Archived: Kingfisher Practice

Updated 13 October 2017

Kingfisher Practice provides a range of primary medical services, including minor surgical procedures from its location at Elthorne Way, Newport Pagnell in Milton Keynes. The practice has a registered manager in place. (A registered manager is an individual registered with CQC to manage the regulated activities provided). The practice plan to provide minor surgical procedures when their registration for surgical procedures with the CQC is complete. In the interim patients requiring any minor surgical procedures are seen at the practice’s sister surgery at Broughton Gate in Milton Keynes.

The practice serves a population of approximately 4,600 patients with slightly higher than average populations of males and females aged 45 to 64 years and males aged 15 to 29 years. There are below average populations of males and females aged 0 to 9 year, 30 to 44 years and 65 to 84 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.

Services are provided under an Alternative Provider Medical Services (APMS) contract, a locally agreed contract with NHS England and GP Practices. The provider is The Practice Group (Phoenix Primary Care), who also deliver services in a number of other locations in England.

The clinical team consists of two male GPs, an advanced nurse practitioner, a practice nurse a health care assistant (HCAs) and a phlebotomist. The team is supported by a practice manager and a team of administrative staff. The practice has recently recruited a female GP to work at the practice and is using locum GPs until her employment commences.

The practice operates from a two storey purpose built property. Patient consultations and treatments take place on the ground level and first floor. There is a car park outside the surgery, with disabled parking available.

The practice has been through a significant period of change in the two years preceding our inspection following the loss of the lead GP. During this period the practice was under the leadership of three different organisations and saw considerable staff shortages and changes; which we were told, impacted significantly on the performance and quality of care provided. At the time of our inspection the current provider had been in situ since May 2016 and has made particular efforts since September 2016 to stabilise the practice and improve the care provided to patients.

Kingfisher Practice is open between 8am and 8pm Monday to Friday In addition to these times, the practice operates extended hours on Saturdays from 8.30am to 12.30pm.

The out of hours service is provided by Milton Keynes Urgent Care Services and can be accessed via the NHS 111 service. Information about this is available in the practice and on the practice website and telephone line.

Updated 13 October 2017

Letter from the Chief Inspector of General Practice

We carried out an announced comprehensive inspection at Kingfisher Practice on 19 September 2017. 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 a system in place for reporting and recording significant events.
• The practice had clearly defined and embedded systems to minimise risks to patient safety.
• Staff were aware of current evidence based guidance. Staff had been trained to provide them with the skills and knowledge to deliver effective care and treatment.
• Results from the most recent national GP patient survey, published in July 2017, showed patients were treated with compassion, dignity and respect and were involved in their care and decisions about their treatment.
• We witnessed a strong focus on improvement at all levels within the practice driven by supportive leadership and cohesive working.
• Information about services and how to complain was available. Improvements were made to the quality of care as a result of complaints and concerns.
• Patients we spoke with said they found it easy to make an appointment with a named GP, 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 practice was aware of the requirements of the duty of candour. Examples we reviewed showed the practice complied with these requirements.

We saw one area of outstanding practice:

• The practice had recognised that some patients were frequently visiting A &E and/or requesting home visits. These patients were identified as being socially isolated and vulnerable, often contacting health services as a means of accessing human contact rather than due to ill health. The practice classified these patients as ‘TLC and Welfare patients’ and appointed a dedicated Welfare Champion and deputy. The Welfare Champion made weekly calls to these patients to check on their general wellbeing and ensure they were receiving appropriate support. These patients also had a bypass telephone number to contact the practice if needed. At the time of our inspection there were 52 TLC patients and eight welfare patients receiving this support. [FJ1][GR2]

The areas where the provider should make improvement are:

• Continue with efforts to identify and support more carers in their patient population.
• Continue with efforts to monitor and improve performance to ensure improvements are sustained; in particular with regard to the management of patients with long term conditions and those with learning disabilities.

Professor Steve Field (CBE FRCP FFPH FRCGP) 

Chief Inspector of General Practice

Updated 13 October 2017

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

• Nursing staff had lead roles in long-term disease management and patients at risk of hospital admission were identified as a priority.
• Performance for diabetes related indicators in the 2015/2016 data were below the Clinical Commissioning Group (CCG) and national averages. For example, the percentage of patients with diabetes, on the register, in whom the last blood pressure reading showed good control in the preceding 12 months, was 49%, where the CCG average was 79% and the national average was 78%. Data presented by the practice for 2016/2017 for the same indicator showed practice performance to have improved to 90%.
• The practice was able to initiate insulin treatment for patients with diabetes.
• The practice followed up on patients with long-term conditions discharged from hospital and ensured that their care plans were updated to reflect any additional needs.
• There were emergency processes for patients with long-term conditions who experienced a sudden deterioration in health.
• Longer appointments and home visits were available when needed.
• A recall system was utilised to manage these patients.
• Patients with long term conditions benefitted from continuity of care with their GP or nurse. 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 multidisciplinary package of care.
• The practice ran an anticoagulant clinic for patients to monitor their treatment. (Anticoagulants are medicines used to prevent blood from clotting).

Updated 13 October 2017

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

• From the sample of documented examples we reviewed we found there were systems 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 accident and emergency (A&E) attendances.
• Childhood immunisations were carried out in line with the national childhood vaccination programme.
• Patients told us, on the day of inspection, that 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.
• The practice worked with midwives, health visitors and school nurses to support this population group. For example, in the provision of ante-natal, post-natal and child health surveillance clinics.
• A range of contraceptive and family planning services were available. This included coil insertion and contraceptive implants (patients referred to the sister practice).

Updated 13 October 2017

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

• Staff were able to recognise the signs of abuse in older patients and knew how to escalate any concerns.
• The practice offered proactive, personalised care to meet the needs of the older patients in its population.
• The practice was responsive to the needs of older patients, and offered home visits and urgent appointments for those with enhanced needs.

• The practice provided a weekly ward round at a residential care home. In addition the practice nurse facilitated a monthly outreach clinic providing treatment room services such as dressings, vaccinations, phlebotomy and ear irrigation.

• The practice followed up on older patients discharged from hospital and ensured that their care plans were updated to reflect any extra needs.
• Where older patients had complex needs, the practice shared summary care records with local care services.
• The practice provided influenza, pneumonia and shingles vaccinations.

Updated 13 October 2017

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

• The needs of these populations had been identified and the practice had adjusted the services it offered to ensure these were accessible, flexible and offered continuity of care, for example, extended opening hours until 8pm Monday to Friday and Saturday morning appointments.
• The practice provided telephone consultations daily.
• The practice had enrolled in the Electronic Prescribing Service (EPS). This service enabled GPs to send prescriptions electronically to a pharmacy of the patient’s choice.
• The practice encouraged the use of the on line services to make it easier to book appointments and order repeat prescriptions.
• The practice encouraged screening for working age people such as bowel screening and cervical screening. For example, 82% of female patients aged 50 to 70 years had been screened for breast cancer in the preceding 3 years, where the CCG average was 76% and the national average was 73%.

Updated 13 October 2017

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

• Patients at risk of dementia were identified and offered an assessment. There was a lead GP for dementia and a member of staff had been appointed as the dementia champion.
• There were 45 patients on the dementia register, all of whom had been invited and 34 had been reviewed between April 2016 and March 2017 (73%).
• The practice had recognised the need to improve services for patients with mental health concerns and we saw evidence of efforts made to do so. In particular the advanced nurse practitioner had engaged with locality leads for mental health to ensure that the practice was considered for future developments to the service and received adequate support when needed.
• The practice regularly worked with multi-disciplinary teams in the case management of patients experiencing poor mental health, including those living with dementia.
• The practice had information available for patients experiencing poor mental health about how they could access various support groups and voluntary organisations.
• The practice had a system to follow up patients who had attended A & E where they may have been experiencing poor mental health.
• Staff interviewed had a good understanding of how to support patients with mental health needs and dementia.

Updated 13 October 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 those with a learning disability.
• End of life care was delivered in a coordinated way which took into account the needs of those whose circumstances may make them vulnerable.
• 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 had information available for vulnerable patients about how to access various support groups and voluntary organisations.
• Staff interviewed 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.