Kiltearn Medical Centre

Updated 25 August 2017

Kiltearn Medical Centre is responsible for providing primary care services to approximately 13,400 patients. The practice is situated in Nantwich, Cheshire. Services are provided from a purpose built building in Nantwich town centre. Co-located with the practice are other GP practices and a pharmacy. The practice is based in an area with lower levels of economic deprivation when compared to other practices nationally. The practice has an above average number of older patients compared to local and national averages.

The practice is managed by six GP partners. In addition there are two salaried GPs. There is a team of nursing staff including an advanced nurse practitioner and healthcare assistants. There are both male and female clinical staff. They are supported by a team of management, reception and administrative staff.

Kiltearn Medical Centre is open from 8am to 6pm Monday to Friday. Extended hours are provided Wednesday morning 7am to 8am, Thursday evening 6.30pm to 8pm and Saturday morning from 9am to 12pm. Patient facilities are located on the ground floor. There are car parks close to the practice. Patients requiring a GP outside of normal working hours are advised to contact the GP out of hours service, by calling 111.

The practice has a General Medical Service (GMS) contract. The practice offers a range of enhanced services including avoiding unplanned hospital admissions, minor surgery, timely diagnosis of dementia and flu and shingles vaccinations.

We undertook a comprehensive inspection of Kiltearn Medical Centre 11 November 2016. The practice was rated as good overall and good for all outcome areas. However a requirement notice was made as improvements were needed to patient access.

Updated 25 August 2017

Letter from the Chief Inspector of General Practice

We carried out an announced comprehensive inspection at Kiltearn Medical Centre on 11 November 2015. The overall rating for the practice was good, however a requirement notice was made as improvements were needed to patient access. The full comprehensive report on the November 2015 inspection can be found by selecting the ‘all reports’ link for Kiltearn Medical Centre on our website at www.cqc.org.uk.

This inspection was undertaken on 20 June 2017 and was an announced comprehensive inspection.

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 checks were carried out, there were systems to protect patients from the risks associated with insufficient staffing levels and 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. 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.

• Access to the service was monitored and significant improvements had been made.

• There was a system in place to manage complaints.

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

Professor Steve Field (CBE FRCP FFPH FRCGP) 

Chief Inspector of General Practice

Updated 25 August 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 ensure regular reviews of patients with long term conditions. The advanced nurse practitioner and nurse practitioner supported patients with complex long term conditions at home and at the practice. The practice worked with community services to provide chronic disease management outreach services to vulnerable and housebound patients. Patients with long term conditions and who were at risk of an unplanned hospital admission were reviewed by the practice nurse following an unplanned hospital admission. This review included an assessment of clinical needs, medication review and social support. The practice pharmacist provided chronic disease clinics and visited housebound patients with medication related issues. The pharmacist had also completed a pain management and medicines qualification to assist with reviewing patient medication. The practice worked with other agencies and health providers to provide support and access to specialist help when needed.

Updated 25 August 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 children and young people who needed to see the GP. Child health promotion information was available on the practice website and in leaflets displayed in the waiting area. The advanced nurse practitioner had undertaken a paediatric training course to enable them to manage common childhood conditions. An outreach clinic was provided at a local college and the advanced nurse practitioner liaised with the college to register students away from home for the first time and who had multiple medical needs. The Patient Participation Group had young patients to represent the views of this population group. Family planning and sexual health services were provided. Gynaecological clinics were led by female GPs and longer appointments were available.

Updated 25 August 2017

The practice is rated as good for the care of older people. The practice kept 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. GPs visited three local nursing homes weekly. V isits were carried out by the same clinicians to provide continuity and these clinicians were available for senior care home staff for advice and guidance outside of these visits. Quarterly meetings with other local GP practices were attended to share best practice within the care home setting. Care plans were in place for all care home residents to support their health and well-being. The practice pharmacist undertook reviews of older patients who were prescribed multiple medications and also supported patients who had difficulty accessing their prescriptions. The practice worked with other agencies and health providers to provide support and access specialist help when needed. Multi-disciplinary meetings were held to discuss and plan for the care of frail and elderly patients.

Updated 25 August 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 6pm Monday to Friday. Extended hours were provided Wednesday morning 7am to 8am, Thursday evening 6.30pm to 8pm and Saturday morning from 9am to 12pm. Patients could book routine appointments in person, via the telephone and on-line. Repeat prescriptions could be ordered on-line or by attending the practice. Telephone consultations were also offered. Mobile phone texts were made to remind patients about appointments and reduce missed appointments and for some test results. The practice offered health promotion and screening that reflected the needs of this population group such as cervical screening, NHS health checks, contraceptive services, smoking cessation advice and family planning services.

Updated 25 August 2017

The practice is rated as good for the care of people experiencing poor mental health (including people with dementia). GPs worked with specialist services to review care and to ensure patients received the support they needed. 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 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 memory clinics, psychiatry and counselling services. Patients were also signposted to relevant services such as Age UK, and the Alzheimer’s Society and were offered resources such as talking therapies and on-line self-help resources.

Updated 25 August 2017

The practice is rated as good for the care of people whose circumstances may make them vulnerable. A register was kept of patients with a learning disability and there was a system to ensure these patients received an annual health check. This check was offered at home or at the practice and there was flexibility in appointment length. Alerts were placed on the records of vulnerable patients and longer appointments were offered. The staff we spoke with had appropriate knowledge about safeguarding vulnerable adults and children 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. The practice referred patients to local health and social care services for support, such as drug and alcohol services and to Alternative Solutions for support with social issues that were having a detrimental impact upon their lives. Alternative Solutions were available at the practice on a weekly basis and were available for support following self or referral by a clinician.