Archived: Kiddrow Medical Practice

Updated 19 April 2016

Kiddrow Medical Practice provides services to around 4,041 patients in the Burnley area of East Lancashire under a General Medical Services (GMS) contract. The building is owned by Community Health Partnerships and shared with other services including district nurses and a pharmacy. Building management is provided by NHS Property Services.

The practice has two male GP partners and one female GP partner (who works one session per week), two practice nurses and a health care assistant (HCA). A practice manager, an office manager and team of seven reception staff support the practice.

The practice is open between 8am and 7pm Monday, Wednesday, Thursday and Friday and 8am until 12pm Tuesdays. The practice has a reciprocal agreement with Rosegrove Surgery nearby, which provides cover on Tuesday afternoons when Kiddrow Medical Practice is closed.

The practice has a predominantly white British population, with a higher than average proportion of patients who are over 55 years old. Practice data shows fewer patients with a long-standing health condition than average, 49%, compared to the national average of 54%.

Out of hours cover is provided by East Lancashire Medical Services Ltd, under a contract with East Lancashire CCG.

Information published by Public Health England rates the level of deprivation within the practice population group as three on a scale of one to 10 (level one represents the highest levels of deprivation and level 10 the lowest). East Lancashire has a higher prevalence of COPD, smoking and smoking related ill-health, cancer, mental health and dementia than national averages.

The practice applied for and achieved the Royal College of General Practitioners (RCGP) Practice Accreditation in 2014 during a time of significant challenge to staff, GPs and patients.

Updated 19 April 2016

Letter from the Chief Inspector of General Practice

We carried out an announced comprehensive inspection at Kiddrow Medical Practice on 23 February 2016. Overall the practice is rated as outstanding.

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

• 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.

• The practice used innovative and proactive methods to improve patient outcomes, working with other local providers to share best practice. For example, the practice had introduced a patient information leaflet regarding medications they should stop taking if they became unwell. This had been shared with other local practices.

• The practice implemented suggestions for improvements and made changes to the way it delivered services in response to feedback from patients and the virtual patient participation group. The practice used emails and text messaging to communicate with over 2000 patients, and received 100 responses with positive feedback for the inspection.

• A variety of partner organisations contacted CQC with positive feedback prior to the inspection.
• 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
• The practice had a clear vision on working in partnership for better health and wellbeing which underpinned commitment to good patient care and safety. Patient feedback and survey data, secondary care data and information from partner organisations evidenced the effectiveness of this approach.
• Feedback from patients about their care was consistently positive. Patients told us they were treated with compassion, dignity and respect and they were involved in their care and decisions about their treatment. They also 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.
• Reflective learning was embedded within the practice at all levels.
• Performance data such as the Quality and Outcomes Framework (QOF) and NHS England, along with National GP patient survey results all demonstrated the practice was making a difference to patient outcomes.

Professor Steve Field (CBE FRCP FFPH FRCGP) 

Chief Inspector of General Practice

Updated 19 April 2016

The practice is rated as outstanding 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 gave individual responsibilities to all staff for managing long-term conditions. National QOF and data from Midlands and Lancashire Commissioning Support Unit corroborated that this was impacting positively on patient care and outcomes.
• QOF indicators for patients with asthma, Chronic Obstructive Pulmonary Disease (COPD, a lung condition), diabetes, heart failure and epilepsy achieved 100% in 2014-15 were all higher than CCG and National averages with low exception reporting.
• 100% of patients with diabetes had a seasonal flu vaccination in the preceding flu season compared to national figures of 94% (2014-15 data).
• For all patients identified as at risk from influenza, 77% received a vaccination compared to 57% nationally (2013-14 data). Current practice figures showed high flu immunisation rates for patients with COPD, coronary heart disease, diabetes and those on the stroke/ transient ischaemic attack (TIA, a mild stroke) registers, although these figures were not validated at the time of our visit.
• 91% of patients with COPD had had a review undertaken including an assessment of breathlessness in the preceding 12 months, national average 90%.
• Longer appointments and home visits were available when needed.
• All these patients had a named GP and a structured annual review to check that their health and medicines needs were being met. For those people with the most complex needs, the named GP worked with relevant health and care professionals to deliver a multidisciplinary package of care.
• The practice focussed on helping patients understand their conditions, and signposted patients to relevant services including a self management programme for patients newly diagnosed with diabetes, exercise on prescription, smoking cessation and healthy lifestyle clinics.
• The practice also promoted the walking group which was run from the practice weekly.
• Data from Midlands and Lancashire Commissioning Support Unit on hospital admissions linked to long-term conditions corroborated that the work the practice did was having a significant impact on reducing hospital attendance and admission compared to the wider CCG area.

Updated 19 April 2016

This population group is rated as good, with outstanding in well-led for this population group.

• 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 high for all standard childhood immunisations, 100% for six of the ten vaccinations for five year old children.
• The practice had procedures to ensure that children who required urgent care were given priority.
• One of the GPs had a special interest in paediatrics.
• 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.
• Notes for 87% of women aged between 25 and 65 recorded that a cervical screening test had been performed in the preceding 5 years, above the national average of 82%.
• Appointments were available outside of school hours and the premises were suitable for children and babies.
• We saw good examples of joint working with midwives, health visitors and school nurses.
• On-line appointment booking and prescription ordering were available and the practice had recently introduced an online messaging system.

Updated 19 April 2016

The practice is rated as outstanding for older people.

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

• The practice endeavoured to offer same day care for over 75’s whenever possible and worked closely with the specialist nurse practitioners for over 75 year old patients

• Data provided by the practice demonstrated lower rates of hospital attendance and admission.

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

• 87% of patients aged 65 and older received a seasonal flu vaccination compared to national figures of 73% (2013-14 data). Practice figures for 2015-16 also showed high numbers of older patients had been vaccinated, although these figures had not been validated.

• The practice worked with local teams to promote fitness for the patients aged over 60 and invited patients to fitness testing within the practice and supported patients with individual plans.

• Patients and staff gave us examples of home visits being conducted in a sensitive manner, and we saw evidence of end of life care plans demonstrating respect for personal preferences.

• The practice was involved in a local trial to reduce multiple medicines prescribing. The effects of medicines interacting can lead to complications in older patients.

Updated 19 April 2016

The practice is rated as good for the care of working-age people (including those recently retired and students, and outstanding in well-led for this population group.

• The practice offered extended hours appointments for patients who could not attend during the working day.
• 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.
• The practice was proactive in offering online services as well as a full range of health promotion and screening that reflected the needs for this age group.
• Telephone appointments were available for patients who could not attend and the practice was proactive in using information technology to improve access to health care such as secure online and text messaging.

Updated 19 April 2016

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

• 100% of people diagnosed with dementia had had their care reviewed in a face to face meeting in the last 12 months, higher than the national figures of 84%. Clinical exception reporting was 11% for this indicator.
• 100% of patients with schizophrenia, bipolar affective disorder and other psychoses had a comprehensive care plan documented in their record in the preceding 12 months compared with national figures of 88%. There were no clinical exceptions for this indicator.
• The practice was proactive in trying to identify patients who were at risk of dementia having noted a lower diagnosis rate than expected.
• Patients with mental health needs were offered annual reviews in longer appointments.
• Staff had completed dementia awareness training.
• The practice regularly worked with multi-disciplinary 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 informed patients experiencing poor mental health how to access various support groups and voluntary organisations and the local mental health service offered appointments within the practice.
• There was 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 people with mental health needs and dementia.

Updated 19 April 2016

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

• The practice held a register of patients living in vulnerable circumstances including homeless people, travellers and those with a learning disability.
• Patients with a learning disability were offered longer appointments for annual reviews.
• The practice regularly worked with multi-disciplinary 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 actively identified patients who were carers and was the pilot site for introducing Carers Link clinics into the practice, which was later rolled out throughout East Lancashire.