Killick Street Health Centre

Updated 17 May 2018

The Killick Street Health Centre (the practice) operates at 75 Killick Street, Islington, London N1 9RH. The building is around twenty years old and is purpose-built. There are good transport links, with King’s Cross station nearby.

The practice provides NHS services through a General Medical Services (GMS) contract to approximately 12,000 patients. It is part of the NHS Islington Clinical Commissioning Group (CCG), which is made up of 34 general practices. The practice is registered with the Care

Quality Commission as a partnership of five GPs, three female and two male, to carry out the following regulated activities - Treatment of disease, disorder or injury; Family Planning, Maternity and midwifery services, Surgical procedures and Diagnostic and screening procedures. The patient profile has a higher than average proportion of younger adults aged 20 – 39, but fewer young children, teenagers and patients aged over-40. There are considerably fewer patients aged 50+, when compared with the national average. The deprivation score for the practice population is in second “most deprived decile”, indicating a high deprivation level among the patient population. The patient group includes refugees, hostel residents and students.

The clinical team is made up of the five partner GPs, two of whom work five clinical sessions a week, with three working four clinical sessions; there is a salaried female GP who works five clinical sessions and two more who work four clinical sessions. There are two full time practice nurses and one who works part-time, usually three-four days a week. The practice also has two healthcare assistants, one full time and the other working one day a week. It is a training practice, with three of the partner GPs accredited as trainers, and there are currently four GP registrars attached. GP registrars are qualified doctors gaining experience in general practice. The administrative team comprises the practice manager, finance manager, five administrative staff and nine receptionists.

The practice reception operates between 8.30 am and 6.30 pm on Monday, Tuesday, Wednesday and Friday. The practice is closed on Thursday afternoon, when the reception operates until 1.00 pm. Telephone calls are answered from 8.00 am. The practice closes for staff training between 1.00 pm and 2.00 pm on the first and third Tuesday of the month.

Appointments with GPs and nurses are available at the following times -

Monday 9.00 am - 7.15 pm

Tuesday 7.30 am - 7.15 pm

Wednesday 7.30 am - 7.15 pm

Thursday 8.00 am - 12.30 pm

Friday 7.30 am - 6.30 pm

The CCG commissions the “IHub” extended hours service, operating until 8.00 pm on weekdays and between 8.00 am and 8.00 pm at weekends at three sites across the borough. Appointments can be booked by patients contacting their own general practice. There is also a walk in service available to all patients at a central location. The practice has opted out of providing an out-of-hours service. Patients calling the practice when it is closed are connected with the local out-of-hours service provider. Information about the out-of-hours provider and NHS 111 service is given in the practice leaflet and on the practice website.

Routine consultations, each ten minutes long, can be booked four to six weeks in advance. Longer or double appointments can be booked for reviews of long term health conditions as well as for patients for very complex healthcare needs, including mental health and behavioural or communication problems. Three of the GPs’ standard appointments are 15 minutes long, allowing some flexibility and choice to patients. Home visits are available for patients who may be house bound. The GPs and nurses are also available for telephone consultations. Routine appointments with GPs may be booked online by patients who have previously registered to use the system. It can also be used to request repeat prescriptions.

Updated 17 May 2018

We carried out an announced comprehensive inspection of Killick Street Health Centre on 17 August 2017. We rated the practice as good for providing effective, caring, responsive and well-led services and the overall rating was good. We rated the practice as requires improvement for providing safe services, as we had concerns relating to infection prevention and control issues, safety checks and mandatory training for staff.

We served a requirement notice relating to the practice’s failure to comply with Regulation 12 (Safe care and treatment) of the Health and Social Care Act 2008 (Regulated Activities) Regulations 2014.

We also recommended two improvements the practice should make under the key questions of effective and well-led, as follows: Proceed with plans to improve how learning from clinical audits is passed on; Proceed with the planned schedule of reviewing governance protocols and policies.

The full comprehensive report on the August 2017 inspection can be found by selecting the ‘reports’ link for Killick Street Health Centre on our website at http://www.cqc.org.uk/location/1-572907531. After the inspection, the practice sent us a plan of actions it intended to take to ensure it was able to meet the legal requirements under the key question, Safe.

This inspection was a focussed inspection carried out as a desk-based review of evidence we requested from the practice in March 2018, looking at the issues previously identified and to check and confirm that the practice had carried out its plan to meet the legal requirements. We found that the practice had taken appropriate action to meet the requirements of the regulations relating to providing a safe service. Accordingly, we have revised the practice’s rating in respect of providing a safe service to good. The revision of the rating does not effect the ratings given after our previous inspection in August 2017 for the other key questions and the six population groups, which were rated good.

The practice also sent us evidence under the key questions of effective and well-led. We saw minutes of clinical meetings and presentations that confirmed the results and learning from a number of recent clinical audits had been reviewed and discussed. The practice sent us confirmation that the review programme of its governance protocols and policies had proceeded to plan.

Professor Steve Field CBE FRCP FFPH FRCGP

Chief Inspector of General Practice

Updated 26 October 2017

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

• Nursing staff had lead roles in long-term disease management and patients at risk of hospital admission were identified as a priority.
• The percentage of patients with diabetes, on the register, in whom the last IFCCHbA1c is 64 mmol/mol or less in the preceding 12 months (01/04/2015 to 31/03/2016) was 87.74%, compared with the local average of 76.07% and the national average of 78.01%.
• The percentage of patients with diabetes, on the register, in whom the last blood pressure reading (measured in the preceding 12 months) is 140/80 mmHg or less (01/04/2015 to 31/03/2016) was 80.69%, compared with the local average of 76.09% and the national average of 77.58%.
• The percentage of patients with hypertension in whom the last blood pressure reading (measured in the preceding 12 months) is 150/90 mmHg or less (01/04/2015 to 31/03/2016) was 86.4% compared with the local average of 80.74% and the national average of 82.9%
• Longer appointments and home visits were available when needed.
• All these patients had a named GP and there was a system to recall patients for 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 26 October 2017

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

• From the sample of documented examples we reviewed we found 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 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.
• Appointments were available outside of school hours and the premises were suitable for children and babies.
• The practice worked with midwives, health visitors and school nurses to support this population group.
• The practice had a “Carers’ Champion” and had identified 269 patients as carers (2.3% of the practice list).

Updated 26 October 2017

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

• Staff were able to recognise the signs of abuse in older patients and knew how to escalate any concerns.
• The practice offered proactive, personalised care to meet the needs of the older patients in its population.
• The practice was responsive to the needs of older patients, and offered home visits and urgent appointments for those with enhanced needs.
• The practice identified at an early stage older patients who may need palliative care as they were approaching the end of life. It involved older patients in planning and making decisions about their care, including their end of life care. The practice used the Gold Standard Framework to share information with other healthcare professionals to ensure that end of life care was delivered in a coordinated way.
• The practice followed up on older patients discharged from hospital and ensured that their care plans were updated to reflect any extra needs.
• Where older patients had complex needs, the practice shared summary care records with local care services.
• Older patients were provided with health promotional advice and support to help them to maintain their health and independence for as long as possible.

Updated 26 October 2017

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

• The needs of this population group had been identified and the practice had adjusted the services it offered to ensure these were accessible and flexible.
• 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 percentage of women aged 25-64 whose notes record that a cervical screening test has been performed in the preceding 5 years (01/04/2015 to 31/03/2016) was 80.74%, compared with the local average of 76.67% and the national average of 81.43%

Updated 26 October 2017

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

• The practice carried out advance care planning for patients living with dementia.
• The percentage of patients diagnosed with dementia whose care plan has been reviewed in a face-to-face review in the preceding 12 months was 91.95%, compared with the CCG average of 83.07% and the national average of 83.77%.
• The percentage of patients with schizophrenia, bipolar affective disorder and other psychoses who have a comprehensive, agreed care plan documented in the record, in the preceding 12 months (01/04/2015 to 31/03/2016) was 95.8%, compared with the local average of 89.69% and the national average of 88.77%
• The practice regularly worked with multi-disciplinary teams in the case management of patients experiencing poor mental health, including those living with dementia.
• Patients at risk of dementia were identified and offered an assessment.
• The practice had information available for patients experiencing poor mental health about how they could 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.
• Clinical staff had received dementia awareness training and those we interviewed had a good understanding of how to support patients with mental health needs and dementia.

Updated 26 October 2017

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 patients, hostel residents and those with a learning disability.
• The practice had a register of 45 patients with a learning disability, of whom 42 (93%) had had an annual health check and had their care plan reviewed. All the patients had been seen by a GP in the preceding 12 months.
• The practice provided services to a local women’s refuge.
• End of life care was delivered in a coordinated way which took into account the needs of those whose circumstances may make them vulnerable.
• 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 had information available for vulnerable patients about how to access various support groups and voluntary organisations.
• Staff interviewed knew how to recognise signs of abuse in children, young people and adults whose circumstances may make them vulnerable. They 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.