunisations.
• Staff and patients told us that children and young people were treated in an age-appropriate way and were recognised as individuals.
• The practice’s uptake for the cervical screening programme was 77%, which was below the CCG and national average of 82%.
• Priority access was offered to all young children who were ill. Appointments were available outside of school hours and the premises were suitable for children and babies.
• Antenatal clinics were held weekly and GPs carried out 6 to 8 week checks for babies. Mothers of all new-borns were sent a welcome pack which included registration forms.
• The practice provided sexual health advice and contraceptive services which included the fitting and removal of contraceptive implants. Patients were also signposted to the local contraception and sexual health clinic where appropriate.
• We saw positive examples of joint working with midwives, health visitors and school nurses.
• There was a range of information for families and young children displayed in the waiting area.

Updated 7 November 2016

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

• Staff worked together and with other community healthcare services. They 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.
• Abdominal aortic aneurysm (AAA) screening services were hosted by the practice for men over the age of 65. AAA is a way of detecting a dangerous swelling (aneurysm) of the aorta, the main blood vessel that runs from the heart.
• The practice offered influenza, pneumococcal and shingles vaccinations to older patients.
• Annual health checks were offered to patients aged 75 and over who had no pre-existing conditions.
• Quarterly meetings were held with the manager of a local nursing home where a number of patients resided. The practice engaged with care homes to ensure that acute care was provided and long term conditions were managed effectively.
• The practice also encouraged its patients to attend national screening programmes for bowel and breast cancer screening. Uptake rates were higher than the local and national averages. For example, 61% of patients aged 60 to 69 were screened for bowel cancer in the preceding 30 months (CCG average 55%, national average 58%).

Updated 7 November 2016

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

• The practice offered early appointments where possible for working patients who could not attend during normal opening hours.

• 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.
• 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.

Updated 7 November 2016

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

• Data showed that 84% of patients diagnosed with dementia had their care reviewed in a face to face meeting in the last 12 months, which was comparable to the national average of 83%.
• Data showed that 97% of patients with schizophrenia, bipolar affective disorder and other psychoses had a comprehensive care plan documented in the record, in the preceding 12 months (CCG average 89%, national average 88%).
• The practice regularly worked with multidisciplinary teams in the case management of patients experiencing poor mental health, including those with dementia.
• The practice carried out advance care planning for patients with dementia.
• The practice had told patients experiencing poor mental health about how to access various support groups and voluntary organisations.
• The practice had a system in place to follow up patients who had attended accident and emergency where they may have been experiencing poor mental health.
• Staff had received dementia friends training. Two members of staff were identified as dementia champions and had received additional dementia training for this role.
• Staff had a good understanding of how to support patients with mental health needs and dementia.

Updated 7 November 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 including homeless people, travellers and those with a learning disability.
• The practice offered longer appointments for patients with a learning disability.
• The practice regularly worked with other health care professionals in the case management of vulnerable patients.
• The practice informed vulnerable patients about how to access various support groups and voluntary organisations.
• 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.
• The practice was registered with the Kirklees ‘safe places’ scheme. This scheme is in place to help vulnerable people from getting lost or disorientated when they go out.
• Written information was clearly displayed to direct carers to the various avenues of support available to them.