Archived: Knoll Medical Practice

Updated 31 May 2016

The Knoll Medical Practice provides primary medical services in Orpington to approximately 8200 patients and is one of 48 practices in Bromley Clinical Commissioning Group (CCG). The practice population is in the third least deprived decile in England.

The practice population has a lower than CCG and national average representation of income deprived children and older people. The practice population of children and working age people is lower than local and national averages and the population of older people is above the local and national averages. Of patients registered with the practice for whom the ethnicity data was recorded, 48% are other white background, 38% are British or mixed British and 12% are Asian or mixed Asian.

The practice operates in converted premises over two floors. Not all patient facilities are wheelchair accessible and there is no lift access to the first floor. For patients with restricted mobility appointments are offered in the ground floor. The practice has access to two doctors’ consultation rooms and one nurse’s consultation room on the ground floor, and one doctors’ consultation room and one nurse’s consultation room on the first floor.

The practice team at the surgery is made up of two full-time GPs (a male and a female) who are partners, one part-time female GP who is a partner, three part-time female salaried GPs and four part-time female practice nurses. The non-clinical practice team consists of a practice manager, a finance manager, a reception manager, two practice secretaries, nine reception staff and seven administration staff members. The practice provides a total of 40 GP sessions per week.

The practice operates under a Personal Medical Services (PMS) contract, and is signed up to a number of local and national enhanced services (enhanced services require an enhanced level of service provision above what is normally required under the core GP contract).

The practice reception and telephone lines are open from 8:00am till 7:00pm Monday to Friday and Saturday from 8:00am till 11:00am. Appointments are available from 8:00am to 12:00pm and 2:00pm to 5:50pm Monday till Friday. Extended hours surgeries are offered on Monday and Thursday 6:30pm to 7:00pm and on Saturdays from 8:00am to 11:00am. The practice nurses also offered early morning and late evening appointments Monday to Friday.

The practice has opted out of providing out-of-hours (OOH) services to their own patients between 6:30pm and 8am and directs patients to the OOH provider for Bromley CCG. The practice has recently signed up to be part of local GP Alliance and provides at least three appointments seven days a week through Primary Care hubs; weekend appointments could be booked in advance. (Primary Care hubs allows patients access to a GP seven days per week, where the clinician has, with patients’ consent, full access to their GP records which allows a full general experience.)

The practice is registered as a partnership with the Care Quality Commission to provide the regulated activities of diagnostic and screening procedures, maternity and midwifery services, family planning services, surgical procedures and treatment of disease, disorder or injury.

Updated 31 May 2016

Letter from the Chief Inspector of General Practice

We carried out an announced comprehensive inspection at Knoll Medical Practice on 14 April 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 a system in place 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 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.
• Patients said they found it easy to make an appointment with a named GP and that there was 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.

There were areas of practice where the provider should make improvements:

• Review the practice policies and procedures.
• Consider documenting discussion fromformal staff meetings and clinical meetings.

Professor Steve Field CBE FRCP FFPH FRCGP 

Chief Inspector of General Practice

Updated 31 May 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.
• The national Quality and Outcomes Framework (QOF) data showed that 77% of patients had well-controlled diabetes, indicated by specific blood test results, compared to the Clinical Commissioning Group (CCG) average of 75% and the national average of 78%. The number of patients who had received an annual review for diabetes was 91% which was above the CCG average of 78% and above the national average of 88%.
• The national Quality and Outcomes Framework (QOF) data showed that 73% of patients with asthma in the register had an annual review, compared to the CCG average of 74% and the national average of 75%.
• Longer appointments and home visits were available for people with complex long term conditions 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.
• The practice provided minor surgical procedures including joint injections, coil and implant fitting which reduced the need for referrals to hospital.

Updated 31 May 2016

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 urgent care and Accident and Emergency (A&E) attendances.
• Immunisation rates were relatively high for all standard childhood immunisations.
• Patients told us that children and young people were treated in an age-appropriate way and were recognised as individuals, and we saw evidence to confirm this.
• The practice’s uptake for the cervical screening programme was 86%, which was in line with the Clinical Commissioning Group (CCG) average of 84% and the national average of 82%.
• Appointments were available outside of school hours and the premises were suitable for children and babies.
• The practice offered weekly midwife clinics and provided well women and well man checks.
• The practice offered sexual health clinics and offered coil and implants fitting.
• The practice sent congratulations letter to new parents after the birth of a baby which also had information about immunisations, six weeks check for babies and post-natal check for mothers.

Updated 31 May 2016

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.
• The practice was responsive to the needs of older people, and offered home visits and urgent appointments for those with enhanced needs.
• The GPs visited a local care home twice each week, supporting the needs of the elderly residents.
• The practice maintained an up-to date end of life care register and proactively identified these patients and worked closely with the palliative care team to support these patients.

Updated 31 May 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 offered late evenings and Saturday morning appointments to accommodate working people.

Updated 31 May 2016

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

• The number of patients with dementia who had received annual reviews was 86% which was above the Clinical Commissioning Group (CCG) average of 84% and national average of 84%.
• 91% of patients with severe mental health conditions had a comprehensive agreed care plan in the last 12 months which was above the CCG average of 84% and in line with the national average of 88%.
• The practice regularly worked with multi-disciplinary teams in the case management of people 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 in place 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 31 May 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 homeless people, travellers and those with a learning disability. These patients were flagged in their clinical system.
• The practice offered appointments for all newly registered looked after children with a named GP and had an alert set up on the computer system.
• The practice offered longer appointments and extended annual reviews for patients with a learning disability; 92% of patients with learning disability had received a health check in the last year.
• The practice regularly worked with multi-disciplinary teams in the case management of vulnerable people.
• 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.