Whitehall Surgery

Updated 14 November 2016

Dr ASA Robinson and Partners (known as Whitehall Surgery) and is a member of the NHS Leeds West Clinical Commissioning Group (CCG). Personal Medical Services (PMS) are provided under a contract with NHS England. The practice is registered with the Care Quality Commission (CQC). They offer a range of enhanced services, which include:

• extended hours 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 located at:

Whitehall Surgery

Wortley Beck Health Centre

Ring Road

Lower Wortley

Leeds

LS12 5SG

The centre is purpose built with easy access for disabled patients or families with pushchairs and there are car park facilities on site.

The patient list size is currently 8,791 and made up of predominantly white British patients, with a small number of patients from mixed ethnic backgrounds. There is a slightly higher than CCG and national average number of patients aged 5 years or older. For example, 22% of the population are aged 18 or younger, compared to 19% for the CCG and 21% nationally. At 59%, there is a lower than CCG (66%) and national (61%) average number of patients who are in paid employment or full time education. However, at 2%, the unemployment status of patients is lower than CCG and national figures of 5%. In addition there are 67% of patients who have a long-standing health condition, compared to 51% CCG and 54% nationally.

There are four GP partners (one male, three female), one female salaried GP, one male associate GP and one female GP registrar. There are regular locum GPs and three female practice nurses. 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.

The practice is open Monday to Friday 7am to 7pm. Appointments can be pre-booked, made on the same day or a telephone consultation can be arranged. 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.) These include local residential and nursing care homes, where the practice has 32 registered patients who reside there.

Updated 14 November 2016

Letter from the Chief Inspector of General Practice

We carried out an announced comprehensive inspection at Dr ASA Robinson and Partners (known as Whitehall Surgery) on 27 September 2016. Overall the practice is rated as good, and for providing safe, caring, responsive and well-led care for all of the population groups it serves. We have rated the practice as outstanding for providing effective services.

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

• 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.)
• There was an open and transparent approach to safety. 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.
• Risks to patients were assessed and well managed.
• There were safeguarding systems in place to protect patients and staff from abuse.
• There was a clear leadership structure, staff were aware of their roles and responsibilities and told us the GPs and practice manager were accessible and supportive. There was evidence of an all-inclusive team approach to providing services and care for patients.
• 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.
• Patients said they were treated with compassion, dignity and respect and they were involved in their care and decisions about their treatment.
• 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; such as providing additional GP appointments or telephone, face to face, Skype, E-consultations via Email

consultations when required.

• Patients said they 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.
• Information regarding the services provided by the practice and how to make a complaint was readily available for 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 engagement with patients.

We saw some areas of outstanding practice:

• The practice had completed a significant number of two cycle audits which demonstrated good outcomes for patients. Over a period of two years and nine months the practice had documented 56 audits, of which 41 were full cycle, the other 15 were to be re run later this year or next year. We saw significant improvements to patient outcomes had been made as a result of this audit activity, including within the areas of palliative care and the prevention of diabetes.

• Care planning within the practice was comprehensive. Details in the plans included regular detailed reviews of the patient, early detection of any deterioration and changes in symptoms, collaboration and liaison between care providers, continuity of care with clinicians and nurses and evidence of the development of close relationships with patients and family/carers. Patient feedback in relation to the support they received was high.

Professor Steve Field (CBE FRCP FFPH FRCGP) 

Chief Inspector of General Practice

Updated 14 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 at high risk of an unplanned hospital admission. Care plans and support were in place for these patients.
• Clinicians had access to a 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 were undertaken with those patients who were deemed most at risk of developing diabetes.
• The practice delivered care and support for some patients using an approach called the 'Year of Care'. This approach enabled patients to have a more active part in determining their own needs in partnership with clinicians. It was currently used with patients who had diabetes.
• 100% of patients with diabetes, on the register, who have had influenza immunisation in the preceding 12 months (CCG average 94%, national average 94%).
• 86% of patients diagnosed with asthma had received an asthma review in the last 12 months (CCG and national averages of 75%).
• 92% of patients diagnosed with chronic obstructive pulmonary disease (COPD) had received a review in the last 12 months (CCG average 89%, national average 90%).
• The practice’s IT use was extensive. The practice bought computers 20 years ago for summaries and repeats and went paper-light in 2000. The practice had developed templates over a period of many years (designed in house and now used across the city) which helped clinicians to provide consistently high quality care across the range of conditions. The recall and review, results handling and communication processes with patients was effective. The practice’s QOF score was 100% in 2014/2015.

Updated 14 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 practice provided or hosted 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 under the age of five.
• At between 95% and 100%, immunisation uptake rates were in line with CCG and national rates for all standard childhood immunisations. There was a dedicated member of staff who followed up those children and their families who did not attend or who were overdue for immunisations.
• Sexual health, contraceptive and cervical screening services were provided at the practice, which included implants and chlamydia screening.
• The practice promoted cervical screening and 84% of eligible patients had received a test (CCG average 79%, national average 82%).
• Routine access for appointments is usually within five days, often 48 hours, and all staff were aware that young children’s conditions may change rapidly. The practice have on-the-day access for patients under five years, and staff are enabled to add or hasten appointments, and bring to a clinician’s attention any patient in distress.

Updated 14 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 was 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 had registered patients who resided in two local residential care homes and Skype tele video calls were due to be undertaken by a GP, at each of these homes, to support provision of care and treatment.
• The practice conduct an annual community flu clinic at New Farnley Community Centre where a ‘Neighbourhood Action’ service provide transport, tea and scones, and arranged for advisors from the fire brigade, healthy eating, ‘Keep Warm in Winter’ and links to exercise and other groups to attend.

Updated 14 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 on evenings, telephone consultations, online booking of appointments and ordering of prescriptions.
• 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.
• Measles, mumps and rubella (MMR) and Meningitis ACWY (The Men ACWY vaccine is given by a single injection into the upper arm and protects against four different causes of meningitis) vaccinations were offered to students. Temporary registration was also available for patients who were staying in the area for less than three months.
• The practice has operated from 7am for many years, but now have extended access from 7am to 7pm. They sought to reserve early and late appointments for those working during the day. To further support the working age population online appointments, electronic prescribing, and increased telephone and Skype consultations were available.
• The practice used their website and social media as platforms to share information with their patients.
• The practice used e-consultations to provide advice on various things, including for travel immunisations, mental health, sick notes and long term conditions like asthma.

Updated 14 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.
• 95% of patients diagnosed with dementia and 92% 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. These were both slightly above CCG and national averages.
• The practice followed up these patients who did not attend their appointments.
• Patients who were at risk of developing dementia were screened and support provided as necessary.
• Staff had a good understanding of how to support patients with mental health needs or dementia.
• The practice had organised in house training with the sector psychiatrist.
• The practice set up direct email correspondence with staff to avoid previous problems with poor communication and delays in information being received.

Updated 14 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.
• An alert was placed on the electronic record of patients who had a learning disability, to raise awareness with staff of any potential vulnerability.
• There was a designated member of staff who managed a register of patients who had a learning disability and ensured they were offered an appointment for an annual health review.