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Inspection Summary


Overall summary & rating

Good

Updated 18 September 2017

Letter from the Chief Inspector of General Practice

Letter from the Chief Inspector of General Practice

We carried out an announced comprehensive inspection at Knights Hill Surgery on 14 December 2016. The overall rating for the practice was requires improvement. The full comprehensive report on the December 2016 inspection can be found by selecting the ‘all reports’ link for Knights Hill Surgery on our website at www.cqc.org.uk.

This inspection was an announced focused inspection carried out on 5 September 2017 to confirm that the practice had carried out their plan to meet the legal requirements in relation to the breaches in regulations that we identified in our previous inspection on 14 December 2016. This report covers our findings in relation to those requirements and also additional improvements made since our last inspection.

Overall the practice is now rated as good.

At our previous inspection on 14 December 2016 we rated the practice as requires improvement for providing caring services as the results from the national GP patient survey showed patients were less satisfied than patients at other practices with GPs, nurses and reception staff. The practice had not carried out systematic analysis of the survey results.

We rated the practice as requires improvement for providing responsive services as evidence showed the practice responded to issues raised, but was not following their own policy or national guidance when responding, and information provided to patients about how to escalate complaints was incorrect. Data from the national GP patient survey showed patients rated the practice below average for ease of making an appointment, and for ease of access to preferred GPs.

We also highlighted in the original inspection other areas where the provider should take action:

  • Implement effective security and monitoring arrangements for prescription forms and pads, and ensure that mechanisms to monitor emergency medicines and prescriptions awaiting collection are effective.
  • Continue to monitor and take action to improve outcomes for patients with diabetes.
  • Monitor and take action to improve patient satisfaction with consultations with GPs, nurses and engagement with reception staff, and with making an appointment.
  • Review how patients with caring responsibilities are identified and recorded on the clinical system to ensure information, advice and support is made available to them.

Our key findings at this inspection were as follows:

  • The practice had reviewed its complaints procedure and now provided accurate information to patients and responded to complaints in line with its policy.
  • Results from the national patient survey 2017 indicated that patient satisfaction with how they were treated and their involvement in their care had increased, and was now similar to CCG and national averages.
  • Results from the national GP patient survey 2017 showed that patients’ satisfaction with how they could access care and treatment remained mixed, with satisfaction with making an appointment and with access to a preferred GP still below local and national averages although they had improved.

We also found that the provider had taken the following action to address the areas where we suggested they should make improvements:

  • The practice had reviewed the security and monitoring arrangements for prescription forms and pads. Blank prescription pads were now locked in a cupboard within a lockable room to which only certain staff had access. An additional security camera had been placed outside the door. A record of prescription pad serial numbers was being maintained and the practice had put a specific policy into place for storage and handling of prescription pads. Any prescriptions in printers were removed and locked away at the end of each day. The practice had also reviewed it system regarding prescriptions awaiting collection. A member of staff checked on a monthly basis to ensure there were no prescriptions awaiting collection for more than two months. If there were they were passed to the pharmacist who would liaise with the patient and, where necessary, the GP. We checked the emergency medicines and found they were all in date.
  • The GP partner had taken on the oversight of the diabetic patient register, and told us they were reviewing this in a monthly basis. They had put into place a plan and procedure for improving diabetic care. This included booking a first appointment with the health care assistant who would collect bio-data such as body weight, height, BMI and carry out a urinalysis. They would also arrange for a blood test. A virtual clinic was available for patients to consult with specialists. Data provided by the practice indicated the practice’s Quality and Outcomes Framework (QOF) performance has improved from 67 points to 81 (out of a possible 86). (QOF is a system intended to improve the quality of general practice and reward good practice.) The practice pharmacists carried out medicines reviews and liaised directly with patients where appropriate.
  • The practice had reviewed the outcomes of the national patient survey and had taken steps to address the areas where they had fallen below average. For example, permanent GPs had been appointed as had an additional pharmacist and reception staff had undergone customer care training. Patient feedback had improved in most areas.
  • The practice had a pack containing information for carers, and at every new patient registration reception staff were expected to ask if the patient was also a carer. The practice had identified it had 157 patients who were also carers. Whilst this number had increased since the last inspection so had the patient list size, so the percentage of identified carers remained at just under 2%.

Professor Steve Field CBE FRCP FFPH FRCGP

Chief Inspector of General Practice

Inspection areas

Safe

Good

Updated 12 April 2017

The practice is rated as good for providing safe services.

  • Most risks to patients were assessed and well managed, but some of the arrangements to manage medicines were not effective. Blank prescription forms were stored on open shelving in an office accessible to staff, and there was no system of monitoring forms within the practice. We found two prescriptions awaiting collection and an out of date medicine that had been missed in the practice checks.
  • There was an effective system in place for reporting and recording significant events.
  • Lessons were shared to make sure action was taken to improve safety in the practice.
  • When things went wrong patients received reasonable support, truthful information, and a written apology. They were told about any actions to improve processes to prevent the same thing happening again.
  • The practice had clearly defined and embedded systems, processes and practices in place to keep patients safe and safeguarded from abuse.

Effective

Good

Updated 12 April 2017

The practice is rated as good for providing effective services.

  • Data from the Quality and Outcomes Framework (QOF) showed that on most indicators patient outcomes were in line with the national average. The practice had taken action on areas of below average performance, and we saw evidence that most were likely to be line with average in 2016/17.
  • Staff assessed needs and delivered care in line with current evidence based guidance.
  • Clinical audits demonstrated quality improvement.
  • Staff had the skills, knowledge and experience to deliver effective care and treatment.
  • There was evidence of appraisals and personal development plans for all staff.
  • Staff worked with other health care professionals to understand and meet the range and complexity of patients’ needs.

Caring

Good

Updated 18 September 2017

Results from the national patient survey 2017 indicated that patient satisfaction with the services they received had increased.

Similar results were received from patients at this practice as from patients at other practices in relation to how GPs, nurses and reception staff treated them.

Patient feedback about their involvement in planning and making decisions about their care and treatment had improved and was similar to local and national averages.

Responsive

Good

Updated 18 September 2017

Results from the national GP patient survey 2017 showed that patients’ satisfaction with how they could access care and treatment remained mixed, with satisfaction with making an appointment and with access to a preferred GP still below local and national averages although they had improved.

We saw the practice had taken action to address the below average performance. Permanent GPs had been recruited; a triage system set up and the telephone system improved.

We found the practice had revised its complaints procedure and it now gave patients correct information on how to escalate a complaint if they were dissatisfied. We reviewed four complaints and saw that these had been acknowledged within the three days stated in the practice complaints policy. Those that had been dealt with had a final response and we saw that in each case the patient was offered details of whom to contact if they were still dissatisfied.

Well-led

Good

Updated 12 April 2017

The practice is rated as good for being well-led.

  • The practice had a clear vision and strategy to deliver high quality care and promote good outcomes for patients. Staff had an understanding of the practice’s values.
  • There was a clear leadership structure and staff felt supported by management. The practice had a number of policies and procedures to govern activity and held regular governance meetings, but not all policies were well implemented.
  • There was an overarching governance framework which supported the delivery of the strategy and good quality care. This included arrangements to monitor and improve quality and identify risk. Not all risks had been identified by these processes, and some systems to manage risk were not working well.
  • The provider was aware of and complied with the requirements of the duty of candour. The partners encouraged a culture of openness and honesty. The practice had systems in place for notifiable safety incidents and ensured this information was shared with staff to ensure appropriate action was taken.
  • The patient participation group was active.
  • There was a focus on innovation and improvement.
Checks on specific services

People with long term conditions

Good

Updated 18 September 2017

The provider had resolved the concerns for caring and responsive at our inspection on 14 December 2016 which applied to everyone using this practice, including this population group. The population group ratings have been updated to reflect this.

Families, children and young people

Good

Updated 18 September 2017

The provider had resolved the concerns for caring and responsive at our inspection on 14 December 2016 which applied to everyone using this practice, including this population group. The population group ratings have been updated to reflect this.

Older people

Good

Updated 18 September 2017

The provider had resolved the concerns for caring and responsive at our inspection on 14 December 2016 which applied to everyone using this practice, including this population group. The population group ratings have been updated to reflect this.

Working age people (including those recently retired and students)

Good

Updated 18 September 2017

The provider had resolved the concerns for caring and responsive at our inspection on 14 December 2016 which applied to everyone using this practice, including this population group. The population group ratings have been updated to reflect this.

People experiencing poor mental health (including people with dementia)

Good

Updated 18 September 2017

The provider had resolved the concerns for caring and responsive at our inspection on 14 December 2016 which applied to everyone using this practice, including this population group. The population group ratings have been updated to reflect this.

People whose circumstances may make them vulnerable

Good

Updated 18 September 2017

The provider had resolved the concerns for caring and responsive at our inspection on 14 December 2016 which applied to everyone using this practice, including this population group. The population group ratings have been updated to reflect this.