East Harling & Kenninghall Medical Practice

Updated 29 July 2016

East Harling and Kenninghall Medical Practice is a two-site practice situated in the villages of East Harling and Kenninghall, Norwich. The practice provides services for approximately 7,994 patients. It holds a General Medical Services contract with South Norfolk CCG.

According to information taken from Public Health England, the patient population is in line with the practice average across England. However, there is a lower than average number of patients aged between 20 and 39. The practice is situated in an area with a low level of socio-economic deprivation.

The practice team consists of two male GPs, three female GPs, a practice manager, an assistant practice manager, three practice nurses, an emergency care practitioner and two healthcare assistants. It also has teams of reception, administration, secretarial and dispensary staff.

East Harling and Kenninghall Medical Practice is open from Monday to Friday. It offers appointments at its East Harling site between 8.30am and 6pm daily. Appointments at the Kenninghall site are available between 8.30am and 6pm on Mondays, Tuesdays, Thursdays and Fridays, and between 8.30am and 1pm on Wednesdays. Extended hours appointments are available every other Saturday between 8.30am and 12pm at alternate sites. Out of hours care is provided by IC24 via the 111 service.

Updated 29 July 2016

Letter from the Chief Inspector of General Practice​

We carried out an announced comprehensive inspection at East Harling and Kenninghall Medical Practice on 1 June 2016. Overall the practice is rated as good.

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

• Staff understood and fulfilled their responsibilities to raise concerns, and to report incidents and near misses. Information about safety was recorded, monitored, appropriately reviewed and addressed.
• The practice had a patient focused culture that ensured 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.
• Feedback from patients about their care was consistently positive. Patients said they were treated with compassion, dignity and respect and they were involved in their care and decisions about their treatment. Data from the National GP Patient Survey published in January 2016 showed that patients rated the practice higher than others for several aspects of care.
• 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 well 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.

We saw several areas of outstanding practice:

• The practice worked alongside a local residential school for children with autism. The practice recognised that the clinical environment could be difficult for these patients, and liased with the school to find out how the process could be improved. The practice held a dedicated quieter time for these patients to attend appointments, and were in the process of collecting photographs of key staff to be given to the school to help students familiarise themselves with practice staff. Furthermore, the practice were undergoing personalised training from the school on how they can best meet the needs of the students.
• The practice had undertaken a two cycle audit on children who did not attend appointments, and developed a safeguarding risk assessment process for those who did not attend.
• The practice manager had participated in a study undertaken by Healthwatch Norfolk that examined how war veterans accessed primary care. This had led to the practice manager drafting their war veterans policy, which was then adopted by Healthwatch groups throughout the county.

Professor Steve Field (CBE FRCP FFPH FRCGP) 

Chief Inspector of General Practice

Updated 29 July 2016

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

• Both GPs and nursing staff had lead roles in chronic disease management and patients at risk of hospital admission were identified as a priority.
• The practice used the information collected for the Quality and Outcomes Framework (QOF) to monitor outcomes for patients (QOF is a system intended to improve the quality of general practice and reward good practice). Data from 2014/2015 showed that performance for diabetes related indicators was 83%, which was below the CCG average by 9% and the national average by 6%. Exception reporting for diabetes related indicators was 5%, which was lower than the CCG average of 12% and the national average of 11% (exception reporting is the removal of patients from QOF calculations where, for example, the patients are unable to attend a review meeting or certain medicines cannot be prescribed because of side effects).
• The practice held clinics with a diabetic nurse facilitator, and offered an in-house insulin conversion service. This was funded by the practice and led by a practice nurse who had received additional training in diabetes care.
• Longer appointments and home visits were available when needed.
• Patients with complex needs had a named GP and a structured annual review to check their health and medicines needs were being met. There was a robust recall system in place to ensure that patients were invited and attended annual reviews.
• 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 29 July 2016

The practice is rated as good for the care of families, children and young people. It is rated as outstanding for providing responsive care to this population group.

• 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 A&E attendances.
• The practice had undertaken a two cycle audit on children who did not attend appointments, and developed a safeguarding risk assessment process for those who did not attend. Furthermore, the practice introduced a new system for booking immunisation appointments that allowed parents improved flexibility in scheduling an appointment. The results of this audit showed a 33% reduction in children not attending appointments.
• Immunisation rates were 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.
• The percentage of women aged 25-64 whose notes recorded that a cervical screening test had been performed in the preceding 5 years was 77%, which was below the CCG average of 84% and national average of 82%.
• Appointments were available outside of school hours and the premises were suitable for children and babies.
• The practice worked alongside a local residential school for children and young adults with autism. The practice recognised that the clinical environment could be difficult for these patients, and liased with the school to find out how the process could be improved. The practice held a dedicated quieter time for these patients to attend appointments, and were in the process of collecting photographs of key staff to be given to the school to help students familiarise themselves with practice staff. Furthermore, the practice were undergoing personalised training from the school on how they can best meet the needs of the students.
• The practice offered a full range of contraception services and chlamydia screening.
• We saw positive examples of joint working with midwives, health visitors and school nurses.

Updated 29 July 2016

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

• The practice worked alongside the Frail and Elderly Team funded by the CCG to lower emergency admissions to hospital and increase the support in the community for frail and vulnerable patients.
• The practice was responsive to the needs of older people and offered home visits and urgent appointments for those with enhanced needs.
• GPs at the practice carried out regular visits to a local care home.
• The practice triaged all home visit requests to facilitate earlier visits where hospital admission may be an outcome.
• Nationally reported data showed that outcomes for patients for conditions commonly found in older people, including rheumatoid arthritis and heart failure, were above local and national averages.

Updated 29 July 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.
• Practice staff carried out NHS health checks for patients between the ages of 40 and 74 years.
• Extended hours appointments were available between 8.30am and 12pm every other Saturday. This time had been chosen following patient feedback.

Updated 29 July 2016

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

• 75% of patients diagnosed with dementia had received a face to face care review in the last 12 months, which was below the CCG average of 86% and the national average of 84%. The practice had not excepted any patients from this service.
• 77% of patients experiencing poor mental health had a comprehensive care plan, which was below the CCG average of 90% and the national average of 88%.
• 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, such as the local Wellbeing Service.
• 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 29 July 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 travellers 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, and held six weekly multidisciplinary team meetings.
• The practice informed vulnerable patients about how to access various support groups and voluntary organisations.
• Patients who were carers were proactively identified and signposted to local carers’ groups. 
• The practice manager had participated in a study undertaken by Healthwatch Norfolk that examined how war veterans accessed primary care. This had led to the practice manager drafting their war veterans policy, which was then adopted by Healthwatch groups throughout the county.
• 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.