Archived: Family Medical Centre - Kirkby

Updated 24 September 2015

The practice provides primary medical services to approximately 3,600 patients through a general medical services (GMS) contract. The services are provided from a single location in the centre of Kirkby-in-Ashfield. The area is a former mining community and has a higher level of deprivation than the national average.

The surgery is a purpose built building over two floors with a lift and stairs to the first floor. Patient facilities are available on the ground floor. Parking is available in the adjacent supermarket car park without charge for up to three hours.

The practice team comprises two GP partners (one male and one female) one of whom is on long term sick leave. The senior GP partner provides ten clinical sessions per week and is supported by part-time locum GPs.

The doctors are supported by two part time practice nurses and a part time phlebotomist (who are all female). The practice employs a full time practice manager, six staff who undertake reception and administrative tasks and two part-time cleaners.

The practice is open between 8am to 6pm Monday to Friday. GP appointments are available from 8.30am to 5.40pm on weekdays. The nursing appointments vary with appointments being available 8am to 11am Monday and Thursday, 8.30am to 5.40pm on Tuesday and Wednesday, and 9am to 3pm on Fridays.

The practice has opted out of providing out-of-hours services to their own patients. This service is provided by Central Nottinghamshire Clinical Services (CNCS) when the practice is closed. Walk in clinics are hosted by the practice on a Wednesday evening and a Saturday morning. These can be used by patients who are registered with a practice within the locality group.

Updated 24 September 2015

Letter from the Chief Inspector of General Practice

We carried out an announced comprehensive inspection at Family medical centre - Kirkby on 14 July 2015. Overall the practice is rated as requires improvement.

Specifically, we found the practice to require improvement for providing safe, effective and well led services. It also required improvement for providing services for all the population groups we inspected. It was good for providing caring and responsive services.

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

• Staff understood and fulfilled their responsibilities to raise concerns, and to report incidents and near misses. However, information about safety was not sufficiently recorded to ensure incidents had been appropriately reviewed, addressed and there was shared learning with staff.
• Risks to patients were not well assessed and managed, with some areas of medicines management, risk management plans and arrangements for dealing with emergencies needing strengthening to ensure people using the service received safe care.
• Performance data showed most patient outcomes were comparable to the local average; with the exception of health promotion and screening.
• Although some clinical audits had been carried out audits were not driving improvement in performance and patient outcomes.
• Patients told us they were treated with compassion, dignity and respect and they were involved in their care and decisions about their treatment.
• Nationally published and practice supplied data showed most patients were happy with the telephone access and appointment system. Patients told us 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.
• Information about services and how to complain was available and easy to understand and records showed the practice responded quickly to written complaints received. Learning from verbal complaints was not always recorded to evidence improvements made and shared learning with staff.
• The practice had suitable facilities to treat patients and meet their needs.
• Although there was a clear leadership structure and staff felt supported by management, the practice was not proactive in seeking feedback from staff and patients to improve the quality of services.

The areas where the provider must make improvements are:

• Ensure there are robust governance arrangements in place ensuring accurate, complete and detailed records are kept in respect of the management of the regulated activities. This includes: information on significant events, incidents and near misses, verbal complaints and information on when complaints should be escalated to other appropriate bodies and their contact details.
• Ensure effective systems are in place to enable the provider to identify, assess and mitigate risks to the health and welfare of patients and others. This includes ensuring: the immunisation status for clinical staff is obtained; the issue and tracking of blank prescription forms kept in the doctor’s bag for home visits meets national guidance; and effective systems are in place to follow-up on secondary care information such as out of hour’s reports, 111 reports and pathology results in the absence of the lead GP.
• Ensure views of staff and patients are proactively sought to inform the delivery of care and that staff are fully engaged and aware of the practice vision.

The areas where the provider should make improvement are:

• Provide accessible information for carers and those experiencing bereavement to enable them to access support.
• Be more proactive in respect of care planning for older people living in long term accommodation (care homes) and where appropriate advance care planning and engaging patients in health promotion and screening programmes.
• The practice should have a PPG in place or an alternative mechanism for obtaining patient feedback to enable them to improve the quality of services provided.
• Ensure audits complete their full audit cycle to demonstrate improvements made to practice.
• Ensure procedures for following up uncollected prescriptions are implemented in line with practice policy.

Professor Steve Field CBE FRCP FFPH FRCGP

Chief Inspector of General Practice

Updated 24 September 2015

The practice was rated as requires improvement in respect of providing safe, effective and well led services. The concerns which led to these ratings apply to everyone using the practice, including this population group.

The practice maintained registers of patients with long term conditions. The 2014/15 data showed good outcomes were achieved for most conditions with improvements required for care of diabetes and stroke.

The GPs were supported by nursing staff in chronic disease management and patients at risk of hospital admission were identified as a priority. Most of these patients had a named GP, a personalised care plan or structured annual review to check that their health and care needs were being met. Recall systems had been improved to ensure patients attended.

The practice worked with multi-disciplinary teams in the case management of people with long-term conditions. Longer appointments and home visits were available when needed.

Updated 24 September 2015

The practice was rated as requires improvement in respect of providing safe, effective and well led services. The concerns which led to these ratings apply to everyone using the practice, including this population group.

Immunisation rates were high for all standard childhood immunisations and children were given priority for appointments. Systems were in place to identify and follow up children living in disadvantaged circumstances and those at risk of abuse. Appointments were available outside of school hours and we saw good examples of joint working with midwives and health visitors.

Updated 24 September 2015

The practice was rated as requires improvement in respect of providing safe, effective and well led services. The concerns which led to these ratings apply to everyone using the practice, including this population group.

Every patient over the age of 75 years had a named GP. Influenza and shingles vaccinations were offered to older patients in accordance with national guidance. Home visits to patients in their own homes or care homes were carried out when requested but arrangements for advance care planning and / or admissions avoidance for older people living in care homes were not robust and there were no care plans in place for these patients at the time of our inspection.

Monthly multi-disciplinary care meetings were held to ensure care was discussed and agreed for older people with complex health care needs.

Updated 24 September 2015

The practice was rated as requires improvement in respect of providing safe, effective and well led services. The concerns which led to these ratings apply to everyone using the practice, including this population group.

Systems to proactively promote health and offer advice needed strengthening. The uptake levels in respect of national screening programmes were lower than the CCG and national average and more proactive steps were needed to secure improvements in this area. For example, the practice had completed 61 NHS health checks for patients aged 45 to 74 years (62% of target) compared to the CCG average of 102%.

Online services for booking appointments and prescriptions were offered. A range of services that reflected the needs of this age group were carried out at the practice. This included family planning services for women of working age and travel vaccinations.

Updated 24 September 2015

The practice was rated as requires improvement in respect of providing safe, effective and well led services. The concerns which led to these ratings apply to everyone using the practice, including this population group.

Practice supplied data for 2014/15 (which had not yet been verified and published) showed 100% of people experiencing poor mental health had been offered an annual physical health check; and care plans were in place for those that required them. The practice regularly worked with multi-disciplinary teams in the case management of patients experiencing poor mental health and dementia. Longer appointments and / or home visits were offered.

The practice assessed patients with risk factors associated with dementia. The practice had achieved a dementia diagnosis rate of 66% and this was in line with the England target rate of 65% and slightly below the CCG average of 71.1%.

Updated 24 September 2015

The practice was rated as requires improvement in respect of providing safe, effective and well led services. The concerns which led to these ratings apply to everyone using the practice, including this population group.

The practice had carried out annual health checks for people with a learning disability and 46% of those on the register had been completed. Records showed liaison with other professionals for follow-up where patients had not attended.

The practice worked with multi-disciplinary teams in the case management of vulnerable people. All staff knew how to recognise signs of abuse in vulnerable adults and children. 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.