Archived: Two Shires Medical Practice

Updated 7 June 2017

Two Shires Medical Practice provides primary medical services to approximately 15,660 patients predominately living in the South Leicestershire area, as well as parts of North Northamptonshire. All patient facilities are accessible. East Leicestershire and Rutland Clinical Commissioning Group (EL&RCCG) commission the practice’s services.

The practice has five GP partners, two salaried GPs and two regular locum GPs (three male and six female). The nursing team consists of a community matron / nurse lead, two advanced nurse practitioners, three practice nurses and three healthcare assistants. The dispensary consists of a Dispensary Manager, two dispensers and a dispensary assistant. They are supported by Practice Director, Practice Manager, Assistant Practice Manager and a team of reception staff and administrative staff.

The practice carries out regulated activities at five sites in total. The main surgery is The Old School Surgery, 2A Station Street, Kibworth, Leicestershire.

Two branch surgeries are located at 6 High Street, Fleckney, Leicestershire and Two Shires Surgery, Torch Way, Market Harborough, Leicestershire.

In addition to this, there are two outreach clinics based in Hallaton, Leicestershire and Medbourne, Leicestershire which offer minor illness clinics on a Monday afternoon.

As part of this inspection, we visited the surgery in Kibworth.

Old School Surgery in Kibworth and Two Shires Surgery in Market Harborough are open between 8am and 5.30pm Monday to Friday. Fleckney Surgery is open from 8am to 12noon and 2pm to 5.30pm Monday to Friday. Extended hours appointments are offered at Old School Surgery on a Monday, Wednesday and Friday between 7.30am and 8am, as well as at Two Shires Surgery on a Tuesday and Thursday between 7.30am and 8am.  Extended hours appointments are also offered from 8am to 12.30pm on alternate Saturdays at Two Shires Surgery, Market Harborough.

The dispensary is open from 8am until 5.30pm Monday to Friday.

The practice operates an on-call service between 5.30pm and 6.30pm. The practice also provides details for the nearest urgent care centres, as well as accident and emergency departments.

When the surgery is closed out-of-hours GP services are provided by Derbyshire Health United which is accessed by telephoning the NHS111 service.

The practice is an approved training practice for the training of General Practice Registrars and has three approved trainers.

Updated 7 June 2017

Letter from the Chief Inspector of General Practice

Two Shires Medical Practice was previously known as Dr Kilpatrick and Partners.

We had previously carried out an announced comprehensive inspection at this practice on 28 July 2016 and found breaches of regulation and rated the practice as ‘Requires improvement’ in the safe and well-led key question. The practice was rated as ‘Requires improvement’ overall. The full comprehensive report on the 28 July inspection can be found by selecting the ‘all reports’ link for Dr Kilpatrick and Partners on our website at www.cqc.org.uk.

Specifically we found that;

• There was no effective system that enabled health care assistants to administer medicines and vaccines in line with the legal requirements.

• The quality and safety of services were not being assessed, monitored and improved and not all the necessary polices and protocols were in place and followed when action was required.

This inspection was an announced focused inspection carried out on 20 April 2017 to confirm that the practice had carried out their plan to meet the legal requirements in relation to the breaches in regulations that we identified in our previous inspection on 28 July 2016. This report covers our findings in relation to those requirements and also additional improvements made since our last inspection.

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The practice is now rated as ‘Good’ in the safe and well-led key questions and ‘Good’ overall.

Our key findings were as follows:

• There were clear policies and protocols in place to ensure that health care assistants only administered medicine and vaccines in line with the legal requirements.

• The practice had reviewed its arrangements for the checking of emergency equipment and fridges used to store vaccines to ensure their efficacy.

In addition we found that:

• Damaged seating had been replaced.

• Emergency medicines and equipment at the Old School Surgery had been secured to prevent unauthorised access.

• The practice had continued to actively seek to identify carers.

• Relevant test results of patients on high risk drugs recommended by secondary care were documented.

• There was an increased frequency of meetings for nursing and healthcare assistants.

• The practice was working with the patient participation group to help increase the group’s involvement.

Professor Steve Field (CBE FRCP FFPH FRCGP) 

Chief Inspector of General Practice

Updated 7 June 2017

The provider had resolved the concerns for safety and well-led identified at our inspection on 28 July 2016 which applied to everyone using this practice, including this population group. The population group ratings have been updated to reflect this.

• GPs and nursing staff had lead roles in chronic disease management, including dementia and diabetes.

• Patients at risk of hospital admission were identified as a priority.

• 85% of those diagnosed with diabetes had a blood test to assess diabetes control (looking at how blood sugar levels have been averaging over recent weeks) compared to the national average of 78%.

• Longer appointments and home visits were available when needed.

• All these patients had a named GP.

• 93% of patients identified with a long-term condition had a structured annual review with a GP or nurse to check their health and medicines needs were being met.

• For those patients with the most complex needs, the named GP worked with relevant health and care professionals to deliver a multidisciplinary package of care.

Updated 7 June 2017

The provider had resolved the concerns for safety and well-led identified at our inspection on 28 July 2016 which applied to everyone using this practice, including this population group. The population group ratings have been updated to reflect this.

• 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 81%, which was comparable to the CCG average of 78% and better than the national average of 74%.

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

• Same day appointments were available for children who needed an urgent appointment.

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

• The practice offered a nurse-led travel vaccination service.

Updated 7 June 2017

The provider had resolved the concerns for safety and well-led identified at our inspection on 28 July 2016 which applied to everyone using this practice, including this population group. The population group ratings have been updated to reflect this.

• Home visits and care plans were carried out by the Community Matron.

• The practice provided outreach clinics in Hallaton and Medbourne for those patients unable to attend the main practice sites.

• Patients were able to telephone for prescription requests and a delivery service was available.

• An integrated care co-ordinator worked with the practice and carried out home visits to review patient’s social needs.

Updated 7 June 2017

The provider had resolved the concerns for safety and well-led identified at our inspection on 28 July 2016 which applied to everyone using this practice, including this population group. The population group ratings have been updated to reflect this.

• 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 and flexible.

• The practice was proactive in offering online services, including requests for repeat prescriptions and booking appointments.

• A full range of health promotion and screening was offered that reflected the needs for this age group.

• Seasonal flu vaccination clinics were provided on Saturdays at each of the surgeries during the flu season.

• Drivers medicals were also available for patients working as taxi and heavy goods vehicle drivers.

Updated 7 June 2017

The provider had resolved the concerns for safety and well-led identified at our inspection on 28 July 2016 which applied to everyone using this practice, including this population group. The population group ratings have been updated to reflect this.

• 97% of those with a diagnosis of schizophrenia, bipolar affective disorder or other had a comprehensive and agreed care plan in place, compared to the national average of 88%.

• 83% of patients with a diagnosis of dementia had their care reviewed in a face-to-face review, compared to the national average of 84%.

• The practice regularly worked with multi-disciplinary teams in the case management of patients experiencing poor mental health, including those living with dementia.

• 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.

• Staff had a good understanding of how to support patients with mental health needs and dementia.

• The practice was able to refer patients to the local community psychiatric nurse and counselling services that were hosted on site

Updated 7 June 2017

The provider had resolved the concerns for safety and well-led identified at our inspection on 28 July 2016 which applied to everyone using this practice, including this population group. The population group ratings have been updated to reflect this.

• The practice held a register of patients living in vulnerable circumstances including travellers and those with a learning disability.

• The practice offered longer appointments for patients with a learning disability.

• The Community Matron was the lead 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 support groups and voluntary organisations.

• Staff knew how to recognise signs of abuse in vulnerable adults and children and were aware of their responsibilities regarding safeguarding concerns.

• The practice’s computer system alerted GPs if a patient was also a carer. The practice had identified 173 patients as carers (1% of the practice list). Carer’s annual reviews were also offered.

• The practice referred to local groups for additional support regarding the management of patients with alcohol and drug dependency issues.

• The practice registered patients with the practice address if they did not have a fixed abode. Staff were also aware they could contact the travelling families team with help to contact patients, if needed.