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King's Medical Practice Good

Inspection Summary


Overall summary & rating

Good

Updated 9 May 2016

Letter from the Chief Inspector of General Practice

We carried out an announced comprehensive inspection at King’s Medical Practice on 9 February 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 GP or nurse 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 practice had the skill mix and staff available to meet the needs of patients.
  • The provider was aware of and complied with the requirements of the Duty of Candour.

We saw three areas of outstanding practice:

  • The practice had a very effective and caring approach to palliative care. We saw evidence that they worked closely with patients, families and other health and care providers in relation to palliative care planning and end of life care planning.

  • The practice offered pre-diabetes screening for patients. The programme involved patients being screened for long term blood sugar levels. Those at a pre-diabetes level were sent an information pack and offered support to discuss improvements and changes in lifestyle and diet. Patients were then recommended to have their blood sugar levels monitored on a 12 month basis to establish if they had moved from having pre-diabetic status to diabetic status.

  • The practice had a very strong training and staff development culture. For example the practice was an advanced training centre and four clinical staff were accredited trainers. Staff were encouraged and supported to progress through career pathways. Additionally opportunities within the practice had been developed for apprenticeships and the practice had a number of apprentices on the staff structure.

There was one area where the provider should make improvement:

  • The practice needed to develop a more effective system for monitoring patients who had been prescribed potentially toxic drugs. We noted four patients who had been prescribed an antirheumatic drug but had failed to have appropriate blood tests performed. Of these only one had evidence of subsequently being recalled for a test by the practice. Since the inspection we have been informed that all patients were followed up by the practice and appropriate tests had been carried out.

Professor Steve Field (CBE FRCP FFPH FRCGP) 

Chief Inspector of General Practice

Inspection areas

Safe

Good

Updated 9 May 2016

The practice is rated as good for providing safe services.

  • There was an effective system in place for reporting and recording significant events.

  • We saw evidence that lessons were shared to make sure action was taken to improve safety in the practice.

  • When there were unintended or unexpected safety incidents, patients received reasonable support, truthful information, a verbal and written apology. They were told about any actions to improve processes to prevent the same thing happening again.

  • The practice had clearly defined and embedded systems, processes and practices in place to keep patients safe and safeguarded from abuse.

  • The practice shared information effectively in relation to patients using a safeguarding resource on the clinical computer record.This allowed access for a range of partners including GPs, child health and health visitors and supported integrated case working.

  • Risks to patients were assessed and well managed.

  • The practice needed to develop a more effective system for monitoring patients who had been prescribed potentially toxic drugs. We noted four patients who had been prescribed an antirheumatic drug but  had failed to have appropriate blood tests performed. Of these only one had evidence of subsequently being recalled for a test by the practice. Since the inspection we have been informed that all patients were followed up by the practice and appropriate tests had been carried out.

Effective

Good

Updated 9 May 2016

The practice is rated as good for providing effective services.

  • Data from the Quality and Outcomes Framework showed many patient outcomes were comparable to or above average for the locality and national averages.

  • Staff assessed needs and delivered care in line with current evidence based guidance.

  • Clinical audits demonstrated quality improvement.

  • Staff had the skills, knowledge and experience to deliver effective care and treatment.

  • There was evidence of appraisals and personal development plans for all staff.

  • Staff worked with multidisciplinary teams to understand and meet the range and complexity of patients’ needs. For example the practice held regular meetings with other health care professionals to discuss palliative care issues.

  • The practice had identified local health needs and developed a number of health improvement and screening programmes to meet these, such work included weight management and pre-diabetes screening programmes.

  • For over 20 years the practice has made weekly planned clinical visits to three large care homes to deliver treatment, carry out reviews and update care plans. We saw evidence that this approach had reduced unplanned hospital admissions and visits to the homes concerned.

Caring

Good

Updated 9 May 2016

The practice is rated as good for providing caring services.

  • Patients we spoke with and comments we received were all extremely positive about the care and service the practice provided. They told us they were treated with compassion, dignity and respect and they were involved in decisions about their care and treatment.

  • The practice worked closely with patients, families and other health and care providers in relation to palliative care planning and end of life care planning.

  • Information for patients about the services available was easy to understand and accessible,

  • We saw staff treated patients with kindness and respect, and maintained patient and information confidentiality.

Responsive

Good

Updated 9 May 2016

The practice is rated as good for providing responsive services.

  • Practice staff reviewed the needs of its local population and engaged with the NHS England Area Team and Clinical Commissioning Group to secure improvements to services where these were identified.

  • Patients said they found it easy to make an appointment with a GP or nurse and 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.

  • Information about how to complain was available and easy to understand and evidence showed the practice responded quickly to issues raised. Learning from complaints was shared with staff and other stakeholders.

Well-led

Good

Updated 9 May 2016

The practice is rated as good for being well-led.

  • The practice had a very strong training and development culture. For example, the practice was an advanced training centre and four clinical staff were accredited trainers and staff were encouraged and supported to progress through career pathways. Additionally opportunities within the practice had been developed for apprenticeships and the practice currently had a number of apprentices on the staff structure.

  • The practice had a clear vision and strategy to deliver high quality care and promote good outcomes for patients. Staff were clear about the vision and their responsibilities in relation to this.

  • There was a clear leadership structure and staff felt supported by management. The practice had a number of policies and procedures to govern activity and held regular governance meetings.

  • There was an overarching governance framework which supported the delivery of the strategy and good quality care. This included arrangements to monitor and improve quality and identify risk, and individual staff members had been allocated defined roles in improving outcomes for patients.

  • The provider was aware of and complied with the requirements of the Duty of Candour (being open and transparent with people who use the service, in relation to care and treatment provided). The partners encouraged a culture of openness and honesty.

  • The practice had systems in place for knowing about notifiable safety incidents and ensured this information was shared with staff to ensure appropriate action was taken

  • The practice proactively sought feedback from staff and patients, which it acted on. The patient participation group was active and felt that the practice was very supportive in relation to their work.

  • There was a strong focus on continuous learning and improvement at all levels.

Checks on specific services

People with long term conditions

Outstanding

Updated 9 May 2016

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

  • The practice had actively managed registers for patients with long term conditions. Patients with a long term condition had care plans in place and are called for review on a regular basis. For those patients with the most complex needs, the named GP worked with relevant health and care professionals to deliver multidisciplinary packages of care.

  • The practice had extensive and effective services in place for palliative care. Within the practice two doctors had undertaken hospice modular posts as part of GP training and two doctors held post graduate qualifications in palliative care. The practice held Gold Standard Framework meetings every six to eight weeks when life limiting illnesses/end of life patient issues where discussed. These meetings were attended by GPs, district nurses and specialist palliative care nurses. Details with regard to cases were kept on the patient record and notes sent to relevant practitioners who could not attend. The practice also used the Electronic Palliative Care Co-ordination System (EPaCCS); this provided a shared locality record for health and social care professionals which allowed rapid access across care boundaries to key information about an individual approaching the end of life, including their expressed preferences for care. Within the practice population 89% of patients receiving palliative care died at their preferred place of death.

  • The practice offered pre-diabetes screening for patients. The programme involved patients being screened for long term blood sugar levels. Those at a pre-diabetes level, but not with actual diabetes, were sent an information pack and offered support to discuss improvements and changes in lifestyle and diet. Patients were then recommended to have their blood sugar levels monitored on a 12 month basis to establish if they had moved from having pre-diabetic status to diabetic status. A practice audit reported in 2016 that of 38 patients who had been identified as being pre-diabetic none had progressed to develop diabetes over a twelve month period and 60% of patients either maintained their blood sugar levels or improved it. In eight patients (21%) there was a significant improvement in their levels.

  • The practice had appointed a lead practitioner for Coronary Obstructive Pulmonary Disease (COPD) and asthma and offered spirometry screening. The percentage of patients with COPD who had a review undertaken in the preceding 12 months was 96% compared to the national average of 89%.

  • The practice offered a range of additional services which could improve health and quality of life for those with a long term condition, this included an effective weight management service. Between 2014 and 2015 this service was accessed by 106 patients who in this period lost a total of 442kg (individual patients losing between 1kg and 23kg).

  • Atrial fibrillation screening was available within the practice.

Families, children and young people

Good

Updated 9 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. Immunisation rates were high for all standard childhood immunisations.

  • The practice had developed a comprehensive post-natal pack for parents which contained details of local healthcare services as well as information in relation to immunisations and common childhood conditions.

  • 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 percentage of women aged 25-64 years whose notes recorded cervical screening had been performed in the preceding five years was 80% and comparable to national figures.

  • Appointments were available outside of school hours and the premises were suitable for children and babies, young children were also prioritised for same day appointments.

  • The practice worked with midwives, health visitors and school nurses to support the needs of this population group. For example, ante-natal, post-natal and child health surveillance clinics.

  • The practice participated in the c-card scheme. This was a card which was issued to patients aged 13 to 24 to allow them access to free contraception.

  • The practice had been accredited by the  Wakefield “Young Inspectors’ programme”, (which is operated by the Youth Association), and which seeks to improve services for children and young people. An audit carried out by young people as part of this programme highlighted the practice use of text reminders and the clarity of the practice website as being beneficial to children and young people and supported their improved access to healthcare.   

Older people

Good

Updated 9 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 provided care for the majority of patients at three large care homes, two small care homes and one large supported care complex (many of these patients had multiple long term conditions and complex care needs). The practice delivered planned weekly clinical sessions at the three large care homes during which a named GP saw acutely ill patients, managed those patients with a chronic illness, undertook reviews, and developed end of life care plans and anticipatory care plans when required. We were told by staff from a care home that clinicians from the practice worked closely with them to improve treatment and care for residents.

    We saw evidence which indicated that care homes that received these sessions had lower accident and emergency attendances per resident and reduced calls for unplanned services when compared to similar providers who did not have structured clinical sessions.

Working age people (including those recently retired and students)

Good

Updated 9 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. For example, the practice offered extended hours opening and telephone consultations.

  • 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 access to a range of additional services including weight management, alcohol and substance misuse support, health trainer support, books on prescription and in-surgery physiotherapy.

People experiencing poor mental health (including people with dementia)

Good

Updated 9 May 2016

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

  • 88% of patients diagnosed with dementia had had their care reviewed in a face to face meeting in the last 12 months, which was better than the national average of 84%.

  • The percentage of patients with schizophrenia, bipolar affective disorder and other psychoses who had a comprehensive and agreed care plan documented was 94% compared to the national average of 89%.

  • 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 participated in the Wakefield Safer Places Scheme (Safer Places is a voluntary scheme that aims to assist vulnerable people with learning disabilities, autism and dementia to feel safer when travelling independently).

  • The practice told patients experiencing poor mental health how to access various support groups and voluntary organisations. This included signposting patients to an online counselling support service for 11-25 year olds and an online community and peer support group for those with mental health concerns.

People whose circumstances may make them vulnerable

Good

Updated 9 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 the frail elderly, those with long term conditions and life limiting illnesses and those with a learning disability.

  • The practice offered longer appointments for vulnerable patients, for example the elderly or those with a learning disability.

  • 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 these included details of local carers support.

  • Staff knew how to recognise signs of abuse in children, young people and adults whose circumstances may make them vulnerable. 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 delivered annual health checks for those with a learning disability.

  • The practice had developed a care co-ordinator role to support vulnerable patients who were at a higher risk of hospital admission or accident and emergency attendance.