Archived: Dr William McKee

Updated 22 June 2016

Letter from the Chief Inspector of General Practice

We carried out a desk based review for Dr William McKee on 10 June 2016. This was to follow up on actions we asked the provider to take after our announced comprehensive inspection on 3 December 2015. During the inspection in December 2015, we identified::;

• Whilst internal assessments had been completed around the management of legionella and fire risks, issues identified had not been actioned. There was scope to involve external professionals in the compilation of an action plan, especially with regard to the safe storage of heat emitting equipment in the loft space.
• Regular fire drills had not been undertaken.
• There was scope to improve the recording of action taken in response to MHRA (Medicines and Healthcare products Regulatory Agency) safety alerts and updates.
• There was scope to improve the management of cleaning schedules through formal monitoring.
• Staff who acted as chaperones had not been trained in accordance with the recent best practice guidelines.
• The provider had not maximised the functionality of the new computer system in order that the practice could run clinical searches, provide assurance around patient recall systems, consistently code patient groups and produce accurate performance data.
• There was scope to ensure and improve the effectiveness of care received by patients through referrals audits and prescribing analysis.
• There was scope to improve the recording of verbal complaints in order to widen shared learning.
• There was scope to improve the arrangements for the security of blank prescription forms.

The practice manager provided us with evidence which showed the practice had put systems in place to improve these systems.

Professor Steve Field (CBE FRCP FFPH FRCGP) 

Chief Inspector of General Practice

Updated 28 January 2016

The practice is rated as good 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. Longer appointments and home visits were available when needed. One appointment was offered to incorporate the needs of patients with two or more chronic diseases to review the patient holistically and to prevent them having to attend more frequently than necessary. Reviews encompassed the effect of the patient’s condition’s on work, relationships, housing, mobility, finance and impact on family or carers. This helped to signpost patients to other sources of support and outside agencies when necessary.

All long-term condition patients had a structured annual review to check that their health and medication needs were being met, and individual care plans were developed as appropriate. For those people with the most complex needs, clinicians worked with relevant health and care professionals to deliver a multidisciplinary package of care.

With the agreement of the local CCG (Clinical Commissioning Group), the practice did not submit a full data set under the Quality and Outcomes Framework in 2013/14. This was due to a change in computer system. This has had an ongoing impact on the data submitted for the 2014-15 Quality and Outcomes Framework. Results for some long term conditions were therefore lower than the practice would have liked. For example, performance for diabetes related indicators was above below the CCG and national average with the practice achieving 73.3% which was 17.1% below the CCG average and 15.9% below national average. Nevertheless, additional inspection work showed that these results were a result of glitches in computer reporting, rather than a failure to deliver good outcomes for patients.

Updated 28 January 2016

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, for example, children and young people who had a high number of A&E attendances Childhood immunisation rates for the vaccinations given to under two year olds ranged from 91.5% to 97.9% and five year olds from 88.6% to 100%. This compares well with the local and national averages. 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. 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 and health visitors who held clinics on site on a weekly basis.

Updated 28 January 2016

The practice is rated as good for the care of older people. Nationally reported data showed that outcomes for patients were good for conditions commonly found in older people. The practice offered proactive, personalised care to meet the needs of the older people in its population and had a range of enhanced services, for example, in dementia and end of life care. It was responsive to the needs of older people, and offered home visits and rapid access appointments for those with enhanced needs.  Age Concern and the Citizens Advice Bureau regularly attended the practice to offer advice to older patients.

Updated 28 January 2016

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

The practice was proactive in offering online appointment bookings, repeat prescriptions, and provided early appointments from 8am. The practice also offered extended evening appointments from 18.30 – 21.00 at a site in Ipswich.

Patients told us that it could be difficult to obtain an appointment with the GP of their choice and this was reflected in some of the comments cards. Nevertheless the national patient survey showed that 90% patients described their experience of making an appointment as good compared to the CCG average of 79% and national average of 73%.

Updated 28 January 2016

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

QOF data reported an achievement of 84.6% for mental health related indicators. 96.3% of people on the practice mental health register had a documented care plan in place (which is better than both the local and national averages). The practice worked with multi-disciplinary teams in the case management of people experiencing poor mental health, including those with dementia and carried out advance care planning for patients with dementia. We saw that 30% of patients with a diagnosis of dementia had received a series of health checks, the practice have given us an assurance that the remaining patients were scheduled for health checks. However the dementia diagnosis rate was below the national average. Staff explained that this was because the computer system was not correctly capturing all patients who had received a diagnosis. The practice acknowledged the need to improve its use of the system in order to provide reliable outcomes information in support of its performance.

The practice had told patients experiencing poor mental health about how to access various types of support and we saw information about this available in the reception area. Triage directed these patients for support quickly during periods of significant personal stress. There was a system in place to follow up patients who had attended accident and emergency (A&E) where they may have been experiencing poor mental health. Most staff had received training on how to care for people with mental health needs, including awareness of Alzheimer’s Disease. The practice also hosted weekly psychiatric outpatient sessions and weekly counselling clinics with mental health link workers.

Updated 28 January 2016

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 those with a learning disability. The practice was in the process of carrying out annual health checks for people with a learning disability. and staff confirmed that all patients on the practice’s learning disability register were invited to attend for this service on an annual basis. The practice offered longer appointments for people with a learning disability.

The practice regularly worked with multi-disciplinary teams in the case management of vulnerable people and used the practice computer system to ensure that locum staff were alerted as to which patients might be vulnerable. Staff knew how to recognise signs of abuse in vulnerable adults and children, and 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 held regular multi-disciplinary meeting to review the needs of end of life patients as part of the gold standards framework. This is a programme designed to provide excellent care for end of life patients working within recognised standards of care.