Archived: Kinson Road Medical Centre

Updated 21 July 2016

Kinson Medical Centre is situated in Kinson which is a suburb of Bournemouth, Dorset.

The practice has an NHSE general medical services contract to provide health services to approximately 8,705 patients. The practice is open between 8.30 and 6.30pm Monday to Friday. Extended hours appointments are offered on Monday and Friday mornings from 7.30am and Monday evenings until 7pm. In addition to pre-bookable appointments that can be booked up to two weeks in advance, telephone appointments are available. Urgent appointments are also available for patients that needed them.

The practice has opted out of providing out-of-hours services to their own patients and refers them to South Western Ambulance Service via the NHS 111 service.

The mix of patient’s gender (male/female) is almost 50%. 14.7% of the patients are aged over 75 years old which was slightly lower than the CCG average of 15% but higher than the national average of 10%. 20% of the practice population were under the age of 20 years. 65.8% have a long standing health condition which was higher than the national average of 54%. There was no data available to us at this time regarding ethnicity of patients but the practice stated that the majority of their patients were white British.

The practice had an established team of four GPs. There are two male and two female GPs. One of the GPs is a partner who holds managerial and financial responsibility for running the business. The GPs are supported by a practice manager, two practice nurses and a health care assistant. The team are supported by a team of 17 part time administration staff who carry out reception, administration, scanning and secretarial duties. There is a vacancy for a GP which is currently being covered by regular locums.

We carried out our inspection at the practice’s only location which is situated at:

440 Kinson Road

Kinson

Bournemouth

Dorset

BH10 5EY

However, GPs from the practice also lease an office and provide consultations at West Howe clinic which is a purpose built facility owned and run by the Dorset community services (Dorset Healthcare University Foundation Trust). This was not inspected on this occasion.

Updated 21 July 2016

Letter from the Chief Inspector of General Practice

We carried out an announced comprehensive inspection at Kinson Road Medical Centre on Wednesday 6 July 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 were proactive in the care of their patient’s needs, For example, the practice was part of the North Bournemouth Poly-pharmacy review project which had seen more than 100 patients having their medicines reviewed.
• Patients over the age of 75 had access to a specialist nurse as part of the local North Bournemouth project. This meant that GPs were able to refer to this service where there is an identified gap in community services provision, for example where a routine BP check is required and patient is unable to access the practice.
• 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 had strong links with community matrons and district nurses to support the care management of patients with long term conditions. Patients were discussed at monthly Multi-Disciplinary Team (MDT) meetings where practitioners shared information to support improvements in health and wellbeing. The district nursing team were in the process of moving to the practice to strengthen communication and the delivery of care to patients further.
• One of the GPs offered an Epidural injection service for patients from the practice and nearby practices who were suffering with long term back pain.
• Feedback from the national patient was in line or slightly below national averages. However, feedback on the day of the inspection was overwhelmingly positive. 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 GP, although added there was sometimes a delay getting an appointment with a named GP. There was continuity of care, with urgent appointments available the same day. The practice had recognised that 58% of the practice patients were aged between 19 and 65 years old and had provided extended hours each week opening at 7:30am on Monday and Friday mornings, as well as access to GP’s until 19:00 on a Monday evening.
• The practice had good facilities and was well equipped to treat patients and meet their needs. The practice was clean, tidy and hygienic. We found that suitable arrangements were in place that ensured the cleanliness of the practice was maintained to a high standard.
• The practice was run efficiently and was well organised. 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.

Professor Steve Field (CBE FRCP FFPH FRCGP) 

Chief Inspector of General Practice

Updated 21 July 2016

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

• Data from Public Health England 2014-15 showed that 68.5% of the practice population had been diagnosed with a long term condition. National data showed this rate was 54%. 2% of the practice population with long term conditions were also housebound
• The practice nursing team took the lead in managing patients and provided care and services including 24 hours blood pressure monitoring, heart monitoring (ECG’s), blood tests, breathing tests (Spirometry for chronic obstructive pulmonary disease), nebulizers for asthma patients and a diabetes service to help patients to manage their condition. These services were offered each day to cater for patient’s lifestyles and availability.
• The practice held specialist clinics for diabetes with the diabetic nurse visiting from the Bournemouth acute hospital.
• GPs were able to refer patients to the community matron for support to housebound patients in their care management. The practice nurse travelled to patient’s homes to administer flu injections and obtain other health data, such as BP.
• The practice had strong links with community matrons and district nurses to support the care management of patients with long term conditions. Patients were discussed at monthly Multi-Disciplinary Team (MDT) meetings where practitioners shared information to support improvements in health and wellbeing. The district nursing team were in the process of moving to the practice to strengthen communication and the delivery of care to patients further.
• One of the GPs offered an Epidural injection service for patients from the practice and nearby practices who were suffering with long term back pain.
• Minor surgery was also available for the removal of ‘long term’ legions and other skin conditions.

• Nursing staff had lead roles in chronic disease management and patients at risk of hospital admission were identified as a priority.
• 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 21 July 2016

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

• Contraceptive and sexual health services were provided. These include contraceptive implant fitting/removal, and prescribing of pregnancy avoidance medicines.
• All patients eligible for cervical screening were provided smear tests during flexible appointments. The practice currently had 81% of eligible patients making use of this service which was comparable to national figures.
• Flexible appointments were available outside of school hours. The reception was pushchair accessible and the waiting room was suitable for children and young people with toys available on request. The practice nurse was available all day Monday to Friday for child immunisations and travel vaccinations.
• All staff were aware of safeguarding responsibilities, through training and accessing polices, including what warning signs to look for.
• Reception staff prioritised and added ‘extra’ appointments in the event of a sick child needing attention, even if the appointment book was full.
• The North Bournemouth health visitor attended the regular practice clinical meeting to discuss and inform of updates concerning children and share other relevant patient information and case updates. This ensures strong links with the community service.

• 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.
• We saw positive examples of joint working with midwives, health visitors and school nurses.
• The GPs referred patients between the ages of 13 and 19 to a local service (SUSSED- a young persons group. SUSSED does not stand for anything) for support for any issues affecting young people. This included information and advice on contraception, emotional health, sexual health, and employment and training.

Updated 21 July 2016

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

• 10.7% of the practice population were over 75 years of age. The practice offered proactive, personalised care to meet the needs of these people.
• The practice was responsive to the needs of older people, and offered home visits and urgent appointments for those with enhanced needs.
• The practice was part of the North Bournemouth Poly-pharmacy review project which had seen more than 100 patients having their medicines reviewed.
• Patients over the age of 75 had access to a specialist nurse as part of the local North Bournemouth project. This meant that GPs were able to refer to this service where there is an identified gap in community services provision, for example where a routine BP check is required and patient is unable to access the practice.
• The practice offered home visits and had established links with care homes. Joint working with other agencies, such as the Dorset wide community provider and Local Authority ensured patient care needs were met or referred to the appropriate provider. Access to intermediate care services was also available through the single point of access referral process.

Updated 21 July 2016

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

• 58% of the practice patients were aged between 19 and 65 years old. Recognising this demographic the practice had provided extended hours each week opening at 7:30am on Monday and Friday mornings, as well as access to GP’s until 19:00 on a Monday evening. The practice actively promoted online services, such as prescription ordering and appointment booking.
• Electronic prescribing also supported patients who were of working age, as any non-controlled medicines could be sent electronically to their chemist of choice which may be closer to their place of work if required.
• The practice used social media and the revised website to provide patients with practice and health updates. For example, the move to electronic prescribing, flu clinic dates and a monthly update on missed appointments had been communicated using the website and social media sites. The practice leaflet also provide guidance and advice on what action to take, before contacting the surgery for appointments.

• 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.

Updated 21 July 2016

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

• 5% of current patients have been diagnosed with a mental health condition.
• The dementia diagnosis rate at the practice was 66.3%. This was above the clinical commissioning group (CCG) average of 60.8% and national average of 62%. Data showed that 85.9% of these patients had had their care reviewed in a face to face meeting in the last 12 months, which was slightly better than the national average of 84%.
• The practice regularly worked with multi-disciplinary teams in the case management of patients experiencing poor mental health, including those with dementia. Patients with dementia were discussed at the ‘Virtual Ward Multi Disciplinary Team (MDT) meeting’, to access alternative support services including those provided by the Local Authority and falls prevention services, patients were supported by a care plan.
• The percentage of patients with schizophrenia, bipolar affective disorder and other psychoses who had a comprehensive, agreed care plan documented in the record, in the preceding 12 months was 95.6% which was slightly higher than the national average of 88.4%.
• All of the patients on the practice mental health register had received a physical health check in the last year.
• 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.
• All GPs monitor those patients who had been referred to or self-referred to community mental health services, ensuring education about alternative services, for example ‘steps to wellbeing’, and these services can be accessed.

Updated 21 July 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. 5% of the practice population were considered vulnerable and included on this register.
• The practice offered longer appointments for patients with a learning disability. 76% of the 74 patients on the practice learning disability register had received an annual review.
• The GP’s work with other agencies. For example, at Multi-Disciplinary meetings, monitoring patient updates and care plans, providing access to voluntary sector organisations and befriending services.
• The practice recognises that those patients where English is not their main language can also be considered vulnerable. The practice had identified eight registered patients that required an interpreter, which was facilitated by the practice
• 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.