Archived: King's College Health Centre

Updated 30 August 2016

King’s College Medical Centre provides primary medical services through a Personal Medical Services (PMS) contract within the London Borough of Westminster. The practice is part of NHS Central London (Westminster) CCG and the South Westminster village network of GP practices. The services are provided from a single location to around 11,000 patients within premises owned by King’s College London University. There were plans to relocate the practice in 2017 to Bush House in the Aldwych with ten consulting rooms and increased space and facilities to deliver an expanded service, including the take on of additional patients. The whole patient population comprises staff and students of the University and their spouses only and the services are specifically tailored for this group, mainly in the 18-25 year age group. There are no patients under the age of 16 registered at the practice and significantly below average numbers over age 35. The practice has been taking on an increasing proportion of International and mature students with varying expectations of NHS services.

At the time of our inspection, there were 2.79 whole time equivalent (WTE) GPs comprising the one partner GP (female), three salaried GPs (two female and one male); and a retired GP (male) who provided ad hoc locum cover. One GP was on maternity leave but due to return in July 2016. The GPs provided 20 clinical sessions per week. Additional ad hoc GP sessions were provided by three regular locums. There was also a nurse partner/centre manager (1 WTE) and a deputy practice manager (1.07 WTE). In addition, the practice employed three practice nurses (two female and one male, 2.04 WTE); two healthcare assistants (0.75 WTE); and three receptionists/ administrative assistants,(a total of 3.5 WTE).

The practice reception is open between 8.30am and 6.30pm Monday to Friday. Appointments were from 9.00am to 6.30pm Monday to Friday. Extended hours appointments are offered between 6.30pm and 8.30pm on Tuesday and Thursday term time only). In addition to pre-bookable appointments that can be booked in advance, urgent appointments are also available for people that needed them. If patients have a medical concern the practice offers a telephone triage advice line Monday to Friday. They will be able to make a same day appointment during the call, if necessary.

There are also arrangements to ensure patients receive urgent medical assistance when the practice is closed. Out of hours services are provided by a local provider. Patients are provided with details of the number to call.

In addition patients are provided with details of four GP surgeries open on Saturdays and Sundays in the Westminster area for patients to attend if required. These surgeries offer a walk-in service, so patients can turn up at these practices and they will be seen.

Updated 30 August 2016

Letter from the Chief Inspector of General Practice

We carried out an announced comprehensive inspection at King’s College Health Centre on 19 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.
• 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.
• The practice had good facilities and in most respects 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 improvements are:

• Ensure all appropriate spill kits are available within the practice.
• Monitor improvements to medicines management to ensure systems remain robust.
• Complete and record a risk assessment of the practice’s decision not to stock medicine excluded from the emergency medicines kit.
• Review the system for the identification of carers to ensure all carers have been identified and provided with support.
• Advertise in the reception area that translation services are available.

Professor Steve Field (CBE FRCP FFPH FRCGP) 

Chief Inspector of General Practice

Updated 30 August 2016

The practice is rated as good for the care of people with long-term conditions.

• Given the practice population group the majority of long-term conditions were those seen in younger people. This included asthma, epilepsy, type 1 diabetes, and mental health conditions including eating disorders.
• Patients had a structured annual review to check their health and medicines needs were being met. For those patients with the most complex needs, GPs worked with relevant health and care professionals to deliver a multidisciplinary package of care.
• Designated staff had lead roles in chronic disease management and patients at risk of hospital admission were identified as a priority. There was a nurse lead for asthma and a GP and healthcare assistant led on diabetes, supported by a second GP who was undertaking the diabetes diploma.
• Performance in 2014/15 for diabetes related QOF indicators was below the national average: 67% compared to 89%. However in 2015/16 this had improved slightly to 70% as a result of providing advanced in-house care and specialist expertise.
• Longer appointments were available when needed.

Updated 30 August 2016

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

• The practice did not have patients registered under the age of 16 years. They nevertheless supported students who were pregnant by providing shared antenatal care. The practice encouraged them to engage with/register at a local practice with family/children’s facilities prior to their confinement date.

Updated 30 August 2016

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

• The practice had less than 10 patients in this population group and treated them an individual basis offering proactive, personalised care to meet their needs.
• The practice was responsive to the needs of older people, and offered home visits and urgent appointments for those with enhanced needs.
• Searches were run to ensure patients were invited for the shingles vaccinations.
• Bowel screening non-responders were contacted by nurses.
• ‘Mini mental’ tests were carried out and referrals made to the community clinic for further assessment if dementia was suspected.

Updated 30 August 2016

The practice is rated as good for the care of working-age people (including those recently retired and students).

• The practice’s whole population was comprised of staff and students of the university and their spouses and the services were specifically tailored for this group.
• The practice provided extensive sexual health services including sexual health screens for patients through the hosting of a specialist clinic twice a week and close links with the local sexual health clinic. The level of screening was one of the highest in Westminster for the national screening campaign.
• Health promotion services were integrated with the university, working together on campaigns and supporting and working with the other student services team members and attending the college health and wellbeing group.
• The practice aimed to provide enhanced engagement and follow up for patients with many not having used primary care services independently before. There were on-going campaigns throughout the year to enable students to catch up on any vaccinations they have missed, with regular text reminders. The practice also offered an extensive travel service, including vaccinations to support students in their gap year and those taking up elective medical placements abroad.
• Reports from out of hours services and walk-in clinics were reviewed by the nurses each day and calls made to patients as appropriate to follow up their condition, provide advice and arrange appointments if needed.
• 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 had implemented social media networks at the request of student groups, through online websites, social media sites, student radio and an input to the residents’ newsletter.

Updated 30 August 2016

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

• Performance in 2014/15 for mental health related QOF indicators was below the national average: 59% compared to 93%. However, the practice had improved performance to 66% in 2015/16.
• The practice regularly worked with multi-disciplinary teams in the case management of patients experiencing poor mental health.
• The practice offered a wide range of services for people with poor mental health. These included GPs with particular mental health expertise, close liaison with the university’s in-house psychiatrist and counselling team, including cognitive behaviour therapists, and close liaison with the local Improving Access to Psychological Therapies (IAPT) service and a Primary Care Plus psychiatric nurse, who saw patients on-site.
• 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 30 August 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 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.