Archived: King Street Medical Centre

Updated 7 January 2016

King Street Medical Centre is based in Accrington and is part of the East Lancashire Clinical Commissioning Group (CCG). The practice has 2042 patients on their register on the day of the inspection.

Information published by Public Health England rates the level of deprivation within the practice population group as two on a scale of one to 10. Level one represents the highest levels of deprivation and level 10 the lowest. Male and female life expectancy in the practice geographical area is 77 years for males and 82 years for females both of which are slightly below the England average of 79 years and 83 years respectively. The numbers of patients in the different age groups on the GP practice register are similar to the average GP practice in England.

The practice had a higher percentage (74.7%) of its population claiming disability allowance than the England average (50.3%).

The practice patient’s population was made up of approximately 30% ethnic minorities with the largest group being Asian and a growing population of Eastern Europeans.

The service is provided by two GP partners (one male, one female). The practice also employs a practice manager, a practice nurse and two reception / administrative staff.

The practice is based in a refurbished building with ramp access situated at the rear of the surgery to assist people with mobility problems. Patients can telephone the surgery beforehand so arrangements can be made. The practice has two consulting rooms, one for each GP and two treatment rooms, one for the nurse and one for the visiting health visitor.

The practice’s main opening times are 8am to 6pm on Mondays, Thursdays and Fridays, 8am to 7:30pm on Tuesdays and 8am to 12:30pm on Wednesdays. There are additional pre-bookable overflow appointments available at a nearby practice Monday to Friday. The practice participates in a local scheme with four other practices for Saturday appointments between 9am and 12pm.

The practice provides online patient access that allows patients to book appointments and order prescriptions.

Updated 7 January 2016

Letter from the Chief Inspector of General Practice

We carried out an announced comprehensive inspection at King Street Medical Centre on 17 November 2015. Overall the practice is rated as requires improvement.

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. However, reviews and investigations were not thorough enough.
• Risks to patients were assessed and well managed, with the exception of those relating to recruitment checks.
• Although some audits had been carried out, we saw no evidence that audits were driving improvement in performance to improve patient outcomes.
• The majority of patients said they were treated with compassion, dignity and respect.
• Urgent appointments were usually available on the day they were requested.
• The practice had a number of policies and procedures to govern activity, but some were overdue a review.
• The practice had proactively sought feedback from patients and had an active patient participation group.

Outstanding practice

• The practice was family friendly and all staff including the GP’s, practice nurse, practice manager and receptionists knew the patients well and most by first name as patients had been attending the practice for many years.

• The service being provided was caring and responsive despite the high level of deprivation, the higher percentage (74.7%) of its population claiming disability allowance than the England average of (50.3%) and having a relatively high patient population of approximately 30% ethnic minorities.

The areas where the provider must make improvements are:

• Ensure recruitment arrangements include all necessary employment checks for all staff employed by the practice and for locum / agency staff. This includes the need for a Disclosure and Baring Service (DBS) check when appropriate.

• Ensure staff files are monitored regularly to make sure they contain the appropriate checks and paperwork.

• Ensure all staff have the relevant training to carry out their role and responsibilities, for example, safeguarding training.

• Ensure all staff receive supervision and appraisal within appropriate timescales.
• Ensure clinical and non-clinical audits, such as infection control audits, and re-audits are implemented to improve patient outcomes.
• Ensure there is a system to monitor the traceability of the prescription paper used in the practice.

In addition the provider should:

• Review and update procedures and guidance.
• Assign roles, such as the infection prevention and control lead, appropriately with job descriptions and ensure staff are aware of the roles and responsibilities they have.
• Review and update the business continuity plan to take into account information technology based eventualities.
• Schedule regular and staff meetings with minutes available to be shared to all staff.
• Improve on the recording and reviews of significant event reviews to include more information.

Professor Steve Field (CBE FRCP FFPH FRCGP) 

Chief Inspector of General Practice

Updated 7 January 2016

The practice is rated as requires improvement for safety, effective and for well-led. The concerns which led to these ratings apply to everyone using the practice, including this population group.

• The GP’s had lead roles in chronic disease management and patients at risk of hospital admission were identified as a priority.
• The practice performed better than the national average in four out of the six diabetes indicators outlined in the Quality of Outcomes Framework (QOF) and was comparable to the national average for the remaining two indicators.
• Longer appointments and home visits were available when needed.
• All these patients had a named GP and a structured annual review to check that their health and medicines needs were being met. For those people with the most complex needs, the named GP worked with relevant health and care professionals to deliver a multidisciplinary package of care.

Updated 7 January 2016

The practice is rated as requires improvement for safety, effective and for well-led. The concerns which led to these ratings apply to everyone using the practice, including 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. Immunisation rates were relatively high for all standard childhood immunisations.
• Patient comments confirmed children and young people were treated in an age-appropriate way and were recognised as individuals, and we saw evidence to confirm this.
• The take up rate for the cervical screening programme of women aged 25-64 was above the CCG and national average (2015).
• The childhood immunisation rate was comparable to the CCG and national average
• Appointments were available outside of school hours and the premises were suitable for children and babies.
• We saw good examples of joint working with midwives, health visitors and school nurses.

Updated 7 January 2016

The practice is rated as requires improvement for safety, effective and for well-led. The concerns which led to these ratings apply to everyone using the practice, including this population group.

• The practice offered proactive, personalised care to meet the needs of the older people in its population.
• It was responsive to the needs of older people, and offered home visits and urgent appointments for those with enhanced needs.

Updated 7 January 2016

The practice is rated as requires improvement for safety, effective and for well-led. The concerns which led to these ratings apply to everyone using the practice, including this population group.

• 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.

Updated 7 January 2016

The practice is rated as requires improvement for safety, effective and for well-led. The concerns which led to these ratings apply to everyone using the practice, including this population group.

• 100% of people diagnosed with dementia had had their care reviewed in a face to face meeting in the last 12 months.
• 100% of people diagnosed with a mental health issue had had their care reviewed in a face to face meeting in the last 12 months.
• The practice regularly worked with multi-disciplinary teams in the case management of people experiencing poor mental health, including those with dementia.
• It 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.
• It 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 people with mental health needs and dementia.

Updated 7 January 2016

The practice is rated as requires improvement for safety, effective and for well-led. The concerns which led to these ratings apply to everyone using the practice, including this population group.

• The practice held a register of patients living in vulnerable circumstances including homeless people, travellers and those with a learning disability.
• It offered longer appointments for people with a learning disability.
• The practice regularly worked with multi-disciplinary teams in the case management of vulnerable people.
• It had told 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.