Hawthorn Surgery

Updated 11 May 2016

Hawthorn Surgery was inspected on Thursday 3rd December 2015, and is situated in the purpose built Wortley Beck Health Centre which houses two general practices The premises were built in 2008 and are well maintained with facilities suitable for the needs of the disabled, and limited car parking. The premises are on the main ring road around Leeds and there are good transport links. The practice population is 5286 (October 2015) and is in the third most deprived group. The practice has more working age patients than the national average and a higher percentage of children aged 0 – 4. What it does:

• There are three partners, two male (full time) and one female who works part-time (0.6)

• The support team includes a practice manager, practice nurse, healthcare assistant (HCA), secretaries, senior receptionists, administration/reception staff, a summariser.

• The practice is a training practice that supports GP Registrars, F2 doctors (doctors who have qualified within the last two years), medical students and GP returners.

• The practice is open between 7am and 7pm Monday to Friday. Appointments are from 7.50am to 11am every morning and to 5.40pm daily as a minimum and additional appointments over lunchtime and in the evenings are provided by locum GPs when required.

• Outside of surgery hours an Out of Hours Service is provided by Local Care Direct and there are a number of local walk-in centres in the vicinity.

Updated 11 May 2016

Letter from the Chief Inspector of General Practice

We carried out an announced comprehensive inspection at Hawthorn Surgery on 3rd December 2015.  Overall the practice is rated as good .

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

• The practice had a clear vision which had quality, safety and personalised care as its top priorities. The strategy to deliver this vision had been shared with stakeholders and was regularly reviewed and discussed with staff.
• There was an open and transparent approach to safety and an effective system in place for reporting and recording significant events.  Staff understood and fulfilled their responsibilities to raise concerns and report incidents and near misses. All opportunities for learning from internal and external incidents were maximised. 
• Risks to patients were assessed and well managed.
• The practice used innovative and proactive methods to improve patient outcomes, working with other local providers to share best practice.  For example, the practice in collaboration with the practice which shares the health centre provided a ‘flu afternoon’ in a local community centre.  Tea and buns were provided and the local Fire Brigade attended to provide advice on fire safety. Patients for either practice would be seen in the session. 
• Feedback from patients about their care was consistently and strongly positive.
• 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.
• Patients said they found it easy to make an appointment with a named GP and that there was continuity of care, with urgent appointments available the same day.
• The practice worked closely with other organisations and with the local community in planning how services were provided to ensure that they meet patients’ needs.  For example a children’s asthma service is a joint venture with six other practices
• The practice implemented suggestions for improvements and made changes to the way it delivered services as a consequence of feedback from patients and from the patient participation group.  The practice had good facilities and was well equipped to treat patients and meet their needs. Information about how to complain was available and easy to understand
• 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.
• Staff assessed patients’ needs and delivered care in line with current evidence based guidance, and had the skills, knowledge and experience to deliver effective care and treatment.
• The provider was aware of and complied with the requirements of the Duty of Candour.

We saw several areas of outstanding practice including:

• Locum GP pack was considered by the inspection team to be excellent and comprehensive and made it easier for locum GPs to settle into work in the practice.
• The practice was able to demonstrate good outcomes for children who were classed as obese through their ‘obesity in children project’.
• The practice is working with six other practices collaboratively to improve care and outcomes for children with asthma, implementing NICE guidelines.
• The Family Football Initiative was developed as an over 50’s walking football club and was started in November 2014 to support patients who felt isolated.  This developed into its current family focus. 
• Daily Mile initiative is in the process of being set up to address isolation and mental health.  This will run every weekday and will start at a local park at 1pm, with all patients welcome to join. 

However, there was one area where the provider should improve:

• Revise and implement a lone worker policy, particularly in relation to the nurse/HCA undertaking home visits.

Professor Steve Field CBE FRCP FFPH FRCGP

Chief Inspector of General Practice

Updated 11 May 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.

• The practice average achievement in the quality and outcomes framework (QOF) diabetes indicators was the same as national average at 84%.

• The national diabetes audit showed that the practice was achieving 9 care processes in 58% of their patients in 2013.  After implementing changes this improved to 80% over a 12 month period.

• 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 ‘Year of Care’ scheme has been introduced for diabetic patients to self-manage their health, with encouraging feedback.

• A system to monitor patients on anti-rheumatic medicines has been introduced and the practice has already experienced several incidents where they have identified deterioration earlier.

• An external audit project has shown that the practice has improved its treatment for patients with atrial fibrillation in accordance with NICE guidance from 69% of patients to 72% in six months.

Updated 11 May 2016

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

• We saw positive examples of joint working with midwives, health visitors and school nurses.   The Safeguarding Lead and Health Visitor meet monthly to discuss concerns about children, parents/carers.

• Staff were able to give clear examples of their understanding of safeguarding vulnerable children, and we saw evidence of clear documentation and good information sharing. 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 o f accident and emergency (A&E) attendances. Immunisation rates were relatively high for all standard childhood immunisations.

• Patients told us that children and young people were treated in an age-appropriate way and were recognised as individuals, and we saw evidence to confirm this.

• The percentage of women aged 24-64 whose notes record that a cervical screening test has been performed in the preceding 5 years was 81% compared with a national rate of 82%

• Appointments were available outside of school hours and the premises were suitable for children and babies.  After receiving patient feedback that the waiting area was not child friendly they purchased a play house and toys.  The most recent survey showed the waiting area was highly rated.

• Walking Football Club for the Over 50s had evolved into a Family Walking Football Club where three generations were playing together.  We saw qualitative research which showed the high value patients placed on this.

Updated 11 May 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.

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

• The percentage of people aged 65 or over who received a seasonal flu vaccination was 79% and higher than the national average at 73%.  They also achieve high targets in shingles and pneumonia immunisations and with assistance from the multidisciplinary team (MDT) they deliver these in care homes, community centres and patients’ houses.

• Longer appointments and home visits were available for older people when needed.

• The practice worked closely and meets regularly with their community matron, palliative care nurse and the wider MDT.  They provided examples where this teamwork had resulted in admission avoidance and improved care, particularly of their 2% highest risk group.

• The practices took part in the Care Home Scheme in monitoring medicines and are carrying out over 75 health checks.

• There was a ‘Knitting Bee’ group initiated by the practice and run by the patients which was popular with their older population.

Updated 11 May 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. An example is extending the opening hours from 7am to 7pm on weekdays in response to patient comments.

• The practice offered online and same day telephone consultations

• The practice was proactive in offering online services as well as a full range of health promotion and screening that reflects the needs of this age group.

Updated 11 May 2016

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

• 87% of patients diagnosed with dementia had their care reviewed in a face to face meeting in the last 12 months, which is higher than the national average of 84%.

• The practice regularly worked with multidisciplinary teams in the case management of people 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 a good understanding of how to support patients with mental health needs and dementia.

• The practice had responded to depression QOF figures by focussing on encouraging attendance for reviews and improving coding to support this.

• The practice has increased their identification of patients with dementia from 48% of predicted prevalence to 87% in one year by using the dementia toolkit.

• The practice is setting up a ‘Daily Mile’ scheme, one of the aims of which is to address isolation in patients with poor mental health.  This involves patients undertaking an hour long walking session every weekday in the local park.

Updated 11 May 2016

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

• The practice proactively carried out medicals with their patients with learning difficulties and because of this has identified issues which would not have presented until later; for example we saw evidence that medical conditions were detected at an early stage through this process. The practice had actively monitored their ‘did not attend’ appointments and had highlighted how often this group and adults with mental health issues failed to attend booked appointments.  The practice is developing a protocol to proactively contact patients prior to their appointment.

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

• The practice offered longer appointments for learning disability annual health checks.  Longer appointments could be requested by Carers.

• The practice regularly worked with multidisciplinary teams in the case management of vulnerable people.

• 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 had previously collaborated with the citizen’s advice bureau (CAB) to provide assistance with benefit related issues.  This service had recently been discontinued due to financial pressures. 

• The practice had a system for identifying patients with a high attendance at A & E which would indicate vulnerable patients.  These patients were discussed at multidisciplinary meetings.