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Archived: Kirkby Community Primary Care Centre Good

The provider of this service changed - see new profile

Inspection Summary


Overall summary & rating

Good

Updated 5 December 2017

Letter from the Chief Inspector of General Practice

We carried out an announced comprehensive inspection at Kirkby Community Primary Care Centre on 7 September 2017. This service was placed into special measures in September 2015. This related to a previous provider that no longer operates this service. This inspection took place following the implementation of a new provider in October 2016 and found significant improvements had been made to the quality of care provided. I am taking this service out of special measures, which reflects the significant improvements in clinical safety, quality assurance and leadership.

Overall the practice is now 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 an effective system in place for reporting and recording significant events.
  • Risks to patients were assessed and well managed.
  • Clinical pharmacists had implemented medicine audits and worked with discharging hospital clinicians to improve patient safety and long-term prescription monitoring.
  • Staff assessed patients’ needs and delivered care in line with current evidence based guidance. Staff had been trained to provide them with the skills, knowledge and experience to deliver effective care and treatment.
  • Patients said they were treated with compassion, dignity and respect and they were involved in their care and decisions about their treatment.
  • Information about services and how to complain was available and easy to understand. Improvements were made to the quality of care as a result of complaints and concerns.
  • Patients 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 provider had established clinical and non-clinical support processes for staff.
  • The practice proactively sought feedback from staff and patients, which it acted on.
  • The provider was aware of and complied with the requirements of the duty of candour.

We saw areas of outstanding practice:

  • There was evidence of sustained and wide-ranging improvements in leadership, governance and patient safety since we last inspected the practice under a previous provider. Improvements had been made at all levels of the practice and there were demonstrable improvements for patients, which had resulted in some patients returning after having left to register with an alternative practice.
  • There was significant focus on multidisciplinary care to meet the needs of vulnerable people and those with complex needs. This included an in-house ‘pathways’ patient advisor and weekly scheduled clinics for those with needs relating to drug and alcohol use.
  • The practice performed significantly better than the CCG in the pre-diabetes education programme, uptake of the improving access to psychological therapies programme and the completion of health checks.

The areas where the provider should make improvement are:

  • The provider should continue to work towards establishing a permanent GP team to ensure consistency of available appointments and clinical governance.

Professor Steve Field CBE FRCP FFPH FRCGP

Chief Inspector of General Practice

Inspection areas

Safe

Good

Updated 5 December 2017

The practice is rated as good for providing safe services.

  • There was an effective system in place for reporting and recording significant events that included continual support from the provider.
  • Lessons were shared to ensure action was taken to improve safety in the practice.
  • When things went wrong patients received reasonable support, truthful information, and a written apology. They were told about any actions to improve processes to prevent the same thing happening again.
  • The practice had clearly defined and embedded systems, processes and practices in place to keep patients safe and safeguarded from abuse.
  • Risks to patients were assessed and well managed.

Effective

Good

Updated 5 December 2017

The practice is rated as good for providing effective services.

  • Data from the Quality and Outcomes Framework (QOF) showed patient outcomes were at or above average compared to the national average. The new provider had established a programme of clinical quality improvement through audits and benchmarking.
  • Staff assessed needs and delivered care in line with current evidence based guidance and maintained an audit trail of improvements.
  • Staff had the skills, knowledge and experience to deliver effective care and treatment.
  • There was evidence of appraisals and personal development plans for all staff, including clear achievement goals.
  • Staff worked with other health care professionals to understand and meet the range and complexity of patients’ needs. This included extensive multidisciplinary working tailored to the needs of the practice population.

Caring

Good

Updated 5 December 2017

The practice is rated as good for providing caring services.

  • Data from the national GP patient survey showed patients rated the practice in line with local and national averages.
  • Patients said they were treated with compassion, dignity and respect and they were involved in decisions about their care and treatment.
  • Information for patients about the services available was easy to understand and accessible.
  • We saw staff treated patients with kindness and respect, and maintained patient and information confidentiality.

Responsive

Good

Updated 5 December 2017

The practice is rated as good for providing responsive services.

  • Practice staff reviewed the needs of its local population and engaged with local service providers and the clinical commissioning group to secure improvements to services where these were identified.
  • Although the practice was staffed by locum doctors, patients said they found it easy to make an appointment with their preferred GP. There was continuity of care, with urgent appointments available the same day.
  • The practice had a range of facilities and was well equipped to treat patients and meet their needs.
  • Information about how to complain was available and easy to understand and evidence showed the practice responded quickly to issues raised. Learning from complaints was shared with staff and other stakeholders.
  • A patient advisor was based in the practice and provided patients with support to access wider community services.
  • The practice offered coils, implants and minor surgery led by a doctor who was a Fellow of the Royal College of Surgeons.

Well-led

Good

Updated 5 December 2017

The practice is rated as good for being well-led.

  • The practice was placed into special measures in 2015. At this inspection we found significant and sustained improvements in all areas, which was clearly evidenced by clinical audit data, safety track record and improved leadership.
  • The leadership team had addressed all of the factors that contributed to our previous rating of inadequate and there was a newly embedded culture of driving change underpinned by quality assurance.
  • The practice had a clear vision and strategy to deliver high quality care and promote good outcomes for patients. Staff were being supported through a period of significant change in leadership and the new provider had ensured clinical and non-clinical support was always available.
  • There was a clear leadership structure and staff felt supported by management. The practice had up to date policies and procedures to govern activity and held regular governance meetings.
  • There was an overarching governance framework, which supported the delivery of the strategy and good quality care. This included arrangements to monitor and improve quality and identify risk.
  • The provider was aware of and complied with the requirements of the duty of candour. The senior team encouraged a culture of openness and honesty. The practice had systems in place for notifiable safety incidents and ensured this information was shared with staff to ensure appropriate action was taken.
  • The practice proactively sought feedback from staff and patients, which it acted on. The patient participation group had been re-established in October 2016 and demonstrated a proactive approach to informing practice development.
  • There was a consistent focus on continuous learning and improvement at all levels.
Checks on specific services

People with long term conditions

Good

Updated 5 December 2017

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

  • Nursing staff and clinical pharmacists had lead roles 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. For those patients with the most complex needs, the GP worked with relevant health and care professionals to deliver a multidisciplinary package of care.
  • The practice demonstrated consistent high levels of performance in diabetes and mental health care and outcomes.
  • The provider’s statement of purpose focused on the provision of multidisciplinary and consistent care for long-term conditions. This was adapted to the needs of the local population and included chronic obstructive pulmonary disease and heart failure.
  • A range of monitoring protocols were in place to ensure timely recall of patients with certain conditions.

Families, children and young people

Good

Updated 5 December 2017

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

  • There were systems in place to identify and follow up children living in disadvantaged circumstances and who were at risk including children who had a high number of accident and emergency attendances. Immunisation rates were higher than CCG and national averages for all standard childhood immunisations.
  • We found evidence children and young people were treated in an age-appropriate way and were recognised as individuals.
  • 87% of eligible patients had undergone cervical screening, which was better than the CCG and national averages.
  • Appointments were available outside of school hours and the premises were suitable for children and babies. This included a children’s waiting area.
  • The practice offered same-day access for children under the age of five.
  • We saw positive examples of joint working with midwives, health visitors and school nurses, including for patients who were vulnerable or those who needed confidential support in areas such as sexual health.

Older people

Good

Updated 5 December 2017

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

  • The practice offered proactive and personalised care to meet the needs of the older people in its population, including military veterans. Patients aged 70 and over represented 8% of the practice list.
  • The practice was responsive to the needs of older people and offered home visits and urgent appointments for those with enhanced needs.
  • 72% of patients over the age of 65 had received a flu, pneumonia and shingles vaccination compared to the CCG average of 73%.
  • The practice undertook joint care home visits with the practice clinical pharmacist to review repeat prescriptions and undertake timely medicine reviews.
  • End of life care was delivered in line with national evidence-based standards, including the Gold Standards Framework and the National Coalition for Palliative Care.

Working age people (including those recently retired and students)

Good

Updated 5 December 2017

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

  • 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 of this age group. This included on-site support for drug and alcohol addiction.
  • Sexual health, coil fitting and contraception services were offered by the practice.

People experiencing poor mental health (including people with dementia)

Good

Updated 5 December 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 was better than the national average.
  • 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 supported patients experiencing poor mental health 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, including those living with dementia.

People whose circumstances may make them vulnerable

Good

Updated 5 December 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.
  • 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. A dedicated patient advisor was based in the practice and offered targeted one-to-one support and signposting to specialist providers.
  • 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 including local crisis teams.