Letter from the Chief Inspector of General Practice

We carried out an inspection of Lofthouse Surgery on 22 October 2014 as part of our comprehensive programme of inspection of primary medical services.

The practice is rated as good. The practice is well led by its partners, staff and the patient reference group. It is a practice that places the patients’ needs and preferences at the heart of its services. Details of these findings are in the following report, but in summary our key findings were as follows:

• The practice is safe. Systems were in place to monitor patient safety. Staff were encouraged by the management team to be proactive in talking to them about incidents and concerns and helping to find solutions.
• All areas of the practice were visibly clean and where issues had been identified relating to infection control, action had been taken.
• The practice is effective. People received care according to professional best practice clinical guidelines. The practice had regular information updates, which informed staff about new guidance to ensure they were up to date with best practice. According to the data from Quality and Outcomes Framework (QOF), an annual reward and incentive programme showing GP practice achievement results, outcomes for patients registered with this practice are above average.
• The service is caring. Patients reported overwhelmingly the positive view they had of the doctors and staff at the surgeries. Practice staff new their patients well. The service ensured people received accessible, individual care, whilst respecting their needs and wishes. The QOF indicators showed that patients felt listened to and involved in decisions about their care and this was better than other practices in the area.
• The service is responsive. The appointment system is guided by the needs and views of the patients. Urgent needs are addressed on the day and the patients in general are able to see the GP of their choice. The service has positive working relationships between staff and other healthcare professionals involved in the delivery of service.
• The service is well led. The practice has a clear vision and set of values which are understood by staff and made known to patients. There is a clear leadership structure in place and quality and performance are monitored and risks are identified and managed. We found that practice ensured that its own internal processes for staff and performance management that are focused on patient outcomes and the quality of care for patients.

There are also several areas of outstanding practice and these include:

• The practice places its patients at the centre of its strategy and plans for the future. There is a clear sense of purpose and strategy that is shared by partners, staff and the Patient Reference Group. Patient statements and the access patients have to medical care and advice affirm the approach the practice is taking.
• Nursing and residential homes in the area enjoy a very positive relationship with this practice. The practice has ward rounds at the local homes so that older people can be seen frequently, effectively and efficiently.
• The practice has outstanding services for people who have learning difficulties and has taken the lead in the CCG and in the Leeds conurbation that is comprised of three CCGs. This ensures that people with learning disabilities have good access to medical care and advice. The practice is well engaged with the providers of care for people with learning disabilities.

Professor Steve Field (CBE FRCP FFPH FRCGP) 

Chief Inspector of General Practice

We did not speak with people who used the service at this inspection because we were checking whether improvements had been made in relation to the recruitment of staff.

We spoke with the practice manager who told us one member of staff had been employed since the last inspection. We looked at the recruitment process of this staff member and found all relevant checks had been completed prior to the staff member starting their employment.

We checked whether the recruitment policy had been updated and we discussed with the practice manager how they would ensure a robust recruitment process would continue to be followed.

We spoke with seven patients. One patient said; “The staff are brilliant. It’s like visiting friends.” Another patient told us; “The doctor explains things and gives you choices.”

We found care and treatment was planned and delivered in a way that met patients’ needs and protected their rights. Patients were involved in decisions about their treatment and they told us they were always able to get an appointment.

The practice had clear information about how to safeguard children and vulnerable adults. Staff we spoke with were aware of what to do if they suspected abuse was happening.

We looked at how new staff were recruited. This included a review of two staff records for staff recruited within the last seven months. Both staff files we looked at did not have any proof of the staff member’s identity, including a recent photograph, as required under regulation 21 (b) Health and Social Care Act 2008 (Regulated Activities) Regulations. Although the practice manager assured us this information had been verified, there was no record of this within the staff files.

The patients we spoke with knew what to do if they wished to make a complaint. The members of staff we spoke with informed us they were aware of the steps to take if a complaint was made directly to them.

This practice is rated as good overall. The practice was previously inspected in October 2014 when it was rated good overall.

The key questions are rated as:

Are services safe? – Good

Are services effective? – Good

Are services caring? – Good

Are services responsive? – Good

Are services well-led? – Good

We carried out an announced comprehensive inspection of Lofthouse Surgery on 7 November 2018 as part of our inspection programme.

At this inspection we found:

• The practice had clear systems to manage risk so that safety incidents were less likely to happen. When incidents did happen, the practice learned from them and improved their processes. Learning from incidents was shared with others to prevent recurrence.
• The practice routinely reviewed the effectiveness and appropriateness of the care it provided. It ensured that care and treatment was delivered according to evidence based guidelines. The practice had developed action plans to improve performance when this had been identified as being required.
• Staff involved and treated patients with compassion, kindness, dignity and respect. Patient feedback was positive regarding the treatment they had received.
• Patients generally found the appointment system easy to use, and reported that they were able to access care when they needed it.
• There was a strong focus on continuous learning and improvement at all levels of the organisation. The practice was an early adopter of health improvement programmes, and actively participated in social prescribing.
• Services had been developed to meet the specific needs of their population.
• The practice worked with others at a locality level to plan and develop services.

We saw one area of outstanding practice:

• The practice had developed extensive and dedicated services which supported patients with a learning disability. We saw that these services had delivered effective outcomes for patients and were responsive to their needs. Learning and experiences from their approach to the delivery of these services were openly shared with others to disseminate best practice.

The areas where the provider should make improvements are:

• Continue to review and improve performance in relation to diabetes and other long-term conditions where performance has been below local and national levels.

Professor Steve Field CBE FRCP FFPH FRCGP
Chief Inspector of General Practice