Kingswood Surgery

Letter from the Chief Inspector of General Practice

We carried out an announced comprehensive inspection at Kingswood Surgery on 1 December 2015.

Overall the practice is rated as requires improvement.

Our key findings across all the areas we inspected were as follows:

• Staff understood their responsibilities to raise concerns, and to report incidents and near misses. However, when there were unintended or unexpected safety incidents, reviews and investigations were not thorough enough.
• Some of the systems and processes to address and identify risks to patients and staff were not always in place or implemented well enough to ensure patients were kept safe.
• There was evidence of appraisals and personal development plans for all staff.
• Staff worked with multidisciplinary teams to understand and meet the range and complexity of people’s needs. Multi-disciplinary team (MDT) meetings took place and the practice was involved in a number of specific MDT initiatives to improve outcomes for patients.
• Data from the Quality and Outcomes Framework (QOF) for 2014/2015 was below the local CCG and national averages. (QOF is a system intended to improve the quality of general practice and reward good practice). We saw evidence that new systems had been put in place to address this and patients were now being systematically recalled and reviewed.
• The practice could not demonstrate how they ensured mandatory and role-specific training was completed for relevant staff.
• Results from the national GP patient survey in respect of patients being treated with compassion, dignity and respect and being involved in care planning was below the CCG and national averages. However, we received mostly positive feedback from patients and CQC comment cards.
• The practice reviewed the needs of its local population and engaged with the NHS England Area Team and Clinical Commissioning Group to secure improvements to services where these were identified.
• The practice offered a wide range of appointments outside of core appointment times.
• Whilst data and some feedback from patients showed that access to appointments was lengthy the practice demonstrated they kept this under review and were trialling new initiatives to improve patient satisfaction. Urgent appointments were available daily with the duty doctor.
• Staff told us they felt supported by the GP partners and made particular reference to the excellent level of support and direction provided by the interim practice manager.
• The practice did not have a business plan in place which was subsequently not monitored or regularly reviewed. The practice had experienced staffing challenges in the last year and demonstrated they were on an improvement trajectory in some areas.
• The practice had an overarching governance framework but this was not always effective. Arrangements for identifying, recording and managing risks, issues and implementing mitigating actions were not always effective or timely.

There were also areas of practice where the provider needs to make improvements.

The areas where the provider must make improvement are:

• All employed persons providing care or treatment to patients must have the qualifications, competence, skills and experience to do so safely. Specifically, this includes ensuring staff training is up to date and the relevant staff are competency assessed and records kept in individual staff files.
• The practice must always assess, monitor and mitigate the risks relating to the health, safety and welfare of patients and others who may be put at risk which arises from the carrying on of the regulated activity.

• There must be systems for assessing the risk of preventing, detecting and controlling the spread of infections. Specifically, ensure that staff are trained and documented audits are carried out in respect of the management of infection control.

• The practice must take action to ensure recruitment arrangements are in line with Schedule 3 of the Health and Social Care Act 2008 to ensure necessary employment checks are in place for all staff. Specifically, this includes completing Disclosure and Barring Service (DBS) checks for those staff that need them.

• The practice must ensure that systems for good governance are in place to assess, monitor and mitigate the risks relating to the health, safety and welfare of patients and staff are effective.

The areas where the provider should make improvements are:

• Ensure access to routine appointments is kept under review so that routine appointments can be accessed in a timely way
• Ensure the practice provides care and treatment in a safe way by ensuring that patients are reviewed in a timely way.
• Ensure the practice records actions from clinical meetings.

Professor Steve Field CBE FRCP FFPH FRCGP

Chief Inspector of General Practice