Kingstone Surgery

Updated 31 October 2016

Dr J D Sleath and Dr R G Warner provide a range of primary medical services from location in western Herefordshire. The practice has a catchment area of 170 square kilometres with relatively low levels of deprivation. It has around 4,300 patients who live mainly in the villages of Kingstone, Clehonger, Madley and the surrounding rural areas.

The practice has two male GP partners and two salaried part time female GPs, two practice nurses and a phlebotomist (a member of staff trained to take blood). The clinical team are supported by a practice manager, assistant practice manager and office manager. The practice has an established team of administrative staff and receptionists. The practice is a dispensing practice and employs a dispensary manager and five dispensary assistants.

The practice has a General Medical Services (GMS) contract with NHS England.

The practice does not routinely provide out of hours services but does provide some out of hours cover for patients approaching the end of life. Information for general out of hours cover was provided for patients. This service is provided in Herefordshire by Primecare, a national company providing primary medical services.

Updated 31 October 2016

Letter from the Chief Inspector of General Practice

We carried out an announced comprehensive inspection of this practice on 28 April 2015. A breach of legal requirements was found. After the comprehensive inspection, the practice wrote to us to say what they would do to meet regulatory requirements in relation to;

• Regulation 17 Health & Social Care Act 2008 (Regulated Activities) Regulations 2014 – Good governance

We undertook a desk based focused inspection for Dr J D Sleath and Dr R G Warner’s practice on 5 October 2016 to check that they had followed their plan and to confirm that they now met regulatory requirements. This report only covers our findings in relation to those requirements. The report from our last comprehensive inspection can be seen by selecting 'all reports' link for Dr J D Sleath and Dr R G Warner on our website at www.cqc.org.uk. Overall the practice is rated as good.

Following our inspection on 28 April 2015, the practice were told they must:

• Establish an effective system to assess, monitor and mitigate the risks relating to the health, safety and welfare of patients, staff and visitors. This must include regular audits of infection prevention and control, arrangements for calibrating equipment used for patient care and a review of policies and procedures to ensure they reflect current legislation and national guidance.

We found that on 5 October 2016 the practice now had improved systems in place.

• The practice had updated practice-specific policies and procedures to support practice and reduce risks associated with infection prevention and control, calibrating equipment and portable appliance testing, and emergency medicines. They had updated policies relating to recruitment, equality and diversity, clinical waste management, consent and chaperones.

• The practice had addressed the areas where we suggested they should make improvements and introduced a system to record that the GP bags were checked to ensure that medicines were correct and in date. They had also introduced a checking system to record the serial numbers of prescriptions and included portable appliance testing as part of the annual equipment calibration checks which had been implemented.

Professor Steve Field CBE FRCP FFPH FRCGP

Chief Inspector of General Practice

Updated 15 October 2015

The practice is rated as good for the care of people with long-term conditions. The practice offered personalised care to meet the needs of patients with long term conditions. They knew their patients well and aimed to provide continuity of care; for example people were usually able to see their preferred GP. The practice encouraged patients to have annual flu vaccinations and national data showed that the practice’s vaccination rates for patients with conditions which increased their risk were in line with the national average.

The practice arranged one appointment for patients with more than one condition to avoid repeat visits to the practice. The practice nurses contributed to the care of patents with long term conditions and completed checks and tests so the results were available for the GPs when they saw patients. Longer appointments and home visits were available when needed.

Updated 15 October 2015

The practice is rated as good for the care of families, children and young people. The practice provided family planning advice and midwives and health visitors were provided with a room to use at the practice so pregnant women and families with babies and young children could access all their healthcare in one place. They held an integrated clinic once a week with a midwife and health visitor to promote effective communication. Childhood immunisation rates were similar to or higher than the local CCG percentage The GPs and practice nurses worked with other professionals where this was necessary, particularly in respect of children living in vulnerable circumstances. Appointments were available outside of school hours.

Updated 15 October 2015

The practice is rated as good for the care of older people. Patients over the age of 75 had a named GP and GPs and practice nurses visited patients at home if they were unable to travel to the practice for appointments. The practice encouraged patients to have annual flu vaccinations and national data showed that the practice’s vaccination rates for patients over 65 were in line with the national average.

The practice offered personalised care to meet the needs of the older people in its population. They knew their patients well and had built up relationships with them over many years. Some older patients who gave us information said they had stayed in the area in order to remain with the practice. The GPs monitored the health of older patients to identify any deterioration in their health. The practice had systems to alert staff to patients with significant health and care needs and those at the end of their life. The GPs provided out of hours care themselves for patients nearing the end of life.

Updated 15 October 2015

The practice is rated as good for the care of working age people, recently retired people and students. The practice building was open from 8am to 6.30pm. The practice provided patients with detailed information about the times when each GP and nurse were available and scored highly in national surveys for patients being able to book appointments with their preferred GP. Appointments were available between 8am and 6pm each day and between 7am and 8am on Mondays and Tuesdays. GPs continued to see patients after 6pm if needed. Patients could pre-book appointments up to six months in advance, book an on the day appointment or attend an ‘open appointment’ session after the main morning surgery. The practice also offered telephone consultations and email consultations if requested by individual patients. The practice provided patients with information about local extended access and open access primary medical services. Patients could book appointments and order prescriptions online.

Updated 15 October 2015

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

The practice based their care and treatment on their knowledge of patients and their families in a holistic way and did not proactively screen patients for dementia. They were confident that their relationships with their patients resulted in them responding promptly and effectively when necessary. When patients came to see them about issues which might be dementia related the practice arranged to review them regularly to monitor any deterioration. The practice worked in partnership with a specialist dementia nurse from the local NHS mental health trust.

The practice made a room available one day a week for a community mental health worker to see patients locally. They also provided a room one day a month for a local psychiatrist to arrange local appointments for their patients. The practice did not charge the mental health trust for this facility because they recognised the benefits to patients of being seen closer to home. People experiencing poor mental health received annual physical health checks.

Updated 15 October 2015

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. There were no patients from travelling communities in the practice catchment. The practice provided annual health checks for people with a learning disability. 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.