Archived: Kelsall Medical Centre

Updated 18 July 2017

Kelsall Medical Centre is responsible for providing primary care services to approximately 5,000 patients. The practice is situated in Church Street in the village of Kelsall, Cheshire. The practice has a medication dispensary. The practice is based in an area with lower levels of economic deprivation when compared to other practices nationally. The practice has a predominantly rural community. Approximately 9% of patients are over the age of 75. The practice was registered with the Care Quality Commission in September 2016.

The staff team includes one partner GP, three salaried GPs, two practice nurses, a health care assistant, a recently appointed practice manager and administration and reception staff. There are both male and female GPs. The nursing team and health care assistant are female.

Kelsall Medical Centre is open from 8am to 6.30pm Monday to Friday. An extended hour’s service for routine appointments and an out of hour’s service are commissioned by West Cheshire CCG and provided by Cheshire and Wirral Partnership NHS Foundation Trust Patient facilities are on the ground floor. The practice has limited on-site parking.

The practice has a General Medical Service (GMS) contract. The practice offers a range of enhanced services including, minor surgery, spirometry, near patient testing and anticoagulation.

We identified that the practice is carrying out minor surgery at a location where it is not registered to do so. We were therefore unable to inspect the premises at which this regulated activity takes place. We advised the registered manager to address this without delay to ensure that the registration is legally correct.

Updated 18 July 2017

Letter from the Chief Inspector of General Practice

We carried out an announced comprehensive inspection at Kelsall Medical Centre on 7 June 2017.

Overall the practice is rated as good.

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

• There were systems in place to reduce risks to patient safety, for example, equipment and premises checks were carried out and there were systems to prevent the spread of infection.

• Staff understood and fulfilled their responsibilities to raise concerns and report incidents and near misses. Staff were aware of procedures for safeguarding patients from the risk of abuse.
• Patients’ needs were assessed and care was planned and delivered following best practice guidance.

• Staff felt supported and they had access to training and development opportunities appropriate to their roles.

• Patients said they were treated with compassion, dignity and respect. We saw staff treated patients with kindness and respect.

• Services were planned and delivered to take into account the needs of different patient groups.

• There was a system in place to manage complaints.

• There were systems in place to monitor and improve quality and identify risk.

The areas where the provider should make improvements are:

• The system for reviewing medication should be reviewed to ensure it is more robust.

• Make a record of the in-house checks of cleaning standards.
• Ensure staff recruitment records contain evidence of information having been gathered about any physical or mental conditions which were relevant (after reasonable adjustments) to the role the person was being employed to undertake.
• Develop a system to ensure all the required recruitment and training information is available for locum GPs.

• A planned programme of audits should be put in place.

• The salaried GPs should have an in-house appraisal in addition to the external appraisal process.
• Provide a more comprehensive record of the induction provided to staff.

Professor Steve Field (CBE FRCP FFPH FRCGP) 

Chief Inspector of General Practice

Updated 18 July 2017

The practice is rated as good for the care of people with long-term conditions. The practice held information about the prevalence of specific long term conditions within its patient population such as diabetes, chronic obstructive pulmonary disease (COPD), cardio vascular disease and hypertension. This information was reflected in the services provided, for example, reviews of conditions and treatment, screening programmes and vaccination programmes. The practice had a system in place to make sure patients received regular reviews for long term conditions. The clinical team took the lead for different long term conditions. The practice had multi-disciplinary meetings to discuss the needs of palliative care patients and patients with complex needs. The practice worked with other agencies and health providers to provide support and access to specialist help when needed.

Updated 18 July 2017

The practice is rated as good for the care of families, children and young people. Child health surveillance and immunisation clinics were provided. Priority was given to young children who needed to see the GP and appointments were available outside of school hours. The staff we spoke with had appropriate knowledge about child protection and how to report any concerns. Child health promotion information was available on the practice website and in leaflets displayed in the waiting area. Family planning and sexual health services were provided.

Updated 18 July 2017

The practice is rated as good for the care of older people. T he practice kept up to date registers of patients’ health conditions and used this information to plan reviews of health care and to offer services such as vaccinations for flu and shingles. The practice worked with other agencies and health providers to provide support and access specialist help when needed. The GPs visited housebound patients to carry out reviews of patients’ health. The practice was working with neighbourhood practices and the Clinical Commissioning Group (CCG) to provide services to meet the needs of older people. The practice shared a daily ward round at Tarporley War Memorial Hospital with its neighbourhood practices. This provision meant that patients had access to care and treatment in a timely manner and avoided duplication of visits. A GP visited a local care home weekly to review patients and monitor the progress of patients approaching the end of their lives. The dispensary provided home delivery of medication to patients who were unable to collect them.

Updated 18 July 2017

The practice is rated as good for the care of working-age people (including those recently retired and students). The practice appointment system and opening times provided flexibility to working patients and those in full time education. The practice was open from 8am to 6.30pm Monday to Friday. Patients could book routine appointments in person, via the telephone and on-line. Telephone consultations were offered and an E Consult system allowing patients to access healthcare advice when the practice was closed. The practice website provided information around self-care and local services available for patients. The practice offered health promotion and screening that reflected the needs of this population group such as cervical screening, contraceptive services, smoking cessation advice and family planning services. Reception staff sign-posted patients who did not necessarily need to see a GP. A phlebotomy service was also provided at the practice which meant that patients did not have to travel to receive this service.

Updated 18 July 2017

The practice is rated as good for the care of people experiencing poor mental health (including people with dementia). The practice maintained a register of patients who experienced poor mental health. The register supported clinical staff to offer patients experiencing poor mental health, including dementia, an annual health check and a medication review. The practice had also identified patients at high risk due to their poor mental health and checked that these patients were seen for a review and that their records were monitored to maintain an overview of their well-being. The practice worked with multi-disciplinary teams in the case management of people experiencing poor mental health, including those with dementia. The practice referred patients to appropriate services such as psychiatry and counselling services.

Updated 18 July 2017

The practice is rated as good for the care of people whose circumstances may make them vulnerable. The practice identified vulnerable patients through multi-disciplinary meetings. A register was kept of patients who were vulnerable. The practice supported a service providing assisted accommodation to men with poor mental health and learning disabilities and provided a clinic every 2-3 months which promoted continuity of patient care. The staff we spoke with had appropriate knowledge about safeguarding vulnerable adults and children and there was a system in place to keep this training updated. Se rvices for carers were publicised and a record was kept of carers to ensure they had access to appropriate services. A member of staff acted as a carer’s link and they were working to identify carers and promote the support available to them through organisations such as the Carers Trust. The practice referred patients to local health and social care services for support, such as drug and alcohol services and to the wellbeing coordinator.