Kirton Medical Centre

Updated 23 January 2017

Kirton Medical Centre provides primary medical services to approximately 5,879 patients residing within Kirton which is a small village located three miles south of the town of Boston. The practice has seen a growth in the patient list size of approximately 800 additional patients within the past four years. The practice also provides services to patients residing in six care homes in Kirton. The practice has a dispensary on site and dispenses medicines to patients of its patient population who live more than one mile away from a local pharmacy.

It is located within the area covered by Lincolnshire East Clinical Commissioning Group (CCG). It is registered with the Care Quality Commission to provide the regulated activities of; the treatment of disease, disorder and injury; diagnostic and screening procedures; maternity and midwifery services and surgical procedures.

The practice is located within a large, spacious, purpose built property. The building is two storey and all areas are accessible to people using wheelchairs and those with other disabilities.

At the time of our inspection the practice employed two GP partners and 16 employed staff which included, one practice manager one deputy practice manager, two advanced nurse practitioners, two practice nurses and a team of dispensers, reception and administration staff.

The practice is open from 8am until 6.30pm Monday to Friday. Appointments are available between these times.

The practice has General Medical Services (GMS) contract which is a contract between the GP partners and the CCG under delegated responsibilities from NHS England.

The practice has a higher number of older patients aged over 65 years of age and 57% of patients have a long standing health condition compared to the national average of 54%.

The practice provides on-line services for patients such as to book routine appointments and ordering repeat prescriptions.

When the surgery is closed GP out-of-hours services are provided by provided by Lincolnshire Community Health Services NHS Trust which can be contacted via NHS111.

Updated 23 January 2017

Letter from the Chief Inspector of General Practice

We carried out an announced comprehensive inspection at Kirton Medical Centre on 8 September 2016. Overall the practice is rated as good.

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

• There was an open and transparent approach to safety and an effective system in place for reporting and recording significant events.
• Risks to patients were assessed and well managed.
• The practice had devised their own internal safeguarding referral form which staff within the practice could complete to raise a safeguarding concern to the safeguarding lead. This form had been shared for wider use within other local practices within East Lincolnshire CCG.
• 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 was the highest achieving practice within its CCG for effectively reducing unnecessary patient attendances to the local accident & emergency (A&E) department at Pilgrim Hospital in Boston. For example, data for 2014-15 showed a 21% decrease in A&E attendances which was the largest decrease in attendance rates compared to eight other practices within the CCG.
• Patients said they were treated with compassion, dignity and respect and they were involved in their care and decisions about their treatment.
• 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 supported by management. The practice proactively sought feedback from staff and patients, which it acted on.
• There were a range of standard operating procedures (SOPs) for the staff responsible for dispensing medicines. (SOPs are documents that explain a procedure for staff to follow. These help to ensure all staff members work in a consistent and safe way). All SOPs had been reviewed on a regular basis.
• The provider was aware of and complied with the requirements of the duty of candour.

The areas where the provider should make improvement are:

• Review process and methods for identification of carers and the system for recording this. To enable support and advice to be offered to those that require it. 

Professor Steve Field (CBE FRCP FFPH FRCGP) 

Chief Inspector of General Practice

Updated 23 January 2017

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.

• Performance for diabetes related indicators was 97% which was higher than the CCG average of 93% and the national average of 90%.

• 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 23 January 2017

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.

• The practice’s uptake for the cervical screening programme was 78%, which was higher than the CCG average of 74% and the national average of 74%.

• 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, health visitors and school nurses.

• Childhood immunisation rates for the vaccinations given were higher than CCG/national averages. For example, childhood immunisation rates for the vaccinations given to under two year olds ranged from 92% to 99% and five year olds from 91% to 97%.

Updated 23 January 2017

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.

• The practice was responsive to the needs of older people, and offered home visits and urgent appointments for those with enhanced needs.

• The practice provided a ‘sound advice’ hearing aid clinic for patients.

• The practice provided an over 75’s service which had been in place for approximately one year. This service delivered extended care to patients aged 75 years and over and provided a high number of home visits to these patients by practice nurses so that patients did not have to travel to the practice.

Updated 23 January 2017

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.

• The practice provided a ‘community surgery scheme’ whereby a consultant provided minor orthopaedic surgical procedures in clinics which were held twice a month at the practice. Other practices locally were able to refer in to this service.
• The practice had recently installed a new telephone system as a result of patient feedback.  This system included a queue system to advise patients of their place in the queuing system which would then help to indicate when their call was expected to be answered.  This system also enabled patients to request repeat prescriptions and also the ability to book appointments without the need to speak to a member of the reception team.

Updated 23 January 2017

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

• Performance for mental health related indicators was 100% which was higher than the CCG average of 89% and the national average of 93%.

• 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.

• Members of staff were ‘dementia friends’.

• The practice had told patients experiencing poor mental health about how to access various support groups and voluntary organisations.

• 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 23 January 2017

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 homeless people, 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.

• 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.