Archived: Kensington Partnership Also known as Dr Wilson & Partners

Updated 27 June 2016

The Kensington Partnership provides services for 8858 patients. The practice has two sites The Kensington Street Health Centre and Lower Grange Medical Centre. Lower Grange Medical Centre is a branch surgery. At the time of the inspection both services were separately registered with CQC.

Please see separate report for Kensington Partnership, Kensington Street Health Centre.

The surgery is situated within the Bradford City Clinical Commissioning group and is registered with the Care Quality Commission (CQC) to provide primary medical services under the terms of a personal medical services (PMS) contract. This is a contract between general practices and NHS England for delivering services to the local community.

Kensington Partnership is registered to provide diagnostic and screening procedures, treatment of disease, disorder or injury and maternity and midwifery services. They offer a range of enhanced services such as childhood immunisations, facilitating timely diagnosis and support for people with dementia and enhanced services for those with a learning disability.

There is a higher than average number of patients under the age of 39, in common with the characteristics of the Bradford City area. There are fewer patients aged over 40 than the national average. The National General Practice Profile states that 60% of the practice population is from an Asian background with a further 7% of the population originating from black, mixed or non-white ethnic groups.

The practice has five GP partners, three of whom are male and two are female. The practice is staffed by a nurse practitioner and three practice nurses, five health care assistants and three substance misuse practitioners. The clinical team is supported by a practice manager and a team of administrative staff. The practice has recently recruited a pharmacist who will commence in June 2016.

The characteristics of the staff team are reflective of the population it serves and they are able to converse in several languages including those widely used by the patients, Urdu, Punjabi, Pushto, English, Polish and Slovakian.

The practice catchment area is classed as being within one of the most deprived areas in England. People living in more deprived areas tend to have a greater need for health services.

Lower Grange Medical Centre is situated within a purpose built building with car parking available. It has a hearing loop and disabled access and facilities.

The surgery is open from 9.00am to 1.00pm Monday to Friday. Patients can also access appointments at the Kensington Health Centre which is open at 8.00am each day and closes at 6.30pm Monday, Tuesday, Thursday and Friday with appointments available between 8.30am and 6.30pm. On a Wednesday the practice offers extended hours appointments until 8.00pm.

When the surgery is closed patients can access the Pharmacy First minor ailments scheme or the walk in centre at Hillside Bridge Health centre which is a local care direct service. Patients are also advised of the NHS 111 service for non –urgent medical advice.

Updated 27 June 2016

Letter from the Chief Inspector of General Practice

We carried out an announced comprehensive inspection at Kensington Partnership, Lower Grange Medical Centre on 18 May 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 and supported by the computer systems used by the practice.

• 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 did not find easy to make an appointment with a named GP. Urgent appointments were available the same day.
• The practice had good facilities and was well equipped to treat patients and meet their needs.
• Reception staff were infrequently acting as chaperones without a Disclosure and Barring Service check (DBS). (DBS checks identify whether a person has a criminal record or is on an official list of people barred from working in roles where they may have contact with children or adults who may be vulnerable). As these staff were not DBS checked and there was no risk assessment in place for this, we were assured that this would stop from the day of our visit.
• There was a clear leadership structure and staff felt supported by management. The practice worked closely with the Patient Participation Group (PPG) and 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.
• The practice had completed five out of six modules to gain accreditation and attain the Gold Standards Framework. The Gold Standards Framework is a systematic, evidence based approach to optimising care for all patients approaching the end of life.
• A Polish and a Czech interpreter were available at the Kensington Street Health Centre site each day to assist patients, who also had access to a benefits adviser one morning per week.

We saw areas of outstanding practice:

The practice offered a level two diabetes clinics where patients could be commenced on insulin therapy without attending hospital. (Insulin is a drug used for diabetics which keeps blood sugar levels from getting too high or too low). This clinic was offered to patients from other surgeries.

We saw excellent use of the clinical computer system used by GP practices in the area. The practice had developed a number of clear and proactive protocols, templates and care plans which helped staff to care for patients in a timely manner and to keep people well and safe. This included a reception protocol developed by GPs at the practice which allowed reception staff to ensure that patients received the most appropriate care and treatment. This clinically led, risk based protocol would direct staff to ring for an ambulance if required, book appointments urgently or ask people to speak to the pharmacy depending on their age and symptoms.

The practice engages the services of both a Polish and a Czech interpreter daily to assist patients with consultations and any issues. There was a benefits adviser available in the practice one morning a week.

The areas where the provider should make improvement are

The practice should ensure that all staff receive an annual appraisal.

The practice must ensure that all staff who act as chaperones for patients have undergone a Disclosure and Barring Service check (DBS).

Professor Steve Field (CBE FRCP FFPH FRCGP) 

Chief Inspector of General Practice

Updated 27 June 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.
• The practice participated in the CCG led Bradford Beating Diabetes initiative and offered a comprehensive range of services for diabetic patients. Additional services offered included supporting patients commencing on insulin (a drug used for diabetics which keeps blood sugar levels from getting too high or too low). This service was also offered to patients from other practices.
• The practice had secured funding to start an obesity management service to complement the diabetic, cardio vascular disease and hypertension clinics.
• The practice offered an anticoagulant service to their own patients and those from other practices. It also offered in-house spirometry and diagnosis for patients with asthma and chronic obstructive pulmonary disease (COPD).
• All these patients had a named GP and a structured annual review to check their health and medicines needs were being met. We saw evidence of comprehensive care plans.
• For those patients with the most complex needs, the named GP worked with other practices and relevant health and care professionals to deliver a multidisciplinary package of care.

Updated 27 June 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.
• 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 whose notes recorded that a cervical screening had been performed was 77%. This was the same as the CCG average, the national average was 82%.
• Appointments were available outside of school hours and the premises were suitable for children and babies.
• We saw positive examples of joint working with midwives, health visitors and school nurses example joint clinics held at the practice.
• The practice offered checks for babies at eight weeks old.

Updated 27 June 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.
• All patients over 75 had a named GP.
• The practice held a register of elderly patients. When these patients called the surgery an alert on their record ensured that they were offered an appointment on that day or placed on a list for the on-call doctor to review.
• The practice held a register of patients who struggled to leave the house. These patients would be offered visits by the GPs, nursing staff and health care assistants when they needed them.
• The practice supported approximately 70 nursing home patients. They held a weekly ward round at the homes and review each patient every month. We were told by the nursing home that they responded quickly to requests for additional home visits and that the service offered was excellent and could not be improved.
• The practice was responsive to the needs of older people, and offered home visits and urgent appointments for those with enhanced needs and ongoing chronic diseases.

Updated 27 June 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 offered an extended hours clinic on a Wednesday at Kensington Street Health Centre where patients could see a GP, a nurse or a health care assistant.
• The practice was proactive in offering online services, patients were able to book and cancel appointments on line and request prescriptions.
• Working age people were able to communicate with the practice via their on line system.
• Patients were able to check their weight, blood pressure and body mass index at any time during surgery opening hours. The results slip would then be handed to the receptionist and the patient followed up if necessary. On the day of our visit a patient used the machine and on production of the results slip was immediately offered a GP appointment the same afternoon.

Updated 27 June 2016

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

• The percentage of patients diagnosed with dementia who had their care reviewed in a face to face meeting in the last 12 months was 84%, which is the same as the CCG and national average.
• The practice had signed up to the Dementia First enhanced service scheme. This enhanced service (ES) is designed to reward GP practices for taking a proactive approach to the timely assessment of patients who may be at risk of dementia and for improvements in services for patients diagnosed with dementia and for their carers.
• The practice offered physical health checks for patients with serious mental illness as part of a CCG initiative.
• The practice carried out advance care planning for patients with dementia. We saw good examples of these.
• The practice had told patients experiencing poor mental health about how to access various support groups and voluntary organisations including MIND
• The practice had a system in place to follow up patients who had attended accident and emergency when they had been experiencing poor mental health.
• Staff had a good understanding of how to support patients with mental health needs and dementia.

Updated 27 June 2016

The practice is rated as good for the care of people whose circumstances may make them vulnerable.

• The practice held a register of all patients living in vulnerable circumstances including those with a learning disability. The practice would signpost homeless patients and refugees to a local GP service with specific skills and abilities to meet their needs.
• The practice offered annual health checks, longer or more frequent appointments and support to people with learning disabilities and their carers.
• The practice worked closely with a charitable church project which offered English lessons for speakers of other languages. Healthcare professionals supported these classes and offered support and information around numerous topics including health, lifestyle, maternity care and the appropriate use of accident and emergency services.
• The practice offered a GP lead substance misuse service and employed three specialist drug workers. This was a holistic service which involved families in their care and offered them support. Members of the substance misuse team were also represented at primary health care meetings and complex cases were discussed.
• The practice supported a complex group of patients from a nearby residential provision; they worked closely with the staff from the service to ensure that these patients were able to attend the surgery in a dignified manner supported by a risk assessment.
• The practice regularly worked with other health care professionals in the case management of vulnerable patients.
• 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 in normal working hours and out of hours. The practice had developed protocols and care plans and templates to support the management of these patients and alert clinicians to any issues.