Archived: Kirkley Mill Health Centre

Updated 5 February 2015

Kirkley Mill Health Centre, in the Great Yarmouth and Waveney clinical commissioning group (CCG) area, provides a range of general medical services to approximately 4600 registered patients living in and around the Kirkley Mill area of Lowestoft.

The practice is provided by a partnership who hold managerial and financial responsibility for the practice. The partners use management support from Malling Health UK Ltd. The practice used to be provided by a single handed GP, but in 2012, the current partnership took over responsibility for the practice. They employ two GPs, (1.5 whole time equivalent) and use locum GPs to cover vacant GP positions, due to difficulties they have had in recruiting GPs. They employ a nurse practitioner and a practice nurse (1.3 whole time equivalent). Nurse practitioners have additional education and training and are qualified to treat certain medical conditions without the direct supervision of a doctor. There is also two health care assistants, four receptionists, including a reception manager, two administration staff and two deputy practice managers, who job share.

The practice is provided in a portakabin which is shared with another GP practice. The reception and waiting room area in the main entrance is shared with patients from the other GP practice. However patients attending Kirkley Mill Medical Centre have a dedicated desk allocated to them. The practice was due to move to a new health centre, on the same site, in two weeks time.

The practice have opted out of providing out of hours services. These are provided by another health care provider called South East Health.

Updated 5 February 2015

Letter from the Chief Inspector of General Practice

We visited Kirkley Mill Health Centre on the 13 October 2014 and carried out a comprehensive inspection. The overall rating for this service is requires improvement. We found the practice to be good in the caring and responsive domains but required improvement in the safe, effective and well led domains. Improvements were required in the service provided to older people, people with long term conditions, families, children and young people, working age people, students and those recently retired, people whose circumstances may make them vulnerable and people experiencing poor mental health, including those with dementia.

 Our key findings were as follows:

• The majority of patients reported that clinical staff gave them enough time, explained their condition and treatment, and involved them in decisions about their care and treatment. However, many of the patients told us there was a lack of GPs which resulted in a lack of continuity of care.
• The management team had been working with patients and staff in order to make improvements at the practice. Patients recognised that improvements had been made and staff were keen to continue to improve the practice.
• The practice was clean and hygienic and had robust arrangements for reducing the risks from healthcare associated infections.

We saw several areas of outstanding practice including:

• Positive feedback from a representative of the traveller community who advised that the practice had provided a flexible service to people from the travelling community.
• A dedicated phone line for a range of health professionals, the local hospital and nursing homes so that quick access to a GP could be obtained if necessary.

There were areas of practice where the provider needs to make improvements. 

Importantly, the provider must:

• A system was in place for reporting, recording and sharing the learning from significant events. However this learning must be embedded in practice.
• The practice needs to ensure that clinicians and non-clinical staff have taken on board learning around all significant events.
• Significant events around delayed referrals had repeatedly occurred. Referrals must be undertaken in a timely manner.
• Complete clinical audit cycles to ensure that appropriate changes are made to patients’ care and treatment to improve their health outcomes.
• Ensure that all staff receive training deemed mandatory by the practice.

In addition the provider should ensure:

• The checking of medicines for stock and expiry dates is documented.
• The knowledge of some of the clinical staff in relation to the Mental Capacity Act (2005) is improved.

Professor Steve Field (CBE FRCP FFPH FRCGP) 

Chief Inspector of General Practice

Updated 5 February 2015

The practice is rated as requires improvement for people with long term conditions. 

The practice supported patients to receive coordinated, multi-disciplinary care whilst retaining oversight of their care.

The practice had effective arrangements for making sure that patients with long term conditions were invited to the practice for annual or more frequent reviews depending on their needs. The practice made use of a mobile text service to remind patients of their appointment time or to notify them that a review of their condition was due. When needed, longer appointments and home visits were available.

However, systems and processes to address risks to patients required improvement. There was scope to improve clinical audit to improve outcomes for patients. 

Updated 5 February 2015

The practice is rated as requires improvement for the population group of families, children and young people. 

Appointments could be booked in person, by telephone or via the practice website. Appointments were available outside of school hours.

Information and advice was available to promote health to women before, during and after pregnancy. Expectant mothers had access to a midwife clinic although this was not held at the practice.

The practice monitored the physical and developmental progress of babies and young children. There were arrangements for identifying and monitoring children who were at risk of abuse or neglect. The nurse practitioner worked closely with the health visitor.

The practice had a register of children who were on the at risk register and those who were cared for. If an appointment was requested for a child on either of these registers, they were given an appointment that day.  

Information and advice on sexual health and contraception was provided during GP and nurse appointments.

The practice identified people with caring responsibilities and those who required additional support which was recorded on their patient record.

However, systems and processes to address risks to patients required improvement. There was scope to improve clinical audit to improve outcomes for patients. 

Updated 5 February 2015

The practice is rated as requires improvement for the care of older people. 

The practice had identified all their patients over 75 years of age. Each patient who was 75 years or older had a named GP who was responsible for the coordination of their care and treatment, in line with recent GP contract changes for 2014 to 2015.

There was a dedicated phone line for a range of health professionals, the local hospital and nursing homes so that quick access to a GP could be obtained if necessary.

Home visits and telephone consultations were available when patients were unable to attend the practice.         

However, systems and processes to address risks to patients required improvement. There was scope to improve clinical audit to improve outcomes for patients. 

Updated 5 February 2015

The practice is rated as requires improvement for the population group 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. Appointments could be booked in person, by telephone or via the practice website. The practice was open on a Saturday morning from 8am to 1pm so patients who worked were able to see a GP outside of usual office hours. 

The practice was proactive in offering online services as well as a full range of health promotion and screening which reflected the needs for this age group.

When patients required referral to specialist services they were offered a choice of services, locations and dates.

However, systems and processes to address risks to patients required improvement. There was scope to improve clinical audit to improve outcomes for patients. 

Updated 5 February 2015

The practice is rated as requires improvement for people experiencing poor mental health (including people with dementia).

People experiencing poor mental health, who required specific care had an alert added onto their patient record. When they contacted the practice this information was highlighted when a member of staff looked at their record. A search was carried out to ensure that all patients experiencing poor mental health had these alerts in place.

The practice had sign-posted patients experiencing poor mental health to various support groups and third sector organisations. The GPs had the necessary skills and information to treat or refer patients with poor mental health. 

However, systems and processes to address risks to patients required improvement. There was scope to improve clinical audit to improve outcomes for patients. 

Updated 5 February 2015

The practice is rated as requires improvement for people whose circumstances may make them vulnerable.

We received positive feedback from a representative of the traveller community who advised that this practice had provided a flexible service to people from the travelling community.

The practice had access to a translation service. Patients who needed this service were identified in advance and this was recorded on their patient record so that the service could be requested in advance of their appointment.

The practice had a register of people with a learning disability and they had fortnightly clinics booked from the end of October 2014 to undertake annual health checks for people with a learning disability. People with learning disabilities were supported to make decisions through the use of care plans which they were involved in agreeing.

Temporary residents were able to register at the practice and were given a different registration form for completion. This included the details of the patient and the reason for their attendance, in order for this information to be sent to their usual GP.

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 and out of hours.  

However, systems and processes to address risks to patients required improvement. There was scope to improve clinical audit to improve outcomes for patients.