Dr John William Keen

We carried out an announced inspection at The Bedford Park Surgery from 3-5 October 2023. Overall, the practice is rated as requires improvement.

Safe – requires improvement

Effective – requires improvement

Caring – good

Responsive – good

Well-led - good

This is the first inspection of this practice since it changed its registration with CQC on 24 November 2021. Since this date, the service has been provided by Dr John William Keen as an individual provider.

Why we carried out this inspection

We carried out this inspection in line with our inspection priorities. This inspection was a comprehensive inspection including all key questions.

How we carried out the inspection

This inspection was carried out in a way which enabled us to spend a minimum amount of time on site.

This included:

• Conducting staff interviews using video conferencing.
• Completing clinical searches on the practice’s patient records system (this was with consent from the provider and in line with all data protection and information governance requirements).
• Reviewing patient records to identify issues and clarify actions taken by the provider.
• Requesting evidence from the provider.
• A short site visit.

Our findings

We based our judgement of the quality of care at this service on a combination of:

• what we found when we inspected
• information from our ongoing monitoring of data about services and
• information from the provider, patients, the public and other organisations.

We found that:

• The practice could not demonstrate that it had effective systems in place to identify and manage risks to patients. We found that it was not managing medicines that require ongoing monitoring in line with guidelines; there were gaps in its implementation of national patient safety alerts; inconsistency in clinical coding of chronic kidney disease and it had documented relatively few medicines reviews. The practice provided information to show it was addressing these issues after the inspection.
• The practice was effectively managing other risks, including infection prevention and control; staff training and recruitment; and readiness for medical emergencies. The practice took action to safeguard patients at risk of abuse.
• The practice was generally assessing patient needs and providing effective care for patients with longer-term conditions. However, its documented management of patients with hypothyroidism was not in line with guidelines, putting patients at risk of harm. The practice provided information to show it was addressing these issues after the inspection.
• Staff dealt with patients with kindness and respect and involved them in decisions about their care.
• Patients could access care and treatment in a timely way. The practice was performing above the local and national average on the National GP Patient Survey for indicators of access.
• The way the practice was led and managed promoted the delivery of high-quality, person-centre care.

We found a breach of regulations. The provider must:

• Ensure care and treatment is provided in a safe way to patients.

In addition, the provider should:

• Engage an expert consultant to carry out the next fire risk assessment to ensure this takes account of current regulations and guidelines.
• Expand its clinical audit programme to ensure it is adhering to clinical guidelines and identify any areas for improvement.

Details of our findings and the evidence supporting our ratings are set out in the evidence tables.

Dr Sean O’Kelly BSc MB ChB MSc DCH FRCA

Chief Inspector of Health Care