Dr Dale S Kinnersley & Partner Also known as Old School Surgery

Updated 16 September 2016

Dr Dale S Kinnersley & Partner, also known as the Old School Surgery is a GP practice located in the village of Chartham Kent. It provides care for approximately 5700 patients. The practice is in a rural area.

There are two partners, one a GP and the other a nurse. The nurse also fulfils the role of practice manager. There is one salaried GP. There is one further practice nurse.

Generally the age of the population the practice serves is close to the national averages. However there are two age groups, 9 – 19 and 40 – 54 years, where the populations are greater than the national average. This is probably due to a large private estate, built in the late 1990s, of family accommodation. The majority of the patients describe themselves as white British. Income deprivation and unemployment are low. Although the practice as a whole is not in an area of deprivation there are pockets of rural deprivation within it.

The practice has a general medical services contract with NHS England for delivering primary care services to local communities. The practice offers a full range of primary medical services and is able to provide, at the branch surgery, pharmaceutical services to those patients on the practice list who live more than one mile (1.6km) from their nearest pharmacy premises. The practice is not a training practice.

The practice is staffed between 8am and 6.30pm Monday to Friday. Between the two branches the practice open between 8.30am and 4pm on Mondays and Wednesdays, 8.30am and 6.30pm Tuesdays and Fridays, 8.30am and 5pm on Thursdays. There is an extended hours surgery every Saturday from 8.30am to 11.30am. There are frequent evening GP and nurse clinics, with appointments arranged to meet the needs of patients with long term conditions. The surgery building is a converted school house with consulting, treatment rooms and administration rooms on the ground floor.

Services are provided from

Old School Surgery,

Bolts Hill

Chartham

Canterbury,

Kent,

CT4 7JY

There is a branch surgery at

The Surgery,

Branch Road,

Chilham ,

Canterbury Kent,

CT4 8DR

We visited both surgeries as part of our inspection

The practice has opted out of providing out-of-hours services to their own patients. This is provided by Integrated Care 24. There is information, on the practice building and website, for patients on how to access the out of hours service when the practice is closed. The practice still provides out of hours services to their patients who live at a care home and a nursing home within their practice area.

Updated 16 September 2016

Letter from the Chief Inspector of General Practice

We carried out an announced comprehensive inspection at Dr Dale S Kinnersley & Partner on 2 June 2016. Overall the practice is rated as good.

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

• There was an open and transparent approach to safety and an effective system for reporting and recording significant events.
• Risks to patients were assessed and well managed.
• Staff assessed patients’ needs and delivered care in line with current evidence based guidance. Staff had been trained to provide them with the skills, knowledge and experience to deliver effective care and treatment.
• Patients said they were treated with compassion, dignity and respect and they were involved in their care and decisions about their treatment.
• Information about services and how to complain was available and easy to understand. Improvements were made to the quality of care as a result of complaints and concerns.
• Patients said they found it easy to make an appointment with a named GP and there was exceptional continuity of care, with urgent appointments available the same day.
• The practice had good facilities and was well equipped to treat patients and meet their needs.
• There was a clear leadership structure and staff felt supported by management. The practice proactively sought feedback from staff and patients, which it acted on.
• The provider was aware of and complied with the requirements of the duty of candour.

We saw areas of outstanding practice:

• In the most recent national survey 93% of patients who responded said that they saw or spoke to their preferred GP compared to the local and national averages of 65% and 59% respectively.

• Other surveys and comments made during the inspection consistently rated practice very highly for its caring approach.

• The practice still provided out of hours services to their patients who lived at a care home and a nursing home within the practice area. Staff at these homes and patients at the end of their lives had telephone numbers that enabled the GPs to be contacted at any time.

• There was evidence that the practice staff supported patients who were vulnerable, such as the housebound, with practical and social, as well as medical needs.

• When unplanned admissions were discussed, as they were each month, discussion about the health and welfare of any carers of those patients was a standing agenda item.

We saw one area where the provider should make improvements:

• The practice should consider recording near misses as reviewing helps to reduce the risk of errors in the future.

Professor Steve Field (CBE FRCP FFPH FRCGP) 

Chief Inspector of General Practice

Updated 16 September 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.
• Quality and outcomes framework data for diabetes showed that the practice had achieved 85% of the available points which was four percentage points below the national average.
• Longer appointments and home visits were available when needed.
• All these patients had a named GP and a structured annual review to check 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 16 September 2016

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

• There were systems 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 comparable to the national results for all standard childhood immunisations.
• The practice’s uptake for the cervical screening programme was 82%, which was comparable to the CCG average of 83% and the national average of 83%.
• Appointments were available outside of school hours and the premises were suitable for children and babies.

Updated 16 September 2016

The practice is rated as good for being well-led.

• The practice had a clear vision and strategy to deliver high quality care and promote good outcomes for patients. Staff were clear about the vision and their responsibilities in relation to it.
• There was a clear leadership structure and staff felt supported by management. The practice had a number of policies and procedures to govern activity and held regular staff and governance meetings.
• There was an overarching governance framework which supported the delivery of the strategy and good quality care. This included arrangements to monitor and improve quality and identify risk.
• The provider was aware of and complied with the requirements of the duty of candour. The partners encouraged a culture of openness and honesty. The practice had systems for reporting safety incidents and shared this information with staff to help that ensure appropriate action was taken
• The practice sought feedback from staff and patients, which it acted on. The patient participation group was active.
• There was a strong focus on continuous learning and improvement at all levels.

Updated 16 September 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 services as well as a full range of health promotion and screening that reflects the needs for this age group.
• The practice arranged evening clinics when needed for working age patients whose conditions needed monitoring or treatment.

Updated 16 September 2016

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

• 74% of patients diagnosed with dementia had had their care reviewed in a face to face meeting in the 12 months to April 2015. This was less than the national average of 84%. The practice provided evidence from the more recent QOF submission (not validated) that the figure to April 2016 was 90%. Moreover the practice had improved the diagnosis and recording of dementia significantly over the last two years.
• 90% of patients diagnosed with schizophrenia, bipolar affective disorder and other psychoses had had their care reviewed in a face to face meeting in the last 12 months, which was more than the local average of 83%.
• The practice regularly worked with multi-disciplinary teams in the case management of patients experiencing poor mental health, including those with dementia.
• The practice 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.
• The practice had a system 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 patients with mental health needs and dementia.

Updated 16 September 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.
• The practice offered longer appointments for patients with a learning disability.
• The practice regularly worked with other health care professionals in the case management of vulnerable patients.
• The practice informed vulnerable patients about how to access various support groups and voluntary organisations.
• 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.