Archived: Kingfisher Practice

Updated 7 January 2016

Kingfisher Practice is a purpose built surgery located within a large community building, called ‘Bentley Medical Centre’. The premises is shared with health and community services as well as two other GP practices. The practice has approximately 4748 patients registered.

The practice has three GP partners (one male, two female), two practice nurses a health care assistant and a practice manager. They are supported by a team of administrative/ reception staff.

The practice also employs locum GPs when needed. The practice is a training practice for GP trainees (fully qualified doctors who wish to become general practitioners), foundation year trainees (FY2) and a teaching practice for medical students. At the time of the inspection there was one GP trainee and one medical student.

The practice holds an Alternative Provider Medical Services (APMS) contract. APMS is a route through which NHS England can contract with a wide range of providers to deliver services tailored to local needs. APMS can be used to provide essential services, additional services where GMS/PMS practices opt out, enhanced services, out-of-hours services or any one element or combination of these services.

The practice is open from 9am to 6pm Mondays, Tuesdays, Wednesdays and Fridays. There are extended opening hours on Saturdays when the practice is open from 9am to 11am (booked appointments only). The practice is open on Thursdays from 9am to 12pm. The practice does not provide an out-of-hours service but has alternative arrangements in place for patients to be seen when the practice is closed. When the practice is closed during core hours on a Thursday afternoon patients can access general medical services by contacting ‘WALDOC’ which provides cover. When the practice is closed during out of hours patients can access general medical services by contacting ‘Primecare’ which is an out-of-hours service provider.

We reviewed the most recent data available to us from Public Health England which showed that the practice is located in an area with a high deprivation score. Data also showed that the practice has a slightly higher than average practice population aged under 18 years in comparison to other practices nationally. The practice also has a higher than the national average number of patients with caring responsibilities.

The practice achieved 94.1% for the Quality and Outcomes Framework (QOF) points for the financial year 2013-2014. This was similar to the national average of 94.2%.The QOF is the annual reward and incentive programme which awards practices achievement points for managing some of the most common chronic diseases, for example asthma and diabetes.

Please note that when referring to information throughout this report, for example any reference to the Quality and Outcomes Framework data, this relates to the most recent information available to the CQC at that time.

Updated 7 January 2016

Letter from the Chief Inspector of General Practice

We carried out an announced comprehensive inspection at Kingfisher Practice on 7 October 2015. Overall the practice is rated as good.

Specifically, we rated the service to be good for providing safe, effective, caring, responsive and well led services. The service provided to the following population groups was also rated as good, these are:

• Older people

• People with long term conditions

• Families, children and young people

• Working age people (including those recently retired and students)

• People whose circumstances may make them vulnerable

• People experiencing poor mental health (including people with dementia).

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

• Staff understood and fulfilled their responsibilities to raise concerns, and to report incidents and near misses. Information about safety was recorded, monitored, appropriately reviewed and addressed.

• There were effective arrangements in place to identify, review and monitor patients with long term conditions. Patients’ needs were assessed and care was planned and delivered following best practice guidance.

• Patients said they were treated with compassion, dignity and respect and they were involved in their care and decisions about their treatment.

• The practice was responsive to the needs of its patient population. There were services aimed at specific patient groups. The practice had good facilities and was well equipped to treat patients and meet their needs. Information about services and how to complain was available and the practice responded quickly to issues raised.

• The practice had a clear vision which had quality and safety as its top priority. There was strong and visible leadership and processes to keep staff informed and engaged in practice matters. The practice proactively sought feedback from patients, which it acted on.

Professor Steve Field (CBE FRCP FFPH FRCGP) 

Chief Inspector of General Practice

Updated 7 January 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 named GP and a structured annual review to check that their health and medication needs were being met. For those people with the most complex needs, the named GP worked with relevant health and care professionals to deliver a multidisciplinary package of care this included regular multidisciplinary team meetings. The practice was an ‘Any qualified provider ’ (AQP) for anti-coagulation services. This enabled both patients registered at the practice and patients registered elsewhere to receive anti- coagulation monitoring at the practice in a dedicated clinic where warfarin prescription could also be issued. There were practice pharmacists who undertook medication reviews for patients on high risk medicines and those with complex needs, as well as hypertension clinics (for patients with high blood pressure).

Updated 7 January 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. Appointments were available outside of school hours and the premises were suitable for children and babies. We saw good examples of joint working with the midwives and health visitors. For example, increasing the uptake of the Pertussis vaccine (whooping cough) for pregnant women and liaising with the health visitors when there were safeguarding concerns. The practice was a UNICEF breast feeding friendly practice and there were posters on display informing patients.

Updated 7 January 2016

The practice is rated as good for the care of older people. Nationally reported data showed that outcomes for patients were good for conditions commonly found in older people. The practice offered proactive, personalised care to meet the needs of the older people in its population and had a range of enhanced services, for example, in dementia and end of life care. It was responsive to the needs of older people, and offered home visits and rapid access appointments for those with enhanced needs.

Updated 7 January 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 reflected the needs for this age group. The practice provided a full range of contraceptive services and offered sexual health screening.

Updated 7 January 2016

The practice is rated as good for the care of people experiencing poor mental health (including people with dementia). There were 55 patients on the mental health register which helped identify people experiencing poor mental health and they had all received an annual physical health check. The practice regularly worked with multidisciplinary teams in the case management of people experiencing poor mental health, including those with dementia. A community psychiatric nurse undertook weekly clinics at the practice.

The practice had told patients experiencing poor mental health about how to access various support groups and voluntary organisations. Staff had received training on how to care for people with mental health needs and dementia. The practice staff had received dementia community friendly training and a dementia awareness stand was in place in the patient waiting area every two months to provide information and advice. The practice was a ‘Dementia friendly practice’. It had a system in place to follow up patients who had attended accident and emergency (A&E) where they may have been experiencing poor mental health.

Updated 7 January 2016

The practice is rated as good for the care of people whose circumstances may make them vulnerable. It had carried out annual health checks for people with a learning disability and offered longer appointments for people with a learning disability. The practice had reached out to the local community by approaching the local Gurdwara (Sikh place of worship) to promote better health by providing basic life support training. One of the GPs worked with a local homeless charity in their own time and was looking at identifying a process for providing flu vaccinations to this vulnerable group.

The practice regularly worked with multidisciplinary teams in the case management of vulnerable people. 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 held a clinic to review patients with substance misuse issues as part of a substance misuse shared care prescribing service. At the time of the inspection there were 13 patients who attended the clinic, there was liaison with the substance misuse team and a key worker attended the clinic with each patient to offer support.