Archived: Kingfisher Practice

Updated 17 November 2016

Kingfisher Practice provides a range of primary medical services to the residents of Luton. The practice has been at its current purpose built location of Churchfield Medical Centre, 322 Crawley Green Road, Luton, LU2 9SB since 2006.

The practice population is pre-dominantly white British with a higher than average number of patients aged 25 to 34 years and 50 to 59 years and a lower than average number aged over 60 years. National data indicates the area is one of lower deprivation. The practice has approximately 8,300 patients with services provided under a General Medical Services (GMS) contract, a nationally agreed contract with NHS England.

The practice is led by two GP partners; one male and one female, and they employ three salaried GPs; two male and one female. The nursing team consists of two nurse prescribers, a chronic disease nurse, a practice nurse and two health care assistants, all female. There are a number of reception and administrative staff led by a practice manager and a deputy practice manager. The practice is a training practice and is currently training two doctors who wish to become GPs.

The practice also runs the National Minor Illness Centre that provides educational courses in minor illness management for nurses, health visitors, paramedics and pharmacists.

The practice is open from 8am to 6.30pm Monday to Friday. The reception is closed from 12.30pm to 1.30pm every day; an emergency telephone number was available during these times if a patient needed to contact a GP urgently.

When the practice is closed out of hours services are provided by Care UK and can be accessed via the NHS 111 service.

Updated 17 November 2016

Letter from the Chief Inspector of General Practice

We carried out an announced comprehensive inspection at Kingfisher Practice on 13 July 2016. Overall the practice is rated as Requires Improvement.

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

• The practice had a significant events policy but it was not followed at all times. Staff were unsure what constituted a significant event. Where significant events had been documented, they were investigated appropriately with lessons learnt identified.
• The practice was not aware of the term duty of candour. However, they were following the general principles that ensured when things went wrong patients received reasonable support, an explanation, and a verbal and written apology. They were told about any actions to improve processes to prevent the same thing happening again.
• Practice specific policies were available to all staff but they were not always followed, particularly in relation to the management of significant events, complaints and recruitment.
• Published data showed patient outcomes were low compared to the national average. The practice had employed a nurse to manage patients with long term conditions and they were able to provide evidence that improvements were being made.
• Single cycle audits had been carried out. There had been no completed second cycle audits to show where improvements made were implemented and monitored, although they did have plans in place to complete these.
• The practice did not have a patient participation group.
• Patients said they were treated with compassion, dignity and respect.
• Staff said they felt supported by the management team and had received regular appraisals.
• The practice had good facilities and was well equipped to treat patients and meet their needs.

The areas where the provider must make improvements are:

• Complete infection control audits and review infection control procedures within the practice to identify areas that are not meeting best practice guidance.
• Operate systems and processes effectively to ensure good governance.
• Ensure the significant event policy is followed and staff understand their responsibility to report significant events.
• Implement processes to ensure continuous clinical improvement such as with clinical audit.
• Ensure implementation of a patient participation group to seek and act on feedback from patients.

In addition the provider should:

• Ensure that all staff understand their requirements under the Duty of Candour.
• Ensure the complaints process is followed and all complaints are responded to within the recommended timeframes.
• Implement a system to record stocks of prescribing stationery to include monitoring the distribution of the blank prescription forms.
• Ensure recruitment arrangements include all necessary employment checks for all staff.
• Ensure staff receive the planned update training on safeguarding vulnerable adults.
• Consider having electrical equipment inspected routinely and tested by a competent person.
• Carry out regular fire drills.
• Continue to identify and support carers.

Professor Steve Field (CBE FRCP FFPH FRCGP) 

Chief Inspector of General Practice

Updated 17 November 2016

The provider was rated as inadequate for well-led and requires improvement for safe, effective and responsive. The issues identified affected all patients including this population group. There were, however, some examples of good practice.

• A member of the nursing staff had a lead role in chronic disease management and patients at risk of hospital admission were identified as a priority.

• 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.

Updated 17 November 2016

The provider was rated as inadequate for well-led and requires improvement for safe, effective and responsive. The issues identified affected all patients including this population group. There were, however, some examples of good practice.

• 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 A&E attendances.

• Immunisation rates were relatively high for all standard childhood immunisations.

• The practice’s uptake for the cervical screening programme was 84%, which was comparable to the CCG average of 80% and the national average of 82%.

• Appointments were available outside of school hours and the premises were suitable for children and babies.

• We saw positive examples of joint working with midwives and health visitors.

• The practice worked with the local fertility service and carried out initial investigations for problems with fertility.

Updated 17 November 2016

The provider was rated as inadequate for well-led and requires improvement for safe, effective and responsive. The issues identified affected all patients including this population group. There were, however, some examples of good practice.

• The practice offered proactive, personalised care to meet the needs of the older people in its population.

• All of these patients had a named GP.

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

• They provided an anti-coagulant monitoring service to avoid the need for patients to travel to the local hospital.

Updated 17 November 2016

The provider was rated as inadequate for well-led and requires improvement for safe, effective and responsive. The issues identified affected all patients including this population group. There were, however, some examples of good practice.

• 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.

• They carried out NHS Health Checks for patients aged 40-74 years.

• Same day urgent appointments were available.

• However, the age profile of patients at the practice showed they were above average for those of working age, but they did not offer extended hours appointments.

Updated 17 November 2016

The provider was rated as inadequate for well-led and requires improvement for safe, effective and responsive. The issues identified affected all patients including this population group. There were, however, some examples of good practice.

• Performance for mental health related indicators was similar to the local and national averages. The practice achieved 88% of available points compared to the CCG average of 90% and the national average of 93%.

• The practice regularly worked with multi-disciplinary 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.

• They made use of alternative treatments such as cognitive behavioural therapy and meditation.

Updated 17 November 2016

The provider was rated as inadequate for well-led and requires improvement for safe, effective and responsive. The issues identified affected all patients including this population group. There were, however, some examples of good practice.

• The practice held a register of patients living in vulnerable circumstances including 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’s computer system alerted GPs if a patient was also a carer. The practice had identified 86 patients as carers, which was 1% of the practice list.