Saffron Health Partnership

Updated 4 October 2016

Dr Kirkham and Partners provides a range of primary medical services, including minor surgical procedures from its location from Biggleswade Health Centre, Biggleswade, Central Bedfordshire

SG18 8DJ. The practice has a branch surgery, Langford Surgery, 111 Church Street, Langford, Biggleswade, SG18 9QA. The practice serves the local population including Upper Caldicott and Lower Caldicott, Dunton, Langford.

The practice serves a population of approximately 13,600 patients with slightly higher than average populations of patients aged 0 to 4 years of age and those aged between 40 to 55 years. There are marginally lower than average populations of patients aged 20 to 34 years. The practice population is largely White British. National data indicates the area served is one of low deprivation in comparison to England as a whole.

The clinical team consists of three male and two female GP partners and one female salaried GP. The GPs are supported by two nurse practitioners, a minor illness nurse, three practice nurses,an assistant practitioner and a phlebotomist. The team is supported by a business manager who manages the IT, data and finance teams, a team of secretaries and patient services team along with other administration staff. The practice also has a dispensary, with four dispensers, managed by the operations manager.

Dr Kirkham and partners are a training practice and take GP trainees from the Bedford General Practice Specialist Training Programme for a period of 6 months at a time. In addition the practice also offered 2 week work experience placement to local sixth from students.

The practice holds a General Medical Services (GMS) contract for providing services, which is a nationally agreed contract between general practices and NHS England for delivering general medical services to local communities.

The practice operates from a shared single storey purpose built property where the practice occupies approximately 37% of the building which is leased from NHS Property Services. There is a car park to the front of the surgery, with adequate disabled parking available.

The practice is open between 8am and 1pm and 1.30pm and 6.30pm Monday to Friday. The branch surgery is open between 8am and 11.30am Monday to Friday. In addition, pre-bookable appointments are available after 6.30pm on Mondays and from 7am on Thursdays and Fridays.

For patients requiring a GP outside practice hours an out of hours service was provided by MDOC. Information about how to access the service was available in the practice and on the practice website and telephone line.

The dispensary at Biggleswade is open every day between 8.30am and 12.30pm and 2pm until 6pm.

Updated 4 October 2016

Letter from the Chief Inspector of General Practice

We carried out an announced comprehensive inspection at Dr Kirkham and Partners on 3 May 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.

• 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 held regular staff and clinical meetings where learning was shared from significant events and complaints.
• 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.
• The provider was aware of and complied with the requirements of the duty of candour.

The areas where the provider should make improvement are:

• Continue to identify and support more carers in their patient population.

Professor Steve Field (CBE FRCP FFPH FRCGP) 

Chief Inspector of General Practice

Updated 4 October 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.
• Performance for diabetes related indicators was comparable to the national average. For example, the percentage of patients with diabetes, on the register, in whom the last blood glucose test reading showed good control in the preceding 12 months was 72% compared to the CCG average of 76% and the national average of 78%.
• 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 more complex needs, the named GP worked with relevant health and care professionals to deliver a multi-disciplinary package of care.
• Nursing staff held lead roles for diabetes, asthma and chronic obstructive pulmonary disease (COPD). There was a GP lead for patients suffering from heart failure. The practice worked with the community diabetic nurse to support the patients whose condition was difficult to manage.
• The practice had set up a notification alert on the clinical system to recall patients to ensure they were regularly reviewed.
• Patients who were unable to attend appointments at the practice could be visited in their home for reviews and condition management.

• The practice held annual diabetes and asthma education evenings for patients to help them understand their treatment and how to manage it.
• Patients identified at risk of hospital admission were identified and flagged on the clinical system to ensure patients received treatment as a priority. All patients had individualised care plans and other health care professionals were involved in care planning dependent upon patient needs.

Updated 4 October 2016

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

• The Practice had a method of flagging for children who may be at risk.
• 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.
• 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, nursery nurses, school nurses and the vaccination team.
• Midwives were based within the practice and held clinics for expectant mothers. The practice offered flu and pertussis vaccinations for pregnant women.
• Immunisation clinics were carried out at two nurses clinics weekly to ensure patient safety due to the complexity of vaccination program and to give more time to parents.
• The practice offered Hepatitis B vaccination for babies who were eligible.
• General appointments and asthma reviews were available for children outside of school hours.
• The Practice offered the meningitis vaccination for school age children and students. They also worked with the school vaccination nurses to offer a catch clinic held at the practice.
• The Practice supported the HPV catch up campaigns and offered appointments for patient who missed school programme.
• The practice’s uptake for the cervical screening programme was 82%, which was comparable to the CCG average of 83% and the national average of 82%.
• Cervical screening appointments were offered in extended hours and during the day.

Updated 4 October 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.
• The practice was responsive to the needs of older people and offered home visits and urgent appointments for those with enhanced needs
• Home visits were available for patients with either acute or long term problems. These visits would be carried out by a GP, a nurse practitioner or the assistant practitioner.
• Shingles, pneumonia and flu vaccinations were available for eligible patients.

Updated 4 October 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.
• The practice was proactive in offering online services for booking appointments and requesting repeat prescriptions as well as a full range of health promotion and screening that reflects the needs for this age group.
• Telephone consultations were available two mornings each week with a GP or a nurse for patients unable to attend the surgery and did not require a face to face appointment. In addition, early morning and evening appointments were available once a week.
• The practice had introduced the electronic prescription service, online booking of appointments, ordering prescriptions and access to their detailed coded health care record to assist patient with engaging in health care.
• The practice organised an annual event, ‘Super Saturday’ held in January each year to engage in a programme called ‘New Year’s Resolutions’ where health checks were offered to eligible patients.
• NHS health checks were offered in during extended hours for patients unable to attend at usual times.

Flu immunisation clinics were held on Saturdays and early morning or eveining, bookable appointments were available, to provide flexibility.

Updated 4 October 2016

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

• 81% of patients diagnosed with dementia who had their care reviewed in a face to face meeting in the last 12 months, comparable to the CCG and national averages of 84%.
• Performance for mental health related indicators were otherwise comparable to local and national averages. For example, the percentage of patients with diagnosed psychoses who had a comprehensive agreed care plan was 92% where the CCG average was 87% and the national average was 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.
• 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.
• Practice offers annual check up for patients on mental health register and offered annual Dementia reviews.
• Regular follow ups were available with same GP to ensure continuity of care.
• Practice had audited the use of anti-depressant medication for younger aged group and had established link to the Mental Health worker to assist with this.
• A community consultant psychiatrist and access to a specialist nurse was available one day a week.
• The practice organised a ‘Raising the awareness of dementia’ evening for patients, supported by Carers in Bedfordshire with another planned for later in 2016.

Updated 4 October 2016

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.
• 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.
• A district nurse chaired a multi-disciplinary team meeting monthly which the practice attended with a social worker to discuss concerns regarding vulnerable adults.
• The Practice had a learning disability register and offered longer appointments and annual health checks with two GPs. These were held as home visits or at the surgery.
• The practice informed vulnerable patients about how to access various support groups and voluntary organisations.
• A social worker was based at the practice.
• The practice used the GSF 'Gold Standard Framework’ to support patients who were approaching the end of their life. These were supported by regular multi-disciplinary teams.
• The practice’s computer system alerted GPs if a patient was also a carer. The practice had identified 87 patients as carers (0.6% of the practice list). The practice had information in folders and displayed on television screens for carers and community support groups for patients.
• The practice regularly worked with other health care professionals in the case management of vulnerable patients.