Kensington Street Surgery Practice

Updated 2 May 2018

Kensington Street Surgery Practice, Kensington Street Health Centre, Whitefield Place, Bradford, BD8 9LB is located near to the centre of Bradford. The building is purpose built with good parking facilities and disabled access.

The practice is registered with the CQC to provide primary care services. It provides Primary Medical Services (PMS) for 5,125 patients under a PMS contract in the Bradford City Commissioning Group (CCG). There are higher than average number of patients under the age of 39, in common with the characteristics of the Bradford City area, and fewer patients aged over 45 than the national average. The National General Practice Profile states that 66% of the practice population is from an Asian background with a further 8% of the population originating from black, mixed or other non-white ethnic groups.

The provider, Dr Ishtiaq Gilkar, is registered to provide diagnostic and screening procedures, treatment of disease, disorder or injury, maternity and midwifery services, family planning and surgical procedures.

Information published by Public Health England, rates the level of deprivation within the practice population group as one, on a scale of one to ten. Level one represents the highest levels of deprivation and level ten the lowest. Male life expectancy is 77 years compared to the national average of 79 years. Female life expectancy is 81 years compared to the national average of 83 years.

The practice has one GP partner, one salaried GP and a number of locum GPs (three male and three female). They also have an advanced nurse practitioner, practice nurse, two clinical pharmacists, a data quality manager, patient engagement lead and two healthcare assistants. The reception team consists of one practice manager, and a number of reception and administrative staff.

The practice is open Monday to Friday from 8:30am to 6pm. Extended hours appointments are also available to all patients at additional locations within the area as the practice is a member of a GP federation: Monday to Friday 6.30pm until 9.30pm and on Saturday and Sunday 11am until 1pm. Patients can also see a physiotherapist and a debt counsellor at these times.

Additional out of hours care is accessed by calling the NHS 111service.

We saw that the previously awarded CQC ratings were displayed in the practice.

Updated 2 May 2018

We carried out an announced comprehensive inspection at Kensington Street Surgery Practice on 3 May 2017. The overall rating for the practice was good. However, a breach of regulations was found which resulted in the practice being rated as requires improvement for providing safe services. The full comprehensive report for the May 2017 inspection can be found by selecting the ‘all reports’ link for Kensington Street Surgery Practice on our website at www.cqc.org.uk.

In addition to the breach of regulation, at the inspection on 3 May 2017 we also said the practice should consider the following areas:

• Continue to improve the identification of carers on the practice register to assure themselves that carers are aware of support available to them.
• Be able to assure themselves that cleaning schedules are in place for multi-patient use clinical equipment.
• Review the arrangements for checking medical supplies at the practice are in date.
• Continue to address issues identified in the national GP survey in order to improve patient satisfaction around accessing the practice.

This inspection was an announced focused inspection carried out on 18 April 2018 to confirm that the practice had carried out their plan to meet the legal requirements in relation to the breach of regulations that we identified at our previous inspection on 3 May 2017. This report covers our findings in relation to those requirements and also additional improvements made since our last inspection.

Overall the practice is rated as good.

At this inspection we found:

• The practice had clear systems and processes in place to manage temperature sensitive medicines.
• The practice and patient engagement lead had improved the number of carers identified at the practice and liaised with the voluntary sector to continue to identify carers. A carers’ resource offered additional support by attending the practice to hold carers events. The number of carers identified by the practice had increased but remained at just less than 1%. A carer identification protocol has been implemented.
• The practice had implemented cleaning schedules for multi-patient use clinical equipment.
• The practice reviewed the stock of medical supplies monthly to ensure they were in date and recorded this.
• The practice was using innovative methods to encourage patients to respond to the GP patient survey and had made a number of changes to improve patient satisfaction. Actions taken included PPG involvement and community engagement events to increase satisfaction with the overall experience of the surgery. Seven day a week access to a GP as part of extended hour’s access via federation membership was available. In addition patients were encouraged to complete the GP patient survey online where it could be translated into a number of different languages. An iPad supplied by the federation was also used to show visual representations of the human body to patients; with the intention of improving patients’ involvement in their consultation, and aiding communication and understanding. GP patient survey results from 2017 showed an overall improvement from 2016. For example, 100% of patients said they had confidence and trust in the last nurse they saw or spoke to.

The areas where the provider should make improvements are:

• Continue to improve further the identification of carers on the practice register to assure themselves that carers are aware of support available to them.

Professor Steve Field CBE FRCP FFPH FRCGPChief Inspector of General Practice

Updated 23 June 2017

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.

• Overall QOF achievement for treatment of diabetes was 89% and was achieved with 3% exception reporting. (This data relates to the previous provider).
• 75% of patients with asthma received an annual review with exception reporting of 2%, which was 6% lower than the local average and 6% below the national average. (This data relates to the previous provider).

• Longer appointments and home visits were available when needed. The practice combined reviews wherever possible to minimise the number of appointments required and sent text reminders to patients.
• 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 or advanced nurse practitioner worked with relevant health and care professionals to deliver a multidisciplinary package of care.
• There were emergency processes in place and referrals were made for patients whose health deteriorated suddenly.
• The practice prioritised patients with long term conditions and their carers for preventative medicines; for instance flu vaccines.
• We found the practice completed full health checks on new patients and follow on support for any identified health needs. Special clinics for health needs such as, coronary heart disease, diabetes, asthma and chronic obstructive pulmonary disease (COPD) were held and systems were in place to identify patients who met the criteria to attend. The practice provided in-house diagnostic care e.g. Electrocardiogram (ECG), 24 hour blood pressure monitoring and spirometry which tests lung function.

Updated 23 June 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. Immunisation rates were lower for all standard childhood immunisations. We saw good examples of joint working with midwives and health visitors.
• Patients told us that children and young people were treated in an age-appropriate way and were recognised as individuals.
• A full range of family planning services were provided and sexual health support for young people was offered, including chlamydia screening.
• Uptake for the cervical screening programme was 70%, which was lower than the CCG average of 85% and the national average of 81%. (This data relates to the previous provider).
• Appointments were available outside of school hours and the premises were suitable for children and babies.
• There were regular baby clinics held and post-natal reviews for female patients. The practice provided sexual health support. GPs and clinical staff were trained to support patients with contraceptive advice.

Updated 23 June 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, and offered home visits and urgent appointments for those with enhanced needs. Housebound patients were supported by clinical staff offering long term conditions and medication reviews in the patient’s own home.
• A range of enhanced services was offered. For example in dementia support, patients with a diagnosis had regular appointments to meet their needs. The patients who had been identified to be at risk of developing dementia were provided with the opportunity of an annual dementia screening.
• Rapid access appointments were available for those with enhanced needs. Extended appointments were provided for this age group. This reduced their visits to the practice and provided better coordination of their care.
• The practice ensured follow up consultations were in place for older patients when discharged from hospital. Patients over the age of 75 had a named GP. Annual health checks were in place for the over 75s.
• Patients told us they were included in their care decisions and health promotion programmes were available. The practice provided flu and shingles vaccination to help protect the health of patients.  Medication reviews were undertaken by the GPs and the pharmacists to reduce the effects on the patient of being on unnecessary medication.  

Updated 23 June 2017

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.
• Appointments could be booked by telephone and online.
• The practice had screening programmes for pre diabetes and hepatitis B and C. The practice was proactive in offering online services as well as a full range of health promotion and screening that reflected the needs of this age group.

Updated 23 June 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 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 in place to follow up patients who had attended accident and emergency where they may have been experiencing poor mental health.
• We saw the practice monitored patients with poor mental health; they used audits to ensure patients had a regular physical health check and follow ups if there was non-attendance.
• The practice offered structured reviews to all patients with severe and enduring mental health conditions with at least annual reviews of their physical and mental health, medicines and revision of their agreed care plan.

Updated 23 June 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 people and those with a learning disability. The practice encouraged homeless people to register with a nearby practice as they were very close and able to meet their specialist needs. The practice had agreed this with the nearby service.
• Patients with a cancer diagnosis or a serious mental illness were followed up by the practice if they missed an appointment.
• 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.
• The practice carried out annual health checks for patients with learning disabilities. The practice also offered longer appointments for vulnerable patients or undertook annual reviews in their home environment if indicated as preferable.
• The practice regularly worked with multi-disciplinary teams in the case management of vulnerable patients. We saw evidence of practice staff advising and signposting vulnerable patients to access various support groups and voluntary organisations, such as alcohol and drug support services.