Kelsey Healthcare Limited Also known as Cator Medical Centre

Updated 1 November 2016

Kelsey Healthcare Limited is a medium sized practice based in Bromley. The practice list size is approximately 9070. Whilst the practice population is diverse there are a higher than average number younger patients. There is a higher than England averages number of female patients aged 0-4 years, 25-44 years old. There is a higher than England average number of males aged 0-9 years and 25-44 years. The practice has a lower than England average number of male and female patients aged 45-85+ years. The practice holds an Alternative Provider Medical Services (APMS) contract.

The practice facilities include six GP consulting room, four nurse/ treatment rooms, two minor surgery rooms, two patient waiting rooms and seven staff and administration offices. The premises are wheelchair accessible and there are facilities for wheelchair users including a lift and disabled toilets and a hearing loop. Other facilities include baby changing facilities and wheelchair accessible toilets. There are lowered reception desks to enable wheelchair users to speak with staff at the reception.

The staff team compromises of seven GPs. There is one partner, one GP retainer (The GP Retainer Scheme is intended as short term support for GPs who have family commitments or health problems which restrict them from working in General Practice in the usual way as partners or salaried GPs) and five salaried GPs. The GP partner works eight sessions a week (female); the GP retainer works four sessions a week; three salaried GPs work eight sessions a week (one male and one female) and another salaried GP works two sessions a week. Other staff included four female nurses and two health care assistants (one male and one female), a female practice manager, a male business manager, thirteen receptionists (part-time workers), six administrators, one reception supervisor and a finance officer.

The practice is open between 8.00am to 7.30pm Monday to Thursday; 8.00am to 6.30pm on Fridays and 8.00am to 12.00pm on Saturdays. When the practice is closed patients are directed (through a recorded message on the practice answerphone) to contact the local out of hour’s provider. This information is also available on the practice website. The practice is based in the same building at the local urgent care centre. Posters are available to make patients aware of this as well.

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

Updated 1 November 2016

Letter from the Chief Inspector of General Practice

We carried out an announced comprehensive inspection at Kelsey Healthcare Limited on 3 August 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 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 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 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.

The areas where the provider should make improvement are:

• Ensure systems are in place to monitor the use of blank prescription pads

• Ensure appropriate systems are in place for portable appliance testing (PAT).

Professor Steve Field CBE FRCP FFPH FRCGP

Chief Inspector of General Practice

Updated 1 November 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.

• There were 211 patients on the diabetes register.

• The percentage of patients with diabetes, on the register, whose last measured total cholesterol (measured within the preceding 12 months) was 5 mmol/l or less was 71%, which was 6% below the CCG average and 7% below the national average. The exception reporting rate for this indicator was 16% compared to the CCG rate of 10% and national rate of 12%.

• The percentage of patients with diabetes, on the register, in whom the last IFCC_HbA1c is 59mmol/mol or less in the preceding 12 months was 63% which was 5% below the CCG average and 7% below the national average. The exception reporting rate for this indicator was 12% which was 4% above the CCG average and 0.2% above the national average.

• Staff managing patients with long term conditions had completed the Warwick Certificate for Optimizing Glycaemic control.

• In-house spirometry was offered.

• Longer appointments and home visits were available when needed.

• Most patients received structured annual review to check the 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 1 November 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 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.

• Appointments were available outside of school hours and the premises were suitable for children and babies.

• We saw positive examples of joint working with midwives, health visitors and school nurses.

• Same day appointments were always offered to children.

• GP and midwife appointments were offered for antenatal care.

• The practice had a dedicated administrator who co-ordinated post-natal checks for all new mothers, six week developmental checks and also arranged childhood immunisations.

Updated 1 November 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.

• All older people had a named GP. The named GP is responsible for repeat prescribing, dealing with paperwork and leading on home visits for all their allocated patients.

• The practice participated in the unplanned admissions direct enhanced service and 143 older patients had a current care plan in place. There was a dedicated patient liaison office for patients on care plan.

• The practice provided medical care to three nursing homes. They had protocols in place outlining how and when registered patients could access GP care.

• The practice held quarterly multidisciplinary meetings which included discussions of the support needs for older population at home.

• Flu vaccinations were offered to all over 65s. The percentage of uptake was in line with the CCG rates.

Updated 1 November 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 held a contract with NHS England which meant they offer extended hours as part of their core service.

• On-line access was available to patients to book appointments and request repeat prescriptions.

• Telephone appointments were available throughout the day.

• Pre-bookable phlebotomy appointments were available from 8.00am to accommodate working population.

• Health checks were offered to patients aged 40-74 years old.

Updated 1 November 2016

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.

• Staff had a good understanding of how to support patients with mental health needs and dementia.

Updated 1 November 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 and 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.

• Translation services were available by telephone or face to face.