Kepier Medical Practice

Updated 29 March 2016

Kepier Medical Practice is located in the Houghton–le-Spring area of Tyne and Wear to the South of the River Wear. The practice provides care and treatment to 8,554 patients from Houghton le Spring and the surrounding areas of Penshaw, Shiney Row, New Herrington, Philadelphia, Fencehouses, Burnside, East Herrington, West Herrington, Newbottle and East Rainton. It is part of the NHS Sunderland Clinical Commissioning Group (CCG) and operates on a Personal Medical Services (GMS) contract.

The practice provides services from the following address, which we visited during this inspection:

Kepier Medical Practice, Leyburn Grove, Houghton le Spring, DH4 5EQ

The practice is located in purpose built premises which were built in 2001. All reception and consultation rooms are fully accessible for patients with mobility issues. There are two large on-site car parks with dedicated disabled parking bays. A local taxi bus runs from the practice car park to the nearby town centre and local areas. There is a pharmacy adjacent to the practice.

The practice is open from 8.30am to 6.30pm on a Monday to Friday with appointments running from 9am to 11.20am and 3.20pm to 5.20pm.

The service for patients requiring urgent medical attention out-of-hours is provided by the NHS 111 service and Northern Doctors Urgent Care Limited (NDUC).

Kepier Medical Practice offers a range of services and clinic appointments including chronic disease management clinics, antenatal clinics, childhood health surveillance and immunisations, travel vaccinations, teenage sexual health, smoking cessation, drug and alcohol dependency and minor surgery. The practice is a training practice and provides training to GP registrars (fully qualified doctors with experience of hospital medicine who are training to become a GP).

The practice consists of:

• Five GP partners (two male and three female)
• Three salaried GPs (all female)
• Two practice nurses (both female)
• Two practice pharmacists
• A Health Care Assistant
• 14 non-clinical members of staff including a practice manager, assistant manager, administration/reception/secretarial staff and a cleaner

The area in which the practice is located is in the fourth (out of ten) most deprived decile. In general people living in more deprived areas tend to have greater need for health services.

The practice’s age distribution profile showed slightly more patients than the national average in all ager groups over the age of 45. Average life expectancy for the male practice population was 77 (national average 79) and for the female population 80 (national average 83).

Updated 29 March 2016

Letter from the Chief Inspector of General Practice

We carried out an announced comprehensive inspection at Kepier Medical Practice on 20 January 2016. Overall the practice is rated as good.

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

• Staff understood and fulfilled their responsibilities to raise concerns, and to report incidents and near misses.
• Risks to patients were assessed and generally well managed. The exception to this was the practices failure to carry out fire evacuation drills.
• The practice carried out clinical audit activity and were able to demonstrate improvements to patient care as a result of this.
• The majority of patients said they were treated with compassion, dignity and respect.
• Urgent appointments were usually available on the day they were requested.
• The practice had a number of policies and procedures to govern activity, which were reviewed and updated regularly
• The practice had proactively sought feedback from patients and had an active patient participation group.
• Information about services and how to complain was available and easy to understand.
• The practice was aware of patient dissatisfaction in respect of the appointment system and access to appointments but were taking steps to try and improve.
• The practice had effective systems in place to support patients with long term conditions. They offered an in house type 2 diabetes insulin initiation service and ensured that patients undergoing initiation were given the mobile phone number for the lead GP for diabetes.

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

Importantly, the provider should:

• Carry out annual fire evacuation drills
• Carry out a risk assessment documenting why it has not been felt necessary for all non-clinical staff to undertake Disclosure and Barring Service (DBS) checks)
• Obtain suitable references for all newly appointed staff prior to commencement of employment
• Comply with their own procedure in respect of cleaning/replacing privacy curtains in consultation rooms
• Safely secure cord/chain mechanisms on vertical blinds to reduce the risk of accidental choking for small children.

Professor Steve Field (CBE FRCP FFPH FRCGP) 

Chief Inspector of General Practice

Updated 29 March 2016

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

Longer appointments and home visits were available when needed. The practice’s computer system was used to flag when patients were due for review. This helped to ensure the staff with responsibility for inviting people in for review managed this effectively. Patients with multiple long term conditions were offered a comorbidity review

Practice nurses were supported in undertaking additional training to help them understand and care for patients with certain long term conditions, such as chronic obstructive pulmonary disease (COPD) and asthma. Smoking cessation advice was available from the practice nurse. The practice had a proactive approach to treating patients with diabetes by ensuring they were offered a review with a GP and by offering a type 2 diabetes insulin initiation service. Patients undergoing initiation were well supported and were given the mobile phone number for the lead GP for diabetes.

The practice regularly referred patients to other services such as local wellbeing ‘Sit ‘N’ ‘B’ Fit’ classes and the recovery at home service. The recovery at home service supported patients who needed short term health or social care support at home rather than them having to stay in or be admitted to hospital or long term care facilities.

Nationally reported Quality and Outcomes Framework (QOF) data (2014/15) showed the practice had achieved good outcomes in relation to some of the conditions commonly associated with this population group. For example:

• The practice had obtained 100% of the points available to them for providing recommended care and treatment for patients with asthma. This was 2.9 percentage points above the local CCG average and 2.6 points above the national average.
• The practice had obtained 100% of the points available to them in respect of hypertension. This was 0.5 percentage points above the local CCG average and 2.2 points above the national average. The practice had engaged in a transformation programme to improve GP capacity by training nursing staff and health care assistants to manage and monitor hypertensive patients with GP oversight.

Updated 29 March 2016

The practice is rated as good for the care of families, children and young people.

The practice had identified the needs of families, children and young people, and put plans in place to meet them. There were processes in place for the regular assessment of children’s development. This included the early identification of problems and the timely follow up of these. Systems were in place for identifying and following-up children who were considered to be at-risk of harm or neglect. For example, the needs of all at-risk children were regularly reviewed at practice multidisciplinary meetings involving child care professionals such as health visitors.

Appointments were available outside of school hours and the premises were suitable for children and babies. Arrangements had been made for new babies to receive the immunisations they needed. Vaccination rates for 12 month and 24 month old babies and five year old children were comparable with national averages. For example, childhood immunisation rates for the vaccinations given to two year olds ranged from 95.3% to 98.8% (compared with the CCG range of 96.2% to 98.9%). For five year olds this ranged from 94.6% to 98.9% (compared to CCG range of 31.6% to 98.9%).

Information from the National Cancer Intelligence Network (NCIN) published in March 2015 indicated that 81.5% of the 1761 female patients aged between 25 and 64 listed with the practice had attended cervical screening (compared to the CCG average of 77.2% and national average of 74.3%).

Pregnant women were able to access antenatal clinics provided by healthcare staff attached to the practice. The practice GPs carried out post-natal mother and baby checks and routinely followed up non-attenders.

The practice was participating in locality projects around childhood obesity and teenage sexual health and participated in the C card scheme (a scheme which entitled young people to free condoms, chlamydia testing and advice on drugs, alcohol and sexual health). The practice had a dedicated youth section on their website.

Updated 29 March 2016

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

Nationally reported data showed the practice had good outcomes for conditions commonly found amongst older people. For example, the practice had obtained 100% of the points available to them for providing recommended care and treatment for patients with heart failure. This was above the local clinical commissioning group (CCG) average of 98.7% and the England average of 97.9%.

Patients aged over 75 had a named GP and the practice offered immunisations for pneumonia and shingles to older people. The practice had a palliative care register and held regular multi-disciplinary meetings to discuss and plan end of life care.

The practice was participating in a local care homes integrated team’s project. This project involved working collaboratively with multi-agency practitioners to improve services available locally for elderly patients to reduce the number of non-urgent admissions to hospital. The practice told us that by working collaboratively with community nurses, pharmacists, podiatrists, dieticians and social workers they had seen a 44% reduction in the number of emergency admissions to hospital from their care homes.

The practice held open days where flu vaccinations were availalble as well support and advice from organisations such as the Citizens Advice Bureau and emotional and mental health support services. The practice also arranged home visits to local nursing homes to deliver flu vaccination sessions.

Updated 29 March 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 met. The practice was open from 8.30am to 6pm on a Monday to Friday although appointments were only available from 9am to 11.30am and 3.20pm to 5.20pm. However, the practice also offered same day and pre bookable telephone consultations to aid patients who worked or were unable to physically attend the surgery.

The practice offered minor surgery, contraceptive services, travel health clinics, smoking cessation and NHS health checks (for patients aged 40-74). The practice had installed a blood pressure machine in the waiting area which patients could use to record their own blood pressure. A system was in place where the results were then recorded on a patient’s record and reviewed by a clinical member of staff if the results fell within a certain range to determine whether further action was required.

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. Patients could opt to receive text message appointment reminders.

Updated 29 March 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 whose care had been reviewed in a face to face meeting in the last 12 months was 82%. This was in line with the national average of 84%.

Patients experiencing poor mental health were sign posted to various support groups and third sector organisations, such as local wellbeing and psychological support services. The practice hosted counsellors from the local charity which provides confidential support services for people experiencing emotional or mental health problems two sessions per week.

The practice worked closely with multi-disciplinary teams in the case management of people experiencing poor mental health including those with dementia. They had been awarded the ‘Dementia Friends’ accreditation and staff had undertaken dementia awareness training. Patients with dementia, and their carers were regularly signposted to a local service for support and advice.

Updated 29 March 2016

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

The practice held a register of patients living in vulnerable circumstances, including those with a learning disability. Patients with learning disabilities were invited to attend the practice for annual hour long health check with a GP and a nurse. They were also routinely offered longer appointments.

The practice had established effective working relationships 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 and out of hours.

The practice was proactive in identifying and supporting carers. Carers were offered an annual health check, flu vaccination and referral to the local carers centre.

The practice hosted representatives from the Citizens Advice Bureau twice per week who were able to provide patients with advice on issues such as debt management and relationship issues.