Archived: Dr A G Kippax & Dr A M Statham Also known as Lathom House Surgery

Updated 5 April 2016

Dr A G Kippax and Dr A M Statham, also known as Lathom House Surgery is located in a residential area of Ormskirk and occupies a converted and extended detached house with a small amount of parking to the front of the property. There is a ramp at the front entrance of the building to facilitate access for those experiencing difficulties with mobility.

The practice delivers services under a general medical services (GMC) contract with NHS England to 4597 patients, and is part of the NHS West Lancashire Clinical Commissioning Group (CCG). The average life expectancy of the practice population is in line with both CCG and national averages for males (79 years) and slightly below the CCG and national average for females (82 years for the practice as opposed to 83 years for both the CCG and nationally). The practice population contains a higher proportion (21.8%) of people over the age of 65 than the national average of 16.7%. The percentage of the practice’s patients resident in nursing homes is 1.2%, which is higher than the national average of 0.5%.

Information published by Public Health England rates the level of deprivation within the practice population group as eight on a scale of one to ten. Level one represents the highest levels of deprivation and level ten the lowest.

The practice is staffed by two GP partners (one female and one male). However, at the time of inspection one of the GP partners had been absent from the practice since July 2015 due to illness. The practice is using long-term locum GP cover to ensure the patients’ needs continues to be met in their absence. The GPs are supported by one nurse practitioner, one practice nurse and two healthcare assistants (HCAs). Clinical staff are supported by a practice manager and four admin and reception staff (two of which spend part of their working hours fulfilling the role of HCAs). The practice is currently recruiting two new reception staff members. At the time of inspection the practice manager had only been in post for two days, as the previous practice manager had ceased employment with the practice the previous week.

The practice is open Monday to Friday between the hours of 8:30am and 6:30pm. Appointments are offered between these times, apart from Wednesday afternoons where appointments are not offered to allow for staff attendance at meetings and training, but the GP remains on call until 6:30pm. Outside normal surgery hours, patients are advised to contact the Out of hours service, offered locally by the provider OWLS CIC Ltd.

Updated 5 April 2016

Letter from the Chief Inspector of General Practice

We carried out an announced comprehensive inspection at Dr A G Kippax and Dr A M Statham on 02/02/2016. Overall the practice is rated as good.

Our key findings across all the areas we inspected were as follows:

• The practice was experiencing a challenging period of time due to the long term absence of one of the GP partners. However, a strong and supportive team ethos was evident as staff worked together and flexibly to overcome this challenge.
• 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.
• Risks to patients were assessed and well managed.
• While we saw that significant events were reported and recorded, the records lacked detail and not all significant events were documented as such. This resulted in learning opportunities not being maximised and made it difficult for the practice to identify and monitor any trends accurately.
• Patients said they were treated with compassion, dignity and respect and they were involved in their care and decisions about their treatment. Patient feedback was very positive about the care received.
• 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.
• Although the practice’s leadership capacity was reduced at the time of inspection, 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 areas where the provider should make improvements are:

• Consider the threshold for reporting, recording, acting on and monitoring significant events, incidents and near misses and improve thematic analysis of these. Ensure investigations into all significant events are thorough and records detail sufficient information in order to maximise learning opportunities.

• Ensure thorough pre-employment recruitment checks are embedded into the practice recruitment process.

• Ensure complaint handling processes fully reflect current guidance.

• Audits should be repeated in order to fully complete the audit cycle and ensure that any changes to practice continue to result in improvements to patient outcomes.

• Consider whether additional locum sessions would be beneficial to reduce pressures during periods of GP partner absence.

Professor Steve Field (CBE FRCP FFPH FRCGP) 

Chief Inspector of General Practice

Updated 5 April 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.

• All these patients had 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.

• Nursing staff were trained to initiate insulin treatments for diabetic patients, allowing them to begin this treatment sooner and reduce the need for the patient to be referred on to secondary care.

• The practice also offered weekly anticoagulant clinics where patients’ bloods were tested and their anti-coagulant medicine reviewed and dose changed as required. This meant they did not need to attend a separate specialist anticoagulant clinic.

Updated 5 April 2016

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

• Staff had received appropriate training and were aware of their responsibilities around safeguarding issues.

• 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 practice’s uptake for the cervical screening programme was 83.66%, which was comparable to the national average of 81.83%.

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

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

Updated 5 April 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 worked closely with local care homes, for example offering training to care home staff in order to reduce the likelihood of patients needing to be admitted into hospital.

• The practice held monthly multidisciplinary palliative care meetings to discuss the needs of patients nearing the end of their lives and ensure their care was coordinated and managed appropriately.

• Flu vaccination rates for the over 65s were 81.7%, and at risk groups 58.93%. These were slightly above and in line with the national averages respectively .

Updated 5 April 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.

• Telephone appointments were offered which allowed access to healthcare advice should a patient be unable to visit the practice in person.

Updated 5 April 2016

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

• The practice’s patients had access to a weekly psychological therapy clinic run by a local organisation on the premises.

• The percentage of patients with schizophrenia, bipolar affective disorder and other psychoses who had a comprehensive, agreed care plan documented in the record in the preceding 12 months was 85.71% compared to the national average of 88.47%.

• The percentage of patients diagnosed with dementia whose care had been reviewed in a face to face review in the preceding 12 months was 91.53% compared to the national average of 84.01%.

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

• The practice offered an enhanced service to facilitate timely diagnosis of dementia.

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

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

• The practice offered a well person health check for patients over the age of 75 years which included a dementia screen.

Updated 5 April 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 or complex needs.

• 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.

• Staff had recently received carer’s awareness training so they were better equipped to identify the needs and offer appropriate support for this vulnerable group.