This practice is rated as Good overall. (Previous rating December 2014 – Good)

The key questions at this inspection are rated as:

Are services safe? – Good

Are services effective? – Good

Are services caring? – Good

Are services responsive? – Good

Are services well-led? - Good

We carried out an announced comprehensive inspection at Kirkham Health Centre on 27 September 2018. This inspection was carried out as part of our inspection programme, and to see whether our recommendations for improvements at our December 2014 inspection had been addressed.

At this inspection we found:

• The practice was in the process of reviewing the service it provided to patients and was implementing a programme of change to improve service delivery and quality. The GP partnership had reviewed their leadership roles, allocating lead responsibilities in line with team member’s strengths and preferences. The new registered manager with the support of the new practice manager were leading these improvements.
• An overarching business plan was in place which provided an overview of the areas the practice wanted to develop, recognising areas requiring improvement and the challenges in achieving their plan.
• The practice had established systems to manage safety incidents. When incidents did happen, the practice learned from them and improved their processes.
• An overarching health and safety risk assessment was being development and the action plan in response to the fire risk assessment was being implemented.
• The practice routinely reviewed the effectiveness and appropriateness of the care it provided. It ensured that care and treatment was delivered according to evidence based guidelines.
• Staff involved and treated patients with compassion, kindness, dignity and respect.
• Patients found the appointment system easy to use and reported that they could access care when they needed it.
• There was a strong focus on continuous learning and improvement at all levels of the organisation.
• The areas we identified at our previous inspection for further development had been addressed. These included improving the storage of medicines, undertaking infection control audits, undertaking a fire risk assessment, updating the practice business continuity plan and ensuring building maintenance certificates were available.

We saw one area of outstanding practice:

• The GP lead for safeguarding, together with a dedicated administrative team were committed to providing a comprehensive proactive system of monitoring and support for victims and potential victim of abuse. Systems in place included daily monitoring of data to identify patient trends, close coordinated working with health and social care professionals and collaboration with the clinical commissioning group (CCG) to develop up to date policies and guidance to share with GP practices within the CCG. Practice meetings were used for staff training and this included quizzes. Staff awareness of a range of safeguarding issues and the systems in place to monitor those at risk meant the practice responded quickly to provide appropriate and coordinated support to patients and their families.

The areas where the provider should make improvements are:

• Implement the actions identified in the fire risk assessment including designating fire marshals and complete an overarching health and safety risk assessment.
• Take action to ensure written protocols for the management of communications coming into the practice are implemented and GP audit of the process is undertaken.
• Actions completed on receipt of patient safety alerts should be logged in order to provide a clear audit trail of what has been done.
• Take action to improve the number of patients registered as carers.

Professor Steve Field CBE FRCP FFPH FRCGPChief Inspector of General Practice

Please refer to the detailed report and the evidence tables for further information.

Letter from the Chief Inspector of General Practice

This is the report of findings from our inspection of Kirkham Health Centre.

We carried out a comprehensive inspection on 2 December 2014. We spoke with patients, members of the patient participation group and staff, including the management team.

The practice was rated as good overall.

Our key findings were as follows:

• Staff understood and fulfilled their responsibilities to raise concerns and report incidents and near misses. Systems were in place to promote identification of safeguarding concerns at the earliest possible opportunity. Lessons were learned and communicated widely to support improvement.
• The practice was proactive in using methods to improve patient outcomes. Best practice guidelines were referenced and used routinely. Patients’ needs were assessed and care planned and delivered in line with current legislation.
• The practice was very proactive in identification of patients at increased risk of hospital admission and creation of care plans to minimise that risk.
• Patients were treated with compassion, dignity and respect. They were involved in decision making about the care and treatment they received.
• Patients had good telephone access to the practice and were seen in a timely manner on arrival for appointments. Non urgent appointments could be booked up to six months in advance
• The practice worked collaboratively with a neighbouring practice, the NHS England Local Area Team and Clinical Commissioning Group to discuss local needs and service improvement.

We saw some areas of outstanding practice including:

• The practice had reviewed patient data to identify those at higher risk of admission to hospital. Care plans had been discussed and agreed with these patients with a view to reducing unplanned admissions. In excess of 2% of the patient population now had care plans in place which exceeded the practice’s national target. They were now aiming to achieve 4% by the year end.

In addition the provider should:

• Medicines should be stored in a more appropriate manner.

• The practice should complete an annual infection prevention and control audit.
• Gas or electrical safety checks should be undertaken. certificates in relation to services at the building.
• The practice should carry out an annual fire risk assessment.
• The practice should update the Business Continuity Plan.

Professor Steve Field (CBE FRCP FFPH FRCGP) 

Chief Inspector of General Practice