Kingsway Medical Centre Also known as Drs. Gittens and partners

Updated 20 May 2016

Kingsway Medical Centre is in Billingham Town centre and has a mixed client group. There are 8735 patients on the practice list. The practice provide an outreach clinic one day per week at Port Clarence, this is a deprived community with no public transport. There are 502 patients from Port Clarence registered with the practice. 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 described the patients living in the Port Clarence area as being significantly more deprived. There are a higher proportion of patients between 45 and the age of 65 on the patient list compared to the practice average across England.

There are four GP partners, two female, and two male and a salaried GP (female). Three practice nurses and two health care assistants (all female), one of the nurses was a nurse prescriber all are female. There is a practice manager who is supported by department leads and a range of reception, medicines management, secretarial and other administration staff.

The practice is training and a teaching practice (Teaching practices take medical students and training practices have GP trainees and F2 doctors).There was one GP registrar placed in the practice at the time of the inspection.

The practice is open from 8.30am to 6pm, Monday to Friday. The practice provides some extended hours on alternate Monday evening from 6.30 until 9.30 and Saturday mornings monthly from 8.30am until 1.30pm. We saw that appointments can be booked by walking into the practice, by the telephone and on line. We saw that the practice had produced specific leaflets for patients to explain this process. The practice did not use a telephone triage system. However telephone slots where patients requested a call back from the GP or nurse were booked at the end of each surgery. Patients requiring a GP outside of normal working hours are advised to contact the GP out of hour’s service provided by Northern Doctors via the NHS 111 service. The practice has a General Medical Service (GMS) contract. The practice is close to the town centre and there is parking available at the practice and nearby. There are good transport links near and good access to public transport.

Updated 20 May 2016

Letter from the Chief Inspector of General Practice

We carried out an announced comprehensive inspection at Kingsway Medical Centre on 10 March 2016. 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.
• Risks to patients were assessed and well managed.
• 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.
• 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 named GP and that 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 and complied with the requirements of the Duty of Candour.

This means providers must be open and transparent with service users about their care and treatment, including when it goes wrong.

We saw three areas of outstanding practice:

• The practice provides an osteopathic service in the practice two days a week. This service offers patients personalised holistic treatments and fast access to care reducing the referrals to acute services. They provide a range of intervention for patients relieving symptoms and enable patients to return to work more quickly. The aim of the service was to improve timely access to care, reduce medicine costs, referrals to secondary care and GP consultation time. The service was commonly used for, lower back, neck and shoulder pain, arthritis, pelvis, sports injuries and postural problems caused by driving and pregnancy. In a 48 week period (288 hours) of clinical treatment time 214 patients received treatment. Of these patients 78% made a complete or significant improvement and for 11% there was no change and the patient was referred back to the GP. A questionnaire given to patients attending the service showed a 100% satisfaction rate with the service.

• The practice held a weekly children’s clinic led by a GP with an interest in Paediatrics. They also held monthly multidisciplinary child health monitoring meetings to discuss the management of children with health concerns. Attendance at A& E for children registered at Kingsway Medical centre is at 52 which are below the CCG average of 55. There were four children, under the age of 18 on the Unplanned Admission Register. 

• The practice had also employed a further salaried GP to ensure they were able to offer patients identified as high risk of admission a good access to care without this impacting on other services provided by the practice. We saw that the practice was below the CCG average for unplanned admissions and attendance at A&E.

Professor Steve Field (CBE FRCP FFPH FRCGP) 

Chief Inspector of General Practice

Updated 20 May 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.

• The practice offered longer appointments, quarterly face to face reviews and same day appointments for those identified as at risk of unplanned admissions.

• The proportion of patients on the diabetes register with a record of foot examinations in the preceding 12 months was 96% which is above the national average of 88%.

• 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 named GP worked with relevant health and care professionals to deliver a multidisciplinary package of care.

• The practice offered a weight management support group highlighting the issues of obesity and promoting health lifestyles.

Updated 20 May 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. Immunisation rates were relatively high for all standard childhood immunisations.

• 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 proportion of women aged 24 -64 who had been cervical screening performed was 80% which was comparable with the national average of 81%.

• Appointments were available outside of school hours and the premises were suitable for children and babies.

• The practice held a weekly children’s clinic led by a GP with an interest in Paediatrics. They were able to provide support and treatment of children in the practice such as stabilising children with asthma.

• The practice held monthly multidisciplinary child health monitoring meetings to discuss the management of children with health concerns.

• We saw positive examples of joint working with midwives, health visitors and school nurses.

Updated 20 May 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.

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

• The practice provides weekly visits to care homes and all care home patients have a care plan.

• All patients over 75 are offered a review consultation with the GP.

Updated 20 May 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.

• 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 early morning telephone calls from 8am until 8.30am for patients who were working and wanted to speak with the GP. They provided extended hours appointments on a Monday every two weeks and a Saturday morning clinic once a month to meet the needs of working people. 89% of patients were satisfied with the practices opening times compared with the CCG average of 77% and the national average of 75%.

Updated 20 May 2016

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

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

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

• The practice had told patients experiencing poor mental health about how to access various support groups and voluntary organisations.

• The practice hosted a range of services in the practice such as Improving Access to Psychological Therapies (IAPT) and counsellors.

• The practice offered shared care of patients with partner organisations such as drug and alcohol dependency.

• 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.

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

Updated 20 May 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 offered longer appointments for patients with a learning disability. The practice had provided extra training and mentorship for the health care assistant undertaking the assessments with the GP.

• The practice had employed a further salaried GP to ensure they were able to offer patients identified as high risk of admission a good access to care without this impacting on other services provided by the practice. They provided longer appointments, access to quarterly face to face reviews same day appointments and follow up of patients admitted within three days of an unplanned admission.

• The practice regularly worked with multi-disciplinary teams in the case management of vulnerable people.

• 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 in normal working hours and out of hours.