The Killingholme Surgery

Updated 9 October 2017

The Killingholme Surgery practice operates from a converted building on Town Street, South Killingholme, North Lincolnshire DN40 3EL. The practice provides General Medical Services (GMS) to approximately 1233 patients living in Immingham and the villages of North and South Killingholme, East Halton, Ulceby, Wootton, Stallingborough, Thornton Curtis and Habrough.

The practice has one male GP and a female nurse practitioner. They are supported by a practice manager and two receptionists and two dispensing staff.

The majority of patients are of white British background. The practice population profile is similar to the England average except the 45-69 years age group is higher than the England average and the 30-45 years age group are lower than the England average. The practice scored five on the deprivation measurement scale, the deprivation scale goes from one to ten, with one being the most deprived. People living in more deprived areas tend to have a greater need for health services.

The practice is open 8am to 6.30pm Monday, Tuesday, Thursday and Friday. The practice is open on Wednesday morning. Appointments are available Monday to Friday 9am to 11am. Afternoon appointments are 4pm to 6pm Monday, Tuesday, Thursday and Friday.

Out of Hours care (from 6.30pm to 8am) is provided through the local out of hours service.

Updated 9 October 2017

Letter from the Chief Inspector of General Practice

We carried out an announced comprehensive inspection at The Killingholme Surgery on 18 August 2017. Overall the practice is rated as good.

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

• There was an open and transparent approach to safety and a system in place for reporting and recording significant events.
• The practice had clearly defined and embedded systems to minimise risks to patient safety.

• Staff were aware of current evidence based guidance. Staff had been trained to provide them with the skills and knowledge to deliver effective care and treatment.
• Results from the national GP patient survey showed patients were treated with compassion, dignity and respect and were involved in their care and decisions about their treatment.
• Information about services and how to complain was available. Improvements were made to the quality of care as a result of complaints and concerns.
• Patients we spoke with said they found it easy to make an appointment with a named GP and there was continuity of care, with urgent appointments available the same day.
• The practice had good facilities and was well equipped to treat patients and meet their needs.
• There was a clear leadership structure and staff felt supported by management. The practice proactively sought feedback from staff and patients, which it acted on.
• The provider was aware of the requirements of the duty of candour. Examples we reviewed showed the practice complied with these requirements.

We found an example of outstanding practice:

• A no-cost medication delivery system to housebound dispensing patients was offered. This service is supported by the PPG and operated by trained volunteers.

However we saw an area where the provider should make improvement:

• Establish a policy to delegate responsibility to dispensary staff when a GP was not on site.

Professor Steve Field (CBE FRCP FFPH FRCGP) 

Chief Inspector of General Practice

Updated 9 October 2017

The practice is rated as good for the care of people with long-term conditions.

• Nursing staff had lead roles in long-term disease management and patients at risk of hospital admission were identified as a priority.
• Performance for diabetes related indicators was100%, this was better than the CCG average of 91% and the national average of 90%.
• The practice followed up on patients with long-term conditions discharged from hospital and ensured that their care plans were updated to reflect any additional needs.
• All these patients had a named GP and there was a system to recall patients for a structured annual review 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 9 October 2017

The practice is rated as good for the care of families, children and young people.

• From the sample of documented examples we reviewed we found there were systems 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 accident and emergency (A&E) attendances.
• Immunisation rates were relatively high for all standard childhood immunisations.
• Patients told us, on the day of inspection, that children and young people were treated in an age-appropriate way and were recognised as individuals.
• Appointments were available outside of school hours and the premises were suitable for children and babies.
• The practice worked with health visitors and school nurses to support this population group.
• The practice had emergency processes for acutely ill children and young people.

Updated 9 October 2017

The practice is rated as good for the care of older people.

• Staff were able to recognise the signs of abuse in older patients and knew how to escalate any concerns.
• The practice offered proactive, personalised care to meet the needs of the older patients in its population.
• The practice was responsive to the needs of older patients, and offered home visits and urgent appointments for those with enhanced needs.
• The practice followed up on older patients discharged from hospital and ensured that their care plans were updated to reflect any extra needs.
• Older patients were provided with health promotional advice and support to help them to maintain their health and independence for as long as possible.

Updated 9 October 2017

The practice is rated as good for the care of working age people (including those recently retired and students).

• The needs of these populations 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 reflects the needs for this age group.

Updated 9 October 2017

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

• 80% of patients diagnosed with dementia had their care reviewed in a face to face meeting in the last 12 months, which is comparable to the CCG average of 80% and the national average of 84%.
• The practice had a system for monitoring repeat prescribing for patients receiving medicines for mental health needs.
• The practice regularly worked with multi-disciplinary teams in the case management of patients experiencing poor mental health, including those living with dementia.
• Patients at risk of dementia were identified and offered an assessment.
• The practice had information available for patients experiencing poor mental health about how they could access various support groups and voluntary organisations.
• The practice had a system to follow up patients who had attended accident and emergency where they may have been experiencing poor mental health.
• Staff interviewed had a good understanding of how to support patients with mental health needs and dementia.
• A counselling service attended the surgery.
• A primary care chaplain attended the practice fortnightly to offer multi-faith spiritual support.

Updated 9 October 2017

The practice is rated as good 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.
• End of life care was delivered in a coordinated way which took into account the needs of those whose circumstances may make them vulnerable.
• 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 had information available for vulnerable patients about how to access various support groups and voluntary organisations.
• Staff interviewed knew how to recognise signs of abuse in children, young people and adults whose circumstances may make them vulnerable. 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.