Knockin Medical Centre

Updated 14 December 2017

Knockin Medical Centre is located in Knockin, Shropshire. It is part of the NHS Shropshire Clinical Commissioning Group. They are a dispensing practice situated in a very rural locality between Oswestry and Shrewsbury covering a large geographic area. This can present significant challenges for the practice with secondary care providers, transport services and patient mobile phone and internet access. Patients who cannot drive can be at risk of extreme isolation. The practice covers all the surrounding villages and rural hillside farms. The total practice patient population is 3,400, mainly in Shropshire but with approximately 150 patients living in Wales.

The practice has a higher proportion of patients aged 65 years and above (36.8%) which is higher than the practice average across England (26.5%). They have a lower than average number of patients aged 0-4 years (3.5%) when compared to the practice average across England (6%). It also has a population, which has a higher percentage of patients with a caring responsibility 23.9% when compared to the practice average across England 18.2%.

The staff team comprises two full time male GP partners. The practice employs a female salaried GP who provides two morning clinics per week. The practice team includes a nurse practitioner and a practice nurse and two healthcare assistants who work part time. There is one full time dispenser and four staff members able to provide dispensary assistance, one of which also has a receptionist role and another a healthcare assistant role. The practice is supported by a practice manager, five receptionists and administrative support staff and a cleaner. In total there are 18 staff employed either full or part time hours. The practice offers access to a community coordinator, a local CCG initiative, where staff sign post patients or their families/carers to various local organisations to promote and enable independent living.

The practice is open Monday to Friday 8am to 6pm. They close at 1pm to 2pm, however, phone lines remain open. The dispensary remains open until 6.30pm Monday to Friday. The practice does not provide an out-of-hours service to its own patients but has alternative arrangements for patients to be seen when the practice is closed through Shropdoc, the out-of-hours service provider. The practice telephones switch to the out-of-hours service at 6pm each weekday evening and at weekends and bank holidays.

The practice has a General Medical Services (GMS) contract with NHS England. This is a contract for the practice to deliver general medical services to the local community or communities. They also provide some Directed Enhanced Services, for example they are a dispensing practice, offer minor surgery and the childhood vaccination and immunisation scheme and for their patients.

Updated 14 December 2017

Letter from the Chief Inspector of General Practice

This practice is rated as Good overall. (Previous inspection 4 November 2015 – Good)

The key questions are rated as:

Are services safe? – Good

Are services effective? – Good

Are services caring? – Good

Are services responsive? – Good

Are services well-led? - Good

As part of our inspection process, we also look at the quality of care for specific population groups. The population groups are rated as:

Older People – Good

People with long-term conditions – Good

Families, children and young people – Good

Working age people (including those recently retired and students – Good

People whose circumstances may make them vulnerable – Good

People experiencing poor mental health (including people with dementia) - Good

We carried out an announced comprehensive inspection at Knockin Medical Centre on 15 November 2017 as part of our inspection programme.

At this inspection we found:

• The practice had clear systems to manage risk so that safety incidents were less likely to happen. When incidents did happen, the practice learned from them and improved their processes.

• The practice routinely reviewed the effectiveness and appropriateness of the care it provided. It ensured that care and treatment was delivered according to evidence- based guidelines.

• Staff involved and treated patients with compassion, kindness, dignity and respect.

• Patients found the appointment system easy to use and reported that they were able to access care when they needed it.

• There was a strong focus on continuous learning and improvement at all levels of the organisation.

The areas where the provider should make improvements are:

• Include a copy of the care management plan nurses provided to patients in the patient record.

• Include timescales for actions to be completed following an infection prevention and control audit.

• Consider how consent for patients attending for an intrauterine coil insertion is documented.

• Implement structured clinical supervision and consider clinical audits to monitor the ongoing competence of staff employed in advanced roles.

• Include equality and diversity training for all staff.

• Develop a practice training policy/protocol that outlines the training considered by the practice to be mandatory taking account of professional best practice and the training expectations of clinical commissioning group (CCG).

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.
• Patients with long-term conditions had a named GP and a structured annual review to check that their health and medicines needs were being met. For those patients with the most complex needs, the named GP worked with relevant health and care professionals to deliver a multidisciplinary package of care.

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.
• 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 practice’s uptake for the cervical screening programme was 84.78%, which was comparable to the national average of 81.88%.
• Appointments were available outside of school hours and the premises were suitable for children and babies.

We saw good examples of joint working with midwives, health visitors and school nurses.

Updated 7 January 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.
• It was responsive to the needs of older people, and offered home visits and urgent 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 and telephone services as well as a full range of health promotion and screening that reflects the needs for this age group.

Updated 7 January 2016

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

• The dementia diagnosis rate was better than the national average. For example, the 2013 to 2014 data showed that the percentage of patients diagnosed with dementia whose care has been reviewed in a face-to-face review in the preceding 12 months was 100%, compared with the national average of 83.82%.
• The practice regularly worked with multi-disciplinary teams in the case management of people experiencing poor mental health, including those with dementia.
• It carried out advance care planning for patients with dementia.
• The practice had told patients experiencing poor mental health about how to access various support groups and voluntary organisations,.
• It had a system in place to follow up patients who had attended accident and emergency where they may have been experiencing poor mental health.
• Staff had a good understanding of how to support people with mental health needs and dementia.
• The practice understood the needs of patients who self-harm and monitored, completed regular reviews and communicated with secondary care providers, such as consultant psychiatrists.

Updated 7 January 2016

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.
• It offered longer appointments for patients with a learning disability and sign posted vulnerable patients in how to access various support groups and voluntary organisations.
• The practice regularly worked with multi-disciplinary 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.