Kingston Health Centre

Updated 15 November 2016

Kingston Health Centre provides primary medical services in Kingston to approximately 9500 patients and is one of 26 practices in Kingston Clinical Commissioning Group (CCG). They are a teaching practice for GP registrars.

The practice population is in the least deprived decile in England. The proportion of children registered at the practice who live in income deprived households is 12%, which is the same as the CCG average of 12%, and for older people the practice value is 12%, which is lower than the CCG average of 13%. The practice has a larger proportion of patients aged 25 to 49 years compared to the CCG average, and a smaller proportion of patients aged 50+. Of patients registered with the practice, the largest group by ethnicity are white (76%), followed by asian (13%), mixed (5%), black (2%) and other non-white ethnic groups (4%).

The practice operates from a 3-storey purpose built premises. Car parking is available on in the surrounding streets and in a nearby car park. The entrance is situated on the ground floor, with stairs and a lift to the first floor which has a reception desk for patients wishing to hand in repeat prescription requests and samples, and three consulting rooms which are used by community services, such as midwives and counsellors. There is a further staircase and lift to the second floor, where the main reception desk and waiting area is situated, along with the consultation rooms, clean and dirty utility rooms, and administrative areas. In total there are two treatment rooms, one nurse consultation room and six GP consultation rooms.

The practice team at the surgery is made up of one full time female GP, one full time male GP and one part time female GP who are partners, and one GP registrar; in total 29 GP sessions are available per week. In addition, the practice also has one female Advanced Nurse Practitioner who provides eight sessions per week, two part time female nurses, and one part time healthcare assistant. The practice team also consists of a practice manager, five reception staff and one administrator.

The practice operates under a General Medical Services (GMS) contract, and is signed up to a number of local and national enhanced services (enhanced services require an enhanced level of service provision above what is normally required under the core GP contract).

The practice is open between 8am and 6.30pm Monday to Friday and 9am to 12pm on Saturdays. Appointments are from 9am to 6.30pm daily. Extended hours appointments are offered from 7.15am to 8am on Mondays, Thursdays and Fridays, and from 9am to 11.30pm on Saturdays.

When the practice is closed patients are directed to contact the local out of hours service.

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

Updated 15 November 2016

Letter from the Chief Inspector of General Practice

We carried out an announced comprehensive inspection at Kingston Health Centre on 9 August 2016. Overall the practice is rated as Good.

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

• Overall, risks to patients were assessed and well managed; however, there were some areas where procedures should be more robust. For example, we observed that the room where medicines were kept was not always locked, and there was no process in place for monitoring the expiry dates for Patient Group Directions (the legal paperwork required for some staff to administer medicines); a new process was implemented by the practice immediately after the inspection, and we saw evidence that all necessary legal documents were immediately put in place.
• Staff understood and fulfilled their responsibilities to raise concerns and report incidents and near misses. All opportunities for learning from internal and external incidents were maximised.
• 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.
• The practice worked closely with other organisations and with the local community in planning how services were provided to ensure that they meet patients’ needs. For example, having identified gaps in the community services commissioned by the CCG, they had successfully campaigned for additional services to be provided, these included the provision of a paediatrician to be part of the eating disorders team in order to address the physical needs of these patients, and for the provision of a complex dressing service for patients with challenging wound care needs.
• Feedback from patients about their care was consistently positive.
• The practice implemented suggestions for improvements and made changes to the way it delivered services as a consequence of feedback from patients and from the patient participation group. For example, following feedback from patients they had introduced Saturday morning appointments.
• The practice had good facilities and was well equipped to treat patients and meet their needs.
• The practice actively reviewed complaints and how they are managed and responded to, and made improvements as a result. Information about making a complaint was available on the practice’s website and a complaints leaflet was available; however, there was no poster in the reception area informing patients about how they could complain.
• 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 a flexible approach to appointments; reception staff could over-ride the appointments system where necessary to meet demand and staff felt that clinical staff trusted their judgement on this.
• The practice had strong and visible clinical and managerial leadership and governance arrangements.
• 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.

We saw two areas of outstanding practice:

The practice was proactive in assessing the needs of their patient population and in adapting their service to meet the needs of their patients. For example, they had tailored their service to patients with learning difficulties by producing information in “easy read” for patients with learning difficulties, this included a “friends and family test” questionnaire and a care plan template, which allowed the patient to identify their support needs. They also worked closely with a local charity which supported homeless people, and as a result had developed a reputation for providing good quality and tailored service to these patients; they had registered 48 homeless patients in the past 12 months.

The practice had taken the initiative in several areas to provide services that were not available elsewhere in the locality, which in some cases involved staff undertaking additional training and completing further qualifications. For example, GPs at the practice had completed a diploma in mental health in order to offer an enhanced level of care to patients with mental health needs and to bridge the gap between the demand for counselling for patients with mental health needs and the limited provision available through the local community mental health team (CMHT); in particular, one of the GPs had qualified to offer psychosexual counselling, which was not available via the CMHT, and had provided this service to 31 patients in the past three years, with each patient receiving 6-8 sessions of 45-60 minutes each. This service is entirely funded by the practice and delivered outside of normal clinical hours.

The areas where the provider should make improvement are:

• Ensure that the new system for monitoring the use of PGDs is robust and effective, and ensure that arrangements for the safe storage of medicines are adhered to.
• They should review how patients with caring responsibilities are identified and recorded on the clinical system to ensure that all of these patients are identified so that information, advice and support can be made available to them.
• They should ensure that they are advertising to patients prior to their appointment that chaperones and translation services are available. They should also display information about their complaints procedure in the patient waiting area.

Professor Steve Field CBE FRCP FFPH FRCGP 

Chief Inspector of General Practice

Updated 15 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.
• GPs at the practice had special clinical interests in areas such as diabetes, dermatology and cardiology.
• Performance for diabetes related indicators were mixed compared to CCG and national averages. Overall the practice achieved 83% of the total QOF points available, compared with an average of 92% locally and 89% nationally. Their exception reporting rate for diabetes related indicators was 12%, which was comparable to the CCG average of 13% and national average of 11%.
• Longer appointments and home visits were available when needed.
• 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 worked with relevant health and care professionals to deliver a multidisciplinary package of care.

Updated 15 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 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.
• Cervical screening had been carried-out for 81% of women registered at the practice aged 25-64, which was comparable to the CCG average of 83% and national average of 82%.
• The practice was approved by the ‘You’re Welcome’ scheme (a quality criteria for young people friendly health services).
• 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 and health visitors.

Updated 15 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. For example, the practice had designated members of staff to provide training to patients on how to use their IT services for booking appointments and requesting prescriptions.
• The practice was responsive to the needs of older people, and offered home visits and urgent appointments for those with enhanced needs.
• The practice liaised with community services such as district nurses, the local rapid response team, and palliative care team to provide a complete package of care to these patients.

Updated 15 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. In response to patient feedback , the practice had begun providing a Saturday morning clinic for pre-booked appointments. Comments received via the CQC comment cards noted that patients found it easy to access early morning appointments, which allowed them to arrive at work on time.
• 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 was a registered travel clinic, and also accredited by the Kingston Integrated Sexual Health scheme to provide a comprehensive sexual health service, including contraceptive implants, a fast-track contraception service and immediate HIV testing for any individual regardless of whether they were registered at the practice. “On the spot” HIV testing was provided to an average of 20 patients per month.
• The practice sent appointment reminders and results by text message.

Updated 15 November 2016

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

• The practice had 32 patients diagnosed with dementia and 90% of these patients had had their care reviewed in a face to face meeting in the last 12 months, which was better than the CCG average of 83% and national average of 84%.
• The practice had 55 patients diagnosed with schizophrenia, bipolar affective disorder and other psychoses, and had recorded a comprehensive care plan for 93% of these patients, compared to a CCG average of 92% and 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.
• GPs at the practice had also completed diplomas in mental health in order to deliver better care to patients with poor mental health, in particular those whose conditions were difficult to manage but did not meet the criteria for hospital treatment. One of the partners had completed training in order to offer psychosexual counselling to patients, which was not available locally.
• 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 and we saw evidence of reception staff putting special arrangements in place to support these patients, for example, they had a system of telephoning some patients with dementia on the day of their appointment to remind them to attend.

Updated 15 November 2016

The practice is rated as outstanding 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. They had registered 48 homeless patients in the past 12 months, and worked closely with local charities to support these patients.

• The practice offered longer appointments for patients with a learning disability. The practice conducted annual reviews of their patients with learning disabilities; they had 14 patients on their learning disability register and had completed reviews of seven of these patients in the past 12 months. They had created an “easy read” template to help these patients to understand the care package that was in place for them.

• 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. They had also created their own patient information leaflets for vulnerable patients. They had an information pack for homeless patients which was given to them when they registered at the practice. They had also produced several leaflets and forms in “easy read” for the benefit of patients with learning disabilities and those who did not speak English as a first language.
• 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.