Kingsnorth Medical Practice

Updated 13 April 2017

Kingsnorth Medical Practice is situated in Kingsnorth, Ashford, Kent and has a registered patient population of approximately 11,157. The practices catchment largely covers new town residential areas with a high ratio of commuting population and young families. The patient population is also transient with an average of 1,350 patients leaving and 1,349 registering with the practice for the years 2014 to 2015 and 2015 to 2016. Eighty nine percent of the population are under the age of 65, with 47% under the age of 18. Eleven percent of the population are over the age of 65.

The practice staff consist of four GP partners (male) and four salaried GPs (female), one GP registrar (female), one community nurse practitioner (male), four practice nurses (female), three healthcare assistants (female), one phlebotomist (female), one practice manager, one deputy practice manager as well as administration and reception staff. Patient areas are on the ground and first floors with waiting rooms in both areas. CCTV cameras allow the reception team to monitor patient safety in the first floor waiting area. A lift provides access to the first floor and all areas are accessible to patients with mobility issues as well as parents with children and babies.

The practice is a teaching and training practice (teaching practices have medical students and training practice have GP trainees and newly qualified doctors).

The practice has a personal medical services contract with NHS England for delivering primary care services to the local community.

Services are provided from Ashford Road, Ashford, Kent, TN23 3ED.

Kingsnorth Medical Practice is open Monday to Friday between the hours of 8am to 6.30pm. Appointments are available from 8.00 am to 6.30 pm Monday to Friday.

There are a range of clinics for all age groups as well as availability of specialist nursing treatment and support.

There are arrangements with other providers (Primecare) via the NHS 111 system to deliver services to patients outside of the practice’s working hours.

Updated 13 April 2017

Letter from the Chief Inspector of General Practice

We carried out an announced comprehensive inspection at Kingsnorth Medical Practice on 17 November 2016. Overall the practice is rated as outstanding.

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

• 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 (PPG).
• A proactive approach to anticipating and managing risks to people who use services was embedded and was recognised as the responsibility of all staff.
• There was an open and transparent approach to safety and an effective system for reporting and recording significant events. Staff understood and fulfilled their responsibilities to raise safeguarding concerns and report incidents and near misses. All opportunities for learning from internal and external incidents were maximised.
• Risks to patients were assessed and well managed.
• Staff were committed to working collaboratively and people who had complex needs were supported to receive coordinated care. There were innovative, proactive and efficient ways to deliver more joined-up care to people who used services. For example, the introduction of the Community Practitioner and the weight management programme.
• Staff assessed patients’ needs and delivered care in line with current evidence based guidance. Staff had been trained to provide them with the skills and knowledge 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. Feedback from patients about their care was consistently positive.
• 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 and non-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 practice had strong and visible clinical and managerial leadership and governance arrangements.
• The provider was aware of and complied with the requirements of the duty of candour.

We saw several examples of outstanding practice:

• The practice offered an extensive range of additional services, providing secondary care closer to home, achieving significant auditable results, benefits and improved outcomes for patients. It reached out to the community and worked in close and constructive partnership with local hospital consultants. Services included a full muscular skeletal service, Cardiology, Ear, Nose and Throat, (including Paediatrics) and Vasectomy. In January 2017, Orthopaedic outpatient clinics were also introduced. The practice ethos of delivering care closer to home had achieved a lower rate of referrals to secondary care. The rate achieved was 41 per 1,000 patients compared to the CCG average of 52 per 1,000 patients. The practice also offered a minor injury service, which was available to registered and non-registered patients. This service had resulted in the practice achieving the second lowest rate within the CCG area for children up to 17 years attending accident and emergency due to injury. The practice worked closely with its Patient Participation Group (PPG) to promote the services offered. It ensured that local schools, sports clubs and children’s clubs were made aware of the minor injuries and other services. They also advertised on community notice boards.

The areas where the provider should make improvement are:

• Ensure that minutes and records of investigations into complaints and significant events are fully auditable and provide accountability.

Professor Steve Field CBE FRCP FFPH FRCGPChief Inspector of General Practice

Updated 13 April 2017

The practice is rated as outstanding 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.
• The practice managed a register of patients who were identified as being at risk of developing diabetes and those patients were screened on an annual basis and supported to reduce the risk by providing appropriate lifestyle advice.
• Where practicable and in support of those patients who worked or who had young families, flexibility was provided around appointments and routine tests. They were arranged at a convenient time for the patient followed by a telephone consultation with the GP.
• The practice also proactively screened patients who attended for flu vaccination and who were identified as being at risk of atrial fibrillation (an abnormal heart rhythm). This had resulted in the practice achieving the highest detection rate within the clinical commissioning group (CCG) area. Early detection and treatment of atrial fibrillation was a factor in reducing the risk of those patients suffering a stroke.
• Patients with long-term conditions were recognised as being at an increased risk of depression and annual reviews included screening for depressive symptoms.
• Patients with long-term/complex conditions were triaged to establish and allocate the appropriate length of time needed to assess and review all current and on-going problems, care and treatment. This facilitated continuity of care in a single consultation and avoided the need for multiple appointments.
• Flu vaccinations rates for patients suffering from long-term conditions were consistently higher than local and national averages. For example: The percentage of patients diagnosed with diabetes who had received the flu vaccination in the year 2015/2016 was 98%, which was five percent above the clinical commissioning group (CCG) and four percent above the national averages. In 2014/2015 the practice rate was 96%, four percent above the CCG and three percent above the national averages. In 2013/2014 the practice rate was 96% which was two percent above the CCG and three percent above the national averages.
• The percentage of patients diagnosed with Stroke or Trans-ischaemic attack who had received the flu vaccination in the year 2015/2016 was 95%, five percent above the CCG and one percent above the national averages. In 2014/2015 the practice rate was 97%, seven percent above the CCG and three percent above the national averages. In 2013/2014 the practice rate was 97%, three percent above the CCG and three percent above the national averages.
• Patients unable to attend the surgery were assessed and reviewed by the community practitioner in consultation with their named GP.
• The percentage of patients on the diabetes register, with a record of a foot examination and risk classification within the preceding 12 months was 90% compared to the Clinical Commissioning Group average of 85% and the national average of 88%.
• 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 13 April 2017

The practice is rated as outstanding for the care of families, children and young people.

• The practice ensured they registered whole families living at the same address to ensure a full picture was available to clinicians.
• 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 held multidisciplinary healthcare meetings for this purpose, with outside agencies in attendance.

• Immunisation rates were relatively high for all standard childhood immunisations.
• The practice routinely sent congratulatory cards to parents following the birth of a child, with appointment invitations. The practice offered a system of one appointment to conduct the mother’s post-natal check, a baby health check and baby immunisations.
• The practice identified that many of the transient commuting population had minimal family and support networks and proactively screened new mothers for symptoms of post-natal depression.
• The practice was proactive in contacting patients and reminding them to attend screening. The percentage of women aged 25-64 whose notes recorded that a cervical screening test had been performed in the preceding 5 years was better than local and national averages at 91% compared to the clinical commissioning group(CCG) average of 82% and the national average of 82%.
• Appointments were available outside of school hours and the premises were suitable for children and babies.
• The practice offered protected drop-in appointments after school/work targeted at young people to allow greater and more flexible access to the service. This has been of particular benefit when patients have wanted to discuss sensitive issues such as emergency contraception, emotional/sexual or other health advice.
• The practice achieved the highest percentage within the CCG area, of children aged two, three and four vaccinated against flu. Non-attenders were contacted and encouraged to attend. The practice made good use of text reminders.
• We saw positive examples of joint working with midwives and health visitors and the practice met with them on a bi-monthly basis. The midwife held weekly clinics at the practice affording staff the opportunity for regular liaison.
• The practice offered minor injury appointments and had achieved the lowest rate within the CCG area for children up to 17 years attending accident and emergency.
• Staff were all trained in safeguarding children to the appropriate level and we saw evidence that safeguarding procedures were effective and well-managed.

Updated 13 April 2017

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

• Whilst the percentage of the patient population that fell within this population group was four percent of the total, the practice viewed this group as often experiencing complex health needs and at a higher risk of an unplanned hospital admission. They recognised the benefits of being proactive in supporting the maintenance of health and well-being and offered innovative, proactive and personalised care to meet the needs of the older people in its population
• The practice demonstrated a holistic approach to the care of its older patients with a focus on care being delivered nearer to home and maintaining continuity. The introduction of the Community Practitioner and the positive partnership they had built with their patients had led to the practice achieving the lowest rate of referral to the district nursing service within the locality.

• The practice was responsive to the needs of older people, and offered home visits and extended appointments for those with enhanced needs. The Community Practitioner allocated the time needed to effectively manage each patients concerns and liaised with other care providers, statutory bodies to ensure appropriate care planning and support was put in place.
• The practice identified all of its older patient’s population and contacted every patient who had not been seen for over a year to check on their health and welfare.
• All staff had received training in safeguarding adults to the appropriate level and we saw evidence that procedures were effective and well-managed.

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Updated 13 April 2017

The practice is rated as outstanding 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 offered telephone consultations and text reminders. These were used to good effect in conjunction with a variety of tests used to monitor long-term conditions. Patients were provided with relevant equipment and guidance to support self-care where appropriate.
• The practice offered over 40 health checks screening blood pressure, cholesterol and blood sugar levels.
• The practice offered two Saturday flu vaccination clinics each October for working patients and carers. Blood pressure checks were also offered at these clinics to maintain essential health monitoring for relevant patients.
• Vasectomy clinics were held on a monthly basis on a Saturday morning to support working age men and their families.

Updated 13 April 2017

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

• 87% of patients diagnosed with dementia had had their care reviewed in a face to face meeting in the last 12 months, (with four exceptions equalling10%), which was better than the clinical commissioning group (CCG) average of 82%, (exception rate of 10%),and the national average of 84% (exception rate of 8%).
• The percentage of patients with schizophrenia, bipolar affective disorder and other psychoses who had had a comprehensive, agreed care plan documented in their record, in the preceding 12 months was 95% (with eight exceptions equalling16%),compared to the CCG average of 86% (exception rate of 10%, and the national average of 88%, (exception rate of 13%).
• The practice regularly worked with multi-disciplinary teams in the case management of patients experiencing poor mental health, including those with dementia.
• The practice was proactive in identifying poor mental health and intervening at an early stage.
• The practice had told patients experiencing poor mental health about how to access various support groups and voluntary organisations.
• The practice had a system 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 many, including non-clinical staff, had received training. All dementia patients received telephone reminders from the reception team on the day of an appointment.
• The community nurse practitioner conducted home visits for dementia patients to undertake medicine reviews and check that medicines was being taken as prescribed and look for potential signs of medicine hoarding.
• The nurse practitioner used the dementia register to arrange for flu, shingles and pneumonia vaccinations.
• The practice achieved the highest rate of dementia diagnosis due to its proactive approach within the older patient population.
• The practice provided accommodation for the mental health team to see patients, including those not registered at the practice.
• The practice operated a safeguarding measure for patients identified as being at high-risk and any cancellation of an appointment by them was referred to the relevant GP and proactively followed up.
• All patients who had attempted self-harm were discussed at the monthly multidisciplinary team meeting.

Updated 13 April 2017

The practice is rated as outstanding for the care of people whose circumstances may make them vulnerable.

• The practice made use of flags on the computer system to highlight patients living in vulnerable circumstances including homeless people, unaccompanied children/asylum seekers, those with language barriers, hearing/speech/vision impairment and those with a learning disability. This enabled the practice to provide tailor-made access to care.
• The practice recognised the value of the reception team in identifying vulnerable patients through their interactions and observations, and reporting concerns was proactively encouraged.
• Any notification that a patient had self-harmed/overdosed was referred to the duty doctor as a priority. Following assessment, the patient would, where possible, be contacted and the patients named GP would be tasked to follow the incident up.
• The practice maintained a register of patients identified as being vulnerable. The practice lead for safeguarding reviewed the care of these patients at the point of registration.
• The practice offered longer appointments for patients with a learning disability. It had a nominated champion for learning disabilities who was available to be present during GP consultations in the practice or the home environment at a time which best met the patient’s individual needs.
• Vulnerable patients’ booked appointments were flagged so that any cancellation by the patient would result in the clinician being alerted and follow up with a telephone call to that patient. The Practice limited the use of the text reminder system so that appointments could not be cancelled automatically. This review of cancellation requests supported the safeguarding of vulnerable patients.
• 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.