Archived: Dr Michael McKeown Also known as Kynance Medical Practice

Updated 16 August 2017

Dr Michael McKeown, also known as Kynance Practice, provides GP led primary care services through a General Medical Services (GMS) contract to around 2,100 patients. (GMS is one of the three contracting routes that have been available to enable commissioning of primary medical services). The practice is part of NHS West London (Kensington and Chelsea, Queen's Park and Paddington) Clinical Commissioning Group (CCG).

The practice staff comprise a male GP principal; a part-time practice business manager; a part-time practice nurse; a personal assistant to the principal GP; a part-time senior administrator; and two part time receptionists/administrative staff. The principal GP provides ten clinical sessions a week. At the time of the inspection, the practice had initiated action to recruit a salaried GP.

The practice is located in a converted residential property with one consulting room on the ground floor, and a treatment room on the first floor.

The practice is open between 8am and 6.30pm Monday to Friday. Walk-in appointments are available from 9am to 10.45am Monday to Friday. Pre-booked appointments are available from 11am to 12.45pm every weekday, and 2pm to 6pm Monday, Tuesday and Thursday; and 2pm to 6.15pm on Fridays. Extended hours are offered on Thursday evening between 6.30pm and 8pm. Urgent appointments are also available for people that needed them.

Appointments can be booked in advance over the telephone, online or in person. The practice opted out of providing out-of-hours services to their patients. Outside of normal opening hours patients are directed to an out-of-hours GP, or the NHS 111 service.

The practice has a higher percentage when compared to national averages of patients aged 65 and over (25% compared with 17%); aged 75 and over (13% compared with 8%); and aged 85 and over (4.7% compared with 2.3%). The practice has a lower percentage when compared to national averages of patients under the age of 18 (9% compared with 21%); aged 5 to 14 (5% compared to 12%) and aged 0 to 4 (2.4% compared to 5.8%).

The service is registered with the Care Quality Commission to provide the regulated activities of diagnostic and screening procedures; treatment of disease, disorder and injury; family planning; and maternity and midwifery services.

Updated 16 August 2017

Letter from the Chief Inspector of General Practice

We carried out an announced comprehensive inspection at Dr Michael McKeown on 9 July 2015. The overall rating for the practice was requires improvement. The full comprehensive report on the July 2015 inspection can be found by selecting the ‘all reports’ link for Dr Michael McKeown on our website at www.cqc.org.uk.

This inspection was undertaken to check the provider had taken the action we said they must and should take and was an announced comprehensive inspection on 8 June 2017. Overall the practice is now rated as good.

Our key findings 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 taken the action we said it must take at our July 2015 inspection to ensure safety incidents were recorded, reviewed and shared with staff.
• The practice now had clearly defined and embedded systems to minimise risks to patient safety. It had taken the action we said it must take at our July 2015 inspection to ensure staff had access to medical oxygen in the event of a medical emergency and confidential patient records were stored securely.
• 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. The practice had taken the action we said it must take at our July 2015 inspection to ensure staff received up to date training relevant to their roles.
• 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 and, in response to action we said it should take at our July 2015 inspection, the complaints procedure was now easily accessible to patients. 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 adequate facilities and equipment 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.

However, there were also areas of practice where the provider needs to make improvements.

The provider should:

• Consider including external safeguarding contact details within the practice’s safeguarding policy documents.

• Continue action to improve QOF performance in areas where performance has been below CCG and national averages.

• Monitor understanding of Gillick and Fraser guidelines to ensure staff knowledge remains up to date.

• Continue to monitor uptake of cervical screening and childhood immunisations to secure improved uptake performance.

• Promote the system for identifying and supporting carers to ensure it is fully embedded and maintained within the practice.

• Consider the introduction of a more structured, planned programme of clinical audit to drive improvement in patient outcomes.

Professor Steve Field (CBE FRCP FFPH FRCGP) 

Chief Inspector of General Practice

Updated 16 August 2017

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

• The nursing had a lead role in long-term disease management and patients at risk of hospital admission were identified as a priority.
• QOF performance for Diabetes related indicators was lower than average: 75% compared to the CCG average of 85% and 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 16 August 2017

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

• 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 uptake rates for the standard childhood immunisations were mixed. For example, performance against national targets was above standard for two of the age two and under targets but below standard for two others. For five year olds, for MMR doses 1 and 2, uptake rates were below CCG and National averages.
• 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 midwives and health visitors to support this population group. For example, in the provision of ante-natal and post-natal and child health surveillance clinics.

Updated 16 August 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 identified at an early stage older patients who may need palliative care as they were approaching the end of life. It involved older patients in planning and making decisions about their care, including their end of life care.
• The practice followed up on older patients discharged from hospital and ensured that their care plans were updated to reflect any extra needs.
• A community pharmacist was attached to the practice who could offer medicines reviews, in the home where necessary, for patients on multiple medications in order to optimise safety and compliance.
• Older patients were provided with health promotional advice and support to help them to maintain their health and independence for as long as possible.
• Referrals to other services including physiotherapy, a falls clinic, and the memory clinic were made to support this group of patients.

Updated 16 August 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, for example, extended opening hours one day a week.
• 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.
• The practice offered women’s and men’s health clinics.

Updated 16 August 2017

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

• The practice carried out advance care planning for patients living with dementia.

• The practice specifically considered the physical health needs of patients with poor mental health and dementia. This included opportunistic screening which was routinely offered to high risk patients. The practice worked with the community matron in the support and care of these patients, with family involvement.

• The practice had a system for monitoring repeat prescribing for patients receiving medicines for mental health need.

• QOF performance was above CCG and National averages for mental health related indicators.

• 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. This included referral to a local memory service.

• The practice had information available for patients experiencing poor mental health about how they could access various support groups and voluntary organisations.

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

Updated 16 August 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 housebound patients, carers, those with a learning disability, and patients receiving end of life care.
• 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 told 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.