Killamarsh Medical Practice

Updated 11 February 2016

Dr JA Sutherland’s practice is also known as Killamarsh Medical Practice and is located in North East Derbyshire. The practice serves the parish of Killamarsh and is situated close to Rother Valley Country Park between Sheffield, Chesterfield and Rotherham. The area was previously a thriving mining community but now many residents commute to Sheffield and other nearby towns for work. The practice was built in 1991 and is currently having a large extension of its premises built to accommodate increased patient numbers and demand for services, as well as for the predicted growth from new housing developments planned locally.

The practice is run by a partnership of five GPs (three male and two female). The practice has a full- time and a part-time practice nurse, and two health care assistants (HCAs). One of the HCAs also works as a care-cordinator. The practice also directly employs a part-time community matron. The clinical team is supported by a full-time practice manager and a team of eight administrative, secretarial and reception staff. The practice use funding provided by the CCG to contract a community pharmacist to work for one session each week.

The registered practice population of 9,114 are predominantly of white British background, and are ranked in the third least deprived decile. The practice age profile is broadly in line with national averages but has slightly higher percentages of patients aged 45-70 years old, and lower percentages of patients below the age of 15.

The practice opens from 8am until 6.30pm Monday to Friday. GP morning appointments times are available from 8am to 10.20am, and afternoon surgeries run from 4pm to 6.20pm, apart from Wednesday afternoons when there are no booked GP surgeries although urgent and essential care is still provided.

The practice supports medical students as part of their eight week placement in general practice. It does not act as a training practice for GP registrars.

The practice has opted out of providing out-of-hours services to its own patients. When the practice is closed patients are directed to Derbyshire Health United (DHU) via the 111 service.

The practice holds a Personal Medical Services (PMS) contract to provide GP services which is commissioned by NHS England. A PMS contract is one between GPs and NHS England to offer local flexibility compared to the nationally negotiated General Medical Services (GMS). The PMS contract offers variation in the range of services which may be provided by the practice and the financial arrangements for those services. The practice also offers a range of enhanced services including minor surgery commissioned by their local CCG

Updated 11 February 2016

Letter from the Chief Inspector of General Practice

We carried out an announced comprehensive inspection at Dr JA Sutherland’s practice (Killamarsh Medical Practice) on 14 December 2015. 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 an effective system in place for reporting and recording significant events, and we saw evidence that learning was applied from events.
• Staff assessed patients’ needs and delivered care in line with current evidence based guidance. Staff had the skills, knowledge and experience to deliver effective care and treatment, and clinicians had lead areas of responsibility.
• Feedback from patients about their care was consistently and strongly positive.
• 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.
• Patients said they found it easy to make an appointment with a GP, and usually this was with a GP of their choice. Routine appointments could often be booked on the day and if not, they were available within two days. Urgent appointments were available the same day, and the practice offered additional appointments on a sit and wait at the end of each morning surgery.
• The practice offered a minor injuries service and data demonstrated that 28 of 30 patients who had accessed this service since April 2015, had been treated without the need for referral to another unit such as the Accident & Emergency (A&E) department.

• The practice used clinical audits to review patient care and took action to improve services as a result.

• The practice had good facilities and was well equipped to treat patients and meet their needs. This was to be enhanced by an extension, including seven new consulting rooms, which was under construction at the time of our inspection.
• The practice worked well with the wider multi-disciplinary team to plan and deliver effective and responsive care to keep vulnerable patients safe. This approach had impacted on unplanned hospital admissions and attendance at Accident and Emergency.
• There was a clear leadership structure and staff felt supported by management.
• The practice reviewed feedback from patients acted upon it. For example, further to comments made on the NHS Choices website, the practice ensured that a member of the reception team was always placed at the front of the reception desk during opening hours.
• The practice implemented suggestions for improvements and made changes to the way it delivered services as a consequence of feedback from patients and from the patient participation group. For example, as part of the extension to the building, the access road would be widened with a footpath to aid patient access from the car park.

We saw two areas of outstanding practice:

• A community pharmacist visited weekly and worked with the practice and the CCG medicine management technician on a variety of prescribing matters. The pharmacist reviewed spirometry results (spirometry is a test used to help diagnose and monitor some lung conditions by measuring how much air can be expelled in one forced breath) and reviewed patients with diagnosed lung disease for advice and medication reviews. The pharmacist had also audited patients with atrial fibrillation to determine if anti-coagulation therapy was required in line with recognised guidance.Approximately 20-25 patients were seen by the pharmacist each month.

• The practice employed their own community matron and care co-ordinator who managed patients by developing individualised care plans involving the wider health and social care team. This helped to keep patients safe in their own home (and in care homes), and also facilitated earlier hospital discharges. Alongside the practice’s proactive approach in providing good access to GP appointments, a measurable impact was seen in the lower attendance at out of hours and A&E services, and the lower rates of unplanned hospital admissions for this practice.

Professor Steve Field (CBE FRCP FFPH FRCGP) 

Chief Inspector of General Practice

Updated 11 February 2016

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

• All patients with a long-term condition had a named GP and nursing staff had lead roles in chronic disease management. For those patients with the most complex needs and associated risk of hospital admission, the practice team worked with health and care professionals to deliver a multidisciplinary package of care.

• Indicators to measure the impact of the management of diabetes were higher than local and national averages. For example, the percentage of patients on the practice register for diabetes with a record of a foot assessment in the preceding 12 months at 94% was approximately 5% above both local and national averages.

• A practice nurse provided initiation of insulin for patients with diabetes.

• Patients with diabetes are referred into the ‘Diabetes and You Programme’ to provide patients with advice and education to help manage their condition.

• QOF indicators for asthma were higher than CCG and national averages. For example, 86.7%of patients with asthma received a review in the preceding 12 months, compared to the CCG and national averages of 74.2% and 75.3% respectively.

• 58% patients on the practice long term condition registers had received a structured annual review during 2014-15 to check that their health and medicines needs were being met.

Updated 11 February 2016

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

• Urgent appointments and a walk in service was available every day to accommodate children.

• 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, or did not attend for planned hospital appointments on more than two occasions. We were informed of examples when practice staff had referred children where safeguarding concerns had been identified. Effective liaison was in place between the practice and the health visiting team.

• Immunisation rates were relatively high for all standard childhood immunisations. For example, vaccination rates  for children under two years old was 100% compared against a CCG average ranging from 97.8 to 98%.

• 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.

• The practice’s uptake for the cervical screening programme was 86.1% which was above the CCG average of 83.9% and the national average of 81.8%.

• A midwife provided services from the surgery. Appointments with the practice nursing team were available outside of school hours, and the premises were suitable for children and babies. A designated children’s play area was sited in the reception.

• The female GPs provided a service to fit coils and contraceptive implants. This service was provided at short notice and often within the initial consultation.

• A teenage youth clinic provided access to support with contraception, and chlamydia screening was offered.

Updated 11 February 2016

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

• The practice offered proactive, personalised care to meet the needs of the older people in its population. Care plans were in place for older patients with complex needs.

• It was responsive to the needs of older people, and offered home visits and urgent appointments for those with enhanced needs.

• The practice provided primary medical services to residents at two local care homes. Managers at these homes were very happy with the level of care provided by the GPs, and described the relationship with the practice as extremely positive. They told us the practice were very responsive and caring, that they accommodated the individual needs of their patients, and that the practice achieved good outcomes for their residents.

• 80% of over 75s had received an annual health check in the last 12 months.

• Flu vaccination rates for the over 65s were 85.9% which was higher than the national figure of 73.2%.

• Nationally reported data showed that outcomes for patients for conditions commonly found in older people, including rheumatoid arthritis and heart failure were in line with or above local and national averages

Updated 11 February 2016

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. This included good access to appointments including telephone consultations.

• The practice was proactive in offering online services and all GP appointments were offered through the online booking system

• Health promotion and screening was provided that reflected the needs for this age group.

Updated 11 February 2016

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

• 89.9% of people diagnosed with dementia had had their care reviewed in a face to face meeting in the last 12 months. This compared to a CCG average of 83.6% and a national average of 84%

• The practice achieved 100% for mental health related indicators in QOF, which was 1.9% above the CCG and 7.2% above the national averages, although the rate of exception reporting was generally higher.

• 100% of patients on the practice’s mental health register had received an annual health check during 2014-15.

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

• It carried out advance care planning for patients with dementia.

• The practice had told patients experiencing poor mental health and patients with dementia about how to access various support groups and voluntary organisations. Leaflets were available in the waiting area on a range of services available for patients and carers.

• It 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 people with mental health needs and dementia.

Updated 11 February 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. Homeless people could register with the practice, although there were none listed at the time of our inspection.

• The practice regularly worked with multi-disciplinary teams in the case management of vulnerable people and informed patients 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 in normal working hours and out of hours.

• The practice provided good care and support for end of life patients. Patients were kept under close review by the practice in conjunction with the wider multi-disciplinary team, and a GP informed us that additional visits had been provided at the weekend, or at night if a death certification had been required.

• The practice adopted an approach that they termed as ‘kid gloves’ for vulnerable patients and carers. This ensured that the practice took a more supportive approach with individuals in recognition of their condition or circumstances. For example, if they were late for their appointment time.

• The practice had carried out annual health checks for people with a learning disability, and 84% had attended for an annual review during 2014-15. It offered longer appointments for people with a learning disability.