Kingswinford Medical Practice

Updated 7 February 2017

Kingswinford Medical Practice is a long established practice located in the Kingswinford area of Dudley, in the West Midlands. There are approximately 7,720 patients of various ages registered and cared for at the practice. Services to patients are provided under a General Medical Services (GMS) contract with NHS England. The practice has expanded its contracted obligations to provide enhanced services to patients. An enhanced service is above the contractual requirement of the practice and is commissioned to improve the range of services available to patients.

The clinical team includes three female GP partners and a female salaried GP, an advanced nurse practitioner, four practice nurses including a nurse prescriber and a health care assistant. The GP partners, practice business manager and deputy practice manager form the management team and they are supported by a team of 11 support staff who cover reception, secretarial and administration roles. The practice is also an approved training practice and provides training to GP Registrars as part of their ongoing training and education, second year student nurses from the University of Wolverhampton and placements for voluntary counsellors from Halesowen College. At the time of our inspection there was one GP Registrar (male) in post.

The practice is open between 7:30am and 7pm during weekdays and appointments are available from as early as 7:30am to 12pm and then from 3:30pm through to 6:30pm. The practice also offers extended hours on Mondays until 7pm. There is a GP on call each afternoon between 12pm and 3:30pm. There are also arrangements to ensure patients received urgent medical assistance when the practice is closed during the out-of-hours period.

To help with the winter pressures the practice also offers Saturday clinics for appointments with either one of two GPs on duty or the advanced nurse practitioner. These clinics run from 3 December 2016 and are due to run until 4 March 2017 as part of the winter pressures scheme.

Updated 7 February 2017

Letter from the Chief Inspector of General Practice

We carried out an announced comprehensive inspection at Kingswinford Medical Practice on 12 January 2017. Overall the practice is rated as good.

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

• Patients said they were treated with care and respect. We saw that staff were friendly and helpful and treated patients with kindness and respect.

• Staff spoken with demonstrated a commitment to providing a high quality service to patients. Audits were used to monitor quality and to make improvements. The practice was proactive in identifying, managing and learning from significant events, incidents, complaints and patient survey responses.

• Patients could access appointments and services in a way and at a time that suited them.

There were longer appointments available for patients when needed. The practice offered urgent access appointments for children, as well as those with serious medical conditions.

• Clinical staff carried out home visits for older patients and patients who would benefit from these. The practice nurses also visited families from a local travelling community to ensure that children were up to date with their immunisations.

• Staff, teams and services were committed to working collaboratively. We saw evidence that multi-disciplinary team meetings took place on a monthly basis with regular representation from other health and social care services including local health visitors and school nurses.

• Some of the practices protocols reflected best practice and were well embedded. For example, the practice utilised a comprehensive system to review their patients’ attendances at the local Accident and Emergency department, use of the ambulance service and emergency hospital admissions. The practice maximised use of this system to aid monitoring and recall systems and to reduce prescription wastage.

• However, during our inspection we noted that governance arrangements were not always effective across specific systems and processes when managing complaints. We also noted that in areas documentation was unclear with regards to patient specific directions (PSDs); for the health care assistant to administer specific vaccinations and to demonstrate that review and authorisation was made by the prescribing GP.

• Staff assured us that they would amend their PSD system to incorporate adequate record keeping and we received further assurance from the practice shortly after our inspection to demonstrate that a more effective system was being utilised.

• Members of the management team indicated that some coding work was required across specific areas to accurately reflect the care plans in place across their mental health and dementia registers. However during our inspection we saw evidence to support that adequate care plans were in place and there was an effective recall system in place for patients needing medication and general health reviews.

• We observed the premises to be visibly clean and tidy. Notices were displayed to advise patients that a chaperone service was available if required however we noted that no male members of staff provided a chaperone service and the clinical team was mostly female, with one male GP registrar in post during our inspection.

The areas where the provider should make improvements are:

• Continue to identify carers in order to provide further support where needed.

• Ensure that policies associated with complaint management reflect guidelines and are embedded in practice.

• Continue to ensure that records and processes are well governed to reflect patient specific direction (PSD) requirements including review, specification and authorisation.

• Consider the need of a male chaperone so that male patients have the option of a male or female chaperone.

• Maximise the functionality of the computer system to consistently code all patient groups and produce accurate performance data.

Professor Steve Field (CBE FRCP FFPH FRCGP) 

Chief Inspector of General Practice

Updated 7 February 2017

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

• We saw evidence that multi-disciplinary team meetings took place on a monthly basis with regular representation from other health and social care services.

• Performance for overall diabetes related indicators was 97%, compared to the CCG average of 86% and national average of 89%.

• The percentage of patients with hypertension having regular blood pressure tests was 86%, compared to the CCG average of 92% and national average of 96%.
• We saw that regular reviews and discussions took place to understand and meet the range and complexity of people’s needs and to assess and plan ongoing care and treatment. Patients with a long term condition were regularly seen in practice for care planning and medication reviews, the practice operated an effective recall system and care plans also formed part of the local quality framework.

Updated 7 February 2017

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

• There were systems in place 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 accident and emergency (A&E) attendances.

• The practice offered urgent access appointments for children, as well as those with serious medical conditions. The practice nurses also visited families from a local travelling community to help ensure that children were up to date with their immunisations.

• Childhood immunisation rates for under two year olds ranged from 71% to 100% compared to the CCG averages which ranged from 74% to 98%. Immunisation rates for five year olds were ranged from 83% to 98% compared to the CCG average of 72% to 98%.

• Data from 2015/16 showed that the practice’s uptake for the cervical screening programme was 99%, compared to the CCG average of 72% and national averages of 73%.
• The local health visitors and school nurses also met with the practice on a monthly basis to discuss specific care needs for families and children. These meetings took place in addition to weekly visits from the health visitors and regular communication with both the school nurses and the health visitors.

Updated 7 February 2017

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

• The practice offered proactive, personalised care to meet the needs of the older people in its population.

• All these patients had a named GP and a structured annual review to check that their health and medicines needs were being met.

• It was responsive to the needs of older people, and offered home visits and urgent appointments for those with enhanced needs. The practice had effective systems in place to identify and assess patients who were at high risk of admission to hospital.

• Immunisations such as influenza and shingles vaccines were also offered to patients at home, such as housebound patients who could not attend the practice.
• The practice was also supporting a local initiative to bring hospital specialists in to the community and therefore began inviting elderly care physicians to the monthly multi-disciplinary team (MDT) meetings. 

Updated 7 February 2017

The practice is rated as good for the care of working-age people (including those recently retired and students).

• Patients could access appointments and services in a way and at a time that suited them.

Appointments could be booked over the telephone, face to face and online.

• The practice offered early appointments from 7:30am during weekdays and also offered extended hours on Mondays until 7pm to suit their working age population.

• To help with the winter pressures the practice also offered Saturday clinics for appointments with either one of two GPs on duty or the advanced nurse practitioner. These clinics started from 3 December 2016 and were due to run until 4 March 2017 as part of the winter pressures scheme.

• The practice was proactive in offering a full range of health promotion and screening that reflected the needs for this age group.
• Practice data highlighted that they identified and offered smoking cessation advice and support to 224 of their patients and 6% had successfully stopped smoking.

Updated 7 February 2017

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

• The practice regularly worked with other health and social care organisations in the case management of people experiencing poor mental health, including those with dementia.

• Performance for mental health related indicators was 94%, compared to the CCG average of 74% and national average of 92%. The practice had 40 patients on their mental health register. The data provided by the practice highlighted that 45% of these patients had a care plan in place.

• 75% of patients diagnosed with dementia had their care reviewed in a face to face meeting in the last 12 months, compared to the national average of 84%.
• The practice also supported patients by referring them to voluntary counsellors who provided counselling services on a weekly basis in the practice.

Updated 7 February 2017

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

• Vulnerable patients were regularly seen in practice for care planning and medication reviews, the practice operated an effective recall system and care plans also formed part of the local quality framework. For example, there were 18 patients registered at the practice with a learning disability and all of these patients had a care plan in place.

• The practice had 35 patients on their palliative care register. The data provided by the practice highlighted that all of these patients had a care plan in place and 86% received medication reviews where eligible within a 12 month period and there were further reviews planned.

• The practice utilised the local Integrated Plus scheme. This scheme was facilitated by the Dudley Council for Voluntary Service (CVS) team to help to provide social support to people who were living in vulnerable or isolated circumstances.
• Immunisations such as influenza and shingles vaccines were also offered to vulnerable patients at home, such as housebound patients who could not attend the practice.