Archived: Kirkby Community Primary Care Centre

Updated 5 December 2017

Kirkby Community Primary Care Centre (KCPCC) is a single-site GP practice based at:

Portland Street

Ashfield Health Village

Kirkby-in-Ashfield

Nottingham

NG17 7AE

KCPCC is operated by Primary Integrated Community Services Ltd (PICS), which is a GP owned provider organisation. PICS is responsible for the practice under an alternative provider medical services (APMS) ‘caretaker contract’ until March 2018 when a new permanent provider will be announced through a tendering process. APMS is a contracting route that enables organisations to negotiate local service contracts and to provide medical services to the extent of the needs of the local population.

The practice has a clinical team of four locum GPs, two advanced nurse practitioners, two practice nurses, a healthcare assistant and two clinical pharmacists. Two locum GPs have worked at the practice on a long-term basis and provided continual care during a change of provider. A practice supervisor, a primary care support coordinator and a team of 11 administrators, secretaries and receptionists provide non-clinical support. A patient advisor is based permanently at the practice. A medical director and clinical lead from PICS provide additional clinical capacity and clinical governance oversight.

The number of weekly GP sessions available varies due to changing availability of locum GPs. During this inspection we looked at GP sessions for a three month period between July 2017 and September 2017 and found the number of weekly sessions varied between 23 and 43. Two long-term locum GPs consistently provide eight sessions each per week.

The practice is readily accessible for people who use wheelchairs and by parents with pushchairs. A portable hearing loop system is available and there are quiet waiting facilities for patients who find the main waiting area can cause anxiety. Private space is available for breast-feeding. A café is available on site along with various other services including the Citizens Advice Bureau.

The practice services a patient list of 5712 and is in an area of high deprivation.

The practice was open between 8am and 6.30pm Monday to Friday and between 9am and 1pm on Saturdays. Appointments were from 8am to 6.15pm Monday to Friday and 9am to 12.30pm on Saturdays.

We previously inspected KCPCC on 19 November 2015. At that time the practice was placed into special measures and the provider was removed from registration with CQC. The inspection on 7 September 2017 was the first inspection we carried out at the practice under the new provider, PICS. PICS took over the practice in October 2016.

Updated 5 December 2017

Letter from the Chief Inspector of General Practice

We carried out an announced comprehensive inspection at Kirkby Community Primary Care Centre on 7 September 2017. This service was placed into special measures in September 2015. This related to a previous provider that no longer operates this service. This inspection took place following the implementation of a new provider in October 2016 and found significant improvements had been made to the quality of care provided. I am taking this service out of special measures, which reflects the significant improvements in clinical safety, quality assurance and leadership.

Overall the practice is now 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.
• Clinical pharmacists had implemented medicine audits and worked with discharging hospital clinicians to improve patient safety and long-term prescription monitoring.
• Staff assessed patients’ needs and delivered care in line with current evidence based guidance. Staff had been trained to provide them with 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. Improvements were made to the quality of care as a result of complaints and concerns.
• Patients said they found it easy to make an appointment with a named GP 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.
• There was a clear leadership structure and staff felt supported by management. The provider had established clinical and non-clinical support processes for staff.
• The practice proactively sought feedback from staff and patients, which it acted on.
• The provider was aware of and complied with the requirements of the duty of candour.

We saw areas of outstanding practice:

• There was evidence of sustained and wide-ranging improvements in leadership, governance and patient safety since we last inspected the practice under a previous provider. Improvements had been made at all levels of the practice and there were demonstrable improvements for patients, which had resulted in some patients returning after having left to register with an alternative practice.
• There was significant focus on multidisciplinary care to meet the needs of vulnerable people and those with complex needs. This included an in-house ‘pathways’ patient advisor and weekly scheduled clinics for those with needs relating to drug and alcohol use.
• The practice performed significantly better than the CCG in the pre-diabetes education programme, uptake of the improving access to psychological therapies programme and the completion of health checks.

The areas where the provider should make improvement are:

• The provider should continue to work towards establishing a permanent GP team to ensure consistency of available appointments and clinical governance.

Professor Steve Field CBE FRCP FFPH FRCGP

Chief Inspector of General Practice

Updated 5 December 2017

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

• Nursing staff and clinical pharmacists 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 their health and medicines needs were being met. For those patients with the most complex needs, the GP worked with relevant health and care professionals to deliver a multidisciplinary package of care.
• The practice demonstrated consistent high levels of performance in diabetes and mental health care and outcomes.
• The provider’s statement of purpose focused on the provision of multidisciplinary and consistent care for long-term conditions. This was adapted to the needs of the local population and included chronic obstructive pulmonary disease and heart failure.
• A range of monitoring protocols were in place to ensure timely recall of patients with certain conditions.

Updated 5 December 2017

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 including children who had a high number of accident and emergency attendances. Immunisation rates were higher than CCG and national averages for all standard childhood immunisations.
• We found evidence children and young people were treated in an age-appropriate way and were recognised as individuals.
• 87% of eligible patients had undergone cervical screening, which was better than the CCG and national averages.
• Appointments were available outside of school hours and the premises were suitable for children and babies. This included a children’s waiting area.
• The practice offered same-day access for children under the age of five.
• We saw positive examples of joint working with midwives, health visitors and school nurses, including for patients who were vulnerable or those who needed confidential support in areas such as sexual health.

Updated 5 December 2017

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

• The practice offered proactive and personalised care to meet the needs of the older people in its population, including military veterans. Patients aged 70 and over represented 8% of the practice list.
• The practice was responsive to the needs of older people and offered home visits and urgent appointments for those with enhanced needs.
• 72% of patients over the age of 65 had received a flu, pneumonia and shingles vaccination compared to the CCG average of 73%.
• The practice undertook joint care home visits with the practice clinical pharmacist to review repeat prescriptions and undertake timely medicine reviews.
• End of life care was delivered in line with national evidence-based standards, including the Gold Standards Framework and the National Coalition for Palliative Care.

Updated 5 December 2017

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 of this age group. This included on-site support for drug and alcohol addiction.
• Sexual health, coil fitting and contraception services were offered by the practice.

Updated 5 December 2017

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

• 80% of patients diagnosed with dementia had their care reviewed in a face to face meeting in the last 12 months, which was better than the national average.
• The practice regularly worked with multi-disciplinary teams in the case management of patients experiencing poor mental health, including those with dementia.
• The practice carried out advance care planning for patients with dementia.
• The practice had supported patients experiencing poor mental health to access various support groups and voluntary organisations.
• The practice had a system in place to follow up patients who had attended accident and emergency where they may have been experiencing poor mental health, including those living with dementia.

Updated 5 December 2017

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 homeless people, travellers and those with a learning disability.
• The practice offered longer appointments for patients with a learning disability.
• The practice regularly worked with other health care professionals in the case management of vulnerable patients. A dedicated patient advisor was based in the practice and offered targeted one-to-one support and signposting to specialist providers.
• 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 including local crisis teams.