The Knoll Surgery

Updated 5 October 2017

The Knoll Surgery is responsible for providing primary care services to approximately 12,170 patients. The practice is situated in Princeway Health Centre in Frodsham, Cheshire. There is a branch practice which is situated in the village of Kingsley, approximately three miles from the main health centre. A medication dispensary service is provided at The Knoll Surgery and medication for acute conditions is dispensed from the branch practice. The practice is based in an area with lower levels of economic deprivation when compared to other practices nationally.

The staff team includes eight partner GPs and a partner who is the manager of the service. A nurse clinician, three practice nurses, two health care assistants, a phlebotomist, practice manager, administration, reception and medication dispensary staff. The Knoll Surgery is open 8am to 6.30pm Monday to Friday. The branch practice is open one afternoon and four mornings each week. The dispensary services are open the same hours as the practices. 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. The extended hour’s service is based in the nearby village of Helsby on Monday and Tuesday evenings.

The practice has a General Medical Services (GMS) contract. The practice offers a range of enhanced services such, minor surgery, timely diagnosis of dementia and avoidance of unplanned hospital admissions.

Updated 5 October 2017

Letter from the Chief Inspector of General Practice

We carried out an announced comprehensive inspection of The Knoll Surgery on 2 November 2016. The overall rating for the practice was good. However, the practice was rated as requires improvement for providing safe services. The full comprehensive report on the November 2016 inspection can be found by selecting the ‘all reports’ link for The Knoll Surgery on our website at www.cqc.org.uk.

This inspection was a desk-based review carried out on 23 August 2017 to confirm that the practice had carried out their plan to meet the legal requirements in relation to the breaches in regulation that we identified at our previous inspection on 2 November 2016. This report covers our findings in relation to those requirements and additional improvements made since our last inspection.

Overall the practice is rated as good and now as good for providing safe services.

Our key findings were as follows:

• Action had been taken to improve the safety of the premises.

In addition, the practice had made the following improvements:

• Action had been taken to improve the security of medication at the branch practice

• The system for ensuring that the protocol around the safe management of vaccines had been reiterated to relevant staff.

• Checks of the stocks of controlled drugs were continuing to be carried out by two staff members.

• The system for identifying dispensing errors and monitoring uncollected prescriptions had been reviewed.

• The system for ensuring staff were provided with the training needed for their roles had been improved.

The areas where the provider should make improvements are:

• Carry out and document weekly in-house checks of the fire alarm and monthly checks of the emergency lighting.

• A copy of the report to confirm the electrical witring at the branch practice is satisfactory should be forwarded to CQC.

Professor Steve Field (CBE FRCP FFPH FRCGP) 

Chief Inspector of General Practice

Updated 18 January 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 no patient missed their regular reviews for long term conditions. Long term conditions were often managed by combining appointments on the same day such as blood tests and medication reviews to reduce the need for multiple appointments. The clinical staff took the lead for different long term conditions and kept up to date in their specialist areas. The practice had monthly multi-disciplinary meetings and weekly clinical meetings to discuss the needs of palliative care patients and patients with complex needs. Alerts were added to patient records to notify reception staff about the specific needs of a patient with a long term condition, such as the need for the patient to see a particular clinician to ensure continuity. The practice worked with other agencies and health providers to provide support and access specialist help when needed. The practice provided information to patients to encourage them to manage their long term conditions and patients were also referred to educational courses on how to manage their conditions.

Updated 18 January 2017

The practice is rated as good for the care of families, children and young people. Child health surveillance and immunisation clinics were provided. Appointments for young and unwell children were prioritised. Telephone consultations for parents worried about their child’s health were offered were this was sooner than an appointment. The staff we spoke with had appropriate knowledge about child protection and how to report any concerns. The practice liaised with the school health team, midwives and health visiting service to discuss any concerns about children and their families and how they could be best supported. 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 January 2017

The practice is rated as good for the care of older people. They 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 practice prioritised patients who may be at risk of poor health due to frailty. Following a medical event such as unplanned hospital attendance the medical needs of these patients were reviewed to identify what could be put in place to prevent future ill-health or hospital admission. The practice was working with neighbourhood practices and the CCG to provide services to meet the needs of older people. They provided an Early Visiting Service to improve patient access to GP services and to the resources needed to support patients at home with the aim of reducing emergency admissions to hospital and use of emergency services. Working with the CCG, neighbouring practices and a local nursing home a service had been recently introduced to avoid unplanned hospital admission by using the nursing home service to support patients who were too frail to remain at home but did not require hospital admission. Monthly meetings between the integrated care team, practice nurses and GPs took place to review the needs of older patients with complex needs and share information. A free delivery service was provided to patients who used the dispensary provided by the practice.

Updated 18 January 2017

The practice is rated as good for the care of working-age people (including those recently retired and students). The practice offered pre-bookable appointments, book on the day appointments and telephone consultations. Patients could order repeat prescriptions and book appointments on-line which provided flexibility to working patients and those in full time education. An automated telephone system enabled patients to book, check or cancel an appointment 24 hours a day. The practice was open from 8am to 6.30pm Monday to Friday allowing early morning and late evening appointments to be offered to this group of patients. The branch practice was open one afternoon and four morning a week allowing patients to access this service also. An extended hour’s service for routine appointments was commissioned by West Cheshire CCG. The practice was also planning to offer extended hour opening from 7am to 8am. The practice website provided information around self-care and local services available for patients.

Updated 18 January 2017

The practice is rated good for the care of people experiencing poor mental health (including people with dementia). The practice maintained a register of patients receiving support with their mental health. Patients experiencing poor mental health were offered an annual review. The practice worked with multi-disciplinary teams in the case management of people experiencing poor mental health, including those with dementia. Alerts were placed on patient records to identify patients who had complex needs or were best treated by their own GP to ensure continuity of care. The practice referred patients to appropriate services such as psychiatry and counselling services. The practice had information in the waiting areas about services available for patients with poor mental health. For example, services for patients who may experience depression.

Updated 18 January 2017

The practice is rated as good for the care of people whose circumstances may make them vulnerable. P atients’ electronic records contained alerts for staff regarding patients requiring additional assistance. For example, if a patient had a learning disability to enable appropriate support to be provided. The staff we spoke with had appropriate knowledge about safeguarding vulnerable adults and all staff had safeguarding training relevant to their role. 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.