Archived: Kilmeny Group Medical Practice

Updated 1 November 2016

Kilmeny Surgery is a member of the Airedale Wharfedale and Craven Clinical Commissioning Group (CCG). Personal Medical Services (PMS) are provided under a contract with NHS England. They also offer a range of enhanced services, which include:

• Childhood vaccination and immunisations

• The provision of influenza and pneumococcal immunisations

• Facilitating timely diagnosis and support for patient with dementia

• Extended hours access

• Improving online access

Kilmeny Surgery is located at 50 Ashbourne Road, Keighley, which is a former mill town in a semi-rural location and is within the 30% most deprived localities in England.

The practice is situated in purpose built premises. There are facilities for people with disabilities and all patients areas are on the ground floor. There are car parking facilities on site with designated disabled parking.

The practice has a patient list size of 13,309 which is made up of a predominantly white British population, with an almost 50:50 ratio of male and female patients. The practice has close links with local residential care homes, where some registered patients reside.

There are seven GP partners, three female and four male, who are supported by three salaried GPs, an advanced nurse practitioner, a pharmacist, two practice nurses and one health care assistants. There is a practice manager and a team of administration and reception staff. The practice also has the support of a CCG employed medicines management pharmacists. The practice is also a training practice and has GPs, medical students and nurses in training

The practice is open between 7am to 8pm on Mondays, 8am and 6pm Tuesday, Wednesday and Fridays and 8am to 8pm on Thursdays. When the practice is closed out-of-hours services are provided by Local Care Direct, which can be accessed via the surgery telephone number or by calling the NHS 111 service.

The practice has good working relationships with local health, social and third sector services to support provision of care for its patients. (The third sector includes a very diverse range of organisations including voluntary, community, tenants’ and residents’ groups.)

One of the GP partners is an executive, for the Airedale Wharfedale and Craven Clinical Commissioning Group and is their mental health lead.

Updated 1 November 2016

Letter from the Chief Inspector of General Practice

We carried out an announced comprehensive inspection at Kilmeny Medical Centre on 23 August 2016. Overall the practice is rated as good for providing safe, effective, caring, responsive and well-led care for all of the population groups it serves.

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

• The ethos and culture of the practice was to provide good quality service and care to patients.

• Patients told us they were treated with compassion, dignity and respect and were involved in care and decisions about their treatment.

• Patients’ needs were assessed and care was planned and delivered following best practice guidance.A

• The practice had good facilities and was well equipped to treat and meet the needs of patients. Information regarding the services provided by the practice and how to make a complaint was readily available for patients.

• Patients we spoke with were positive about access to the service. They said they found it generally easy to make an appointment, there was continuity of care and urgent appointments were available on the same day as requested.

• The practice of, and complied with, the requirements of the duty of candour. (The duty of candour is a set of specific legal requirements that providers of services must follow when things go wrong with care and treatment.)

• The partners a culture of openness and honesty which was reflected in their approach to safety.

• Risks to patients were assessed and well managed.

• There were comprehensive safeguarding systems in place; particularly around vulnerable children and adults.

• The practice sought patient views how improvements could be made to the service, through the use of patient surveys, the NHS Friends and Family Test and the Patient Participation Group (PPG).

• There was a clear leadership structure.

• The GP partners were forward thinking, aware of future challenges to the practice and were open to innovative practice.

We saw an area of outstanding practice:

• The practice was one of three practices who pioneered a wellbeing project. The practice identified 10 patients as being in need of additional support to manage their illnesses and referred to the multidisciplinary project team led by a consultant clinical psychologist and linked to an academic institute. The project evaluated extremely well and had been shared across Yorkshire and Humber as a good example of a new model of care. As a result of the wellbeing project the practice identified that chronic pain was an issue not well understood or managed by most health professionals. The practice had started a support group for patients living with chronic pain and has developed an education process for patients and other clinicians in the best practice model of managing chronic pain. As a result the practice could evidence a number of patients who had reduced or stopped long term use of painkillers and empowered them to manage and accept their condition successfully. Patients told us how empowered they had become as a result of support from the practice.

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.

• The GPs had lead to check patients’ health care and treatment needs were being met.

• The practice maintained a register of patients who were a high risk of an unplanned hospital admission. Care plans and support was in place for these patients.

• 84% of diagnosed diabetic patients had a blood sugar level within the normal limits in the preceding 12 months (CCG average 84%, national average 78%).

• 85% of patients with hypertension (high blood pressure) who had a reading within normal limits in the last 12 months (CCG average 85% and national averages of 84%).

• 84% of patients diagnosed with asthma, on the register and had received a review in the last 12 months (CCG average 77% and national average 75%).

• The practice identified those patients who had complex needs. For patients who had life limiting conditions the practice and ensured they were on the palliative care register and discussed them at the Gold Standards Framework meeting to ensure the correct support and care was delivered.

• The practice delivered a diabetic clinic with specialist nurse and dietician which include the initiation of insulin.

• The practice supported patients living with chronic pain and supported medication reduction.

• The practice had a blood pressure monitoring machine available in a private area of the reception, to enable patients to check their own blood pressure. The results were then printed out and given to reception to put into the patient’s record. If there were any abnormalities, patients were invited to see a clinician for follow-up.

Updated 1 November 2016

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

• The practice worked with midwives, health visitors and school nurses to support the needs of this population group. For example, the provision of ante-natal, post-natal and child health surveillance clinics.

• There were systems in place to identify and follow up children living in disadvantaged circumstances and who were at risk.

• Patients told us children and young people were treated in an age-appropriate way and were recognised as individuals.

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

• Immunisation rates were higher or with the CCG and national rates for all standard childhood immunisations.

• Sexual health, contraceptive and cervical screening services were provided at the practice.

• 92% of eligible patients had received cervical screening (CCG average 84% and national average 82%).

• The practice offered flexible clinics for postnatal examinations which included immunisations and child health checks reducing the number of surgery visits patients needed to make.

• Appointments were available with both male and female GPs.

Updated 1 November 2016

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

• The practice provided proactive, responsive and person-centred care to meet the needs of the older people in its population. All elderly patients had a named GP.
• The practice worked closely with other health and social care professionals, such as the district nursing and local neighbourhood teams, to ensure housebound patients received the care and support they needed.
• The practice participated in Airedale Wharfedale and Craven Clinical Commissioning Group (CCG) initiatives to reduce the rate of elderly patients’ acute admission to hospital.
• Patients who were considered to be at risk of frailty were identified and support offered as appropriate.
• Care plans were in place for those patients who were considered to have a high risk of an unplanned hospital admission and patients were reviewed as needed.
• Health checks were offered for all patients over the age of 75 who had not seen a clinician in the previous 12 months.
• Patients were signposted to other local services for access to additional support, particularly for those who were isolated or lonely.
• The practice delivered a successful Enhanced Primary Care Scheme to assist with the care of complex patients and reduce hospital admissions.

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 these patients 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 provided extended hours appointments on Mondays and Thursdays, telephone consultations, online booking of appointments and ordering of prescriptions.
• The practice offered a range of health promotion and screening that reflected the needs for this age group.
• Health checks were offered to patients aged between 40 and 74 who had not seen a GP in the last three years.
• Students were offered public health recommended vaccinations prior to attending university.
• Travel health advice and vaccination were available.
• GPs at the practice demonstrated specialist skills and held clinics for musculo-skeletal problems, skin conditions, chronic pain and anticoagulation

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 multidisciplinary teams in the case management of people in this population group, for example the local mental health team.
• Patients and/or their carer were given information on how to access various support groups and voluntary organisations.
• 96% of patients diagnosed with dementia had received a face to face review of their care in the preceding 12 months (CCG average 89%, national average 84%).
• 100% of patients who had a complex mental health problem, such as schizophrenia, bipolar affective disorder and other psychoses, who had a comprehensive, agreed care plan documented in their record in the preceding 12 months (CCG average 94% and national averages of 88%).
• Staff had a good understanding of how to support patients with mental health needs or dementia.
• All staff had completed the Dementia Friendly Training.
• One of the GP’s was the lead for mental health provision for the CCG, and volunteered the practice to participate in the wellbeing project and the learning from the project was shared across the CCG.

Updated 1 November 2016

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

• Staff knew how to recognise signs of abuse in children, young people and adults whose circumstances may make them vulnerable. They 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.
• The practice could evidence a number of children who were on a child protection plan (this is a plan which identifies how health and social care professionals will help to keep a child safe).
• Patients who had a learning disability received an annual review of their health needs and a care plan was put in place. Carers of these patients were also encouraged to attend, were offered a health review and signposted to other services as needed.
• Those patients who were on the autistic spectrum disorder were coded on the practice computer system, which enabled additional support to be provided as needed.
• We saw there was information available on how patients could access various local support groups and voluntary organisations.
• There was a self-referral alcohol and drugs service delivered from the practice by a voluntary organisation.