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Inspection Summary


Overall summary & rating

Good

Updated 27 October 2020

We previously carried out an announced comprehensive inspection at Kings Cross Surgery on 31 May 2017 as part of our inspection programme. Following the inspection we rated the practice as Good overall, however we rated it as requires improvement for providing Caring services. You can read the full report, published on 7 August 2017, by selecting the ‘all reports’ link for Kings Cross Surgery on our website at: .

On 16 September 2020, we carried out a desk-based review to confirm that the practice had resolved the issues we identified at our previous inspection in May 2017. This report covers our findings in relation to those requirements.

We found the practice is now meeting those requirements and we have amended the rating for this practice accordingly. The practice is now rated Good for the provision of Caring services. We previously rated the practice as Good for providing Safe, Effective, Responsive and Well-led services.

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

  • what we found when we reviewed the information sent to us by the provider
  • information from our ongoing monitoring of data about services and
  • information from the provider.

We have rated the practice as Good for providing Caring services because:

  • The practice provided care in a way which kept patients safe and protected them from avoidable harm.
  • It had developed and implemented an App (computer application) to improve patient access.
  • The practice regularly reviewed the results of the national GP patient survey, and ran its own patient survey to measure levels of patient satisfaction.
  • Comments received, about the practice, on the NHS Choices website showed patients were satisfied with the care they received.

When we last inspected, we also found high levels of exception reporting from the practice’s cervical screening programme. At this inspection the practice had made improvements this programme.

  • We saw evidence from the practice’s own system confirming, for eligible patients:

    • An average of 82% of patients underwent screening;

  • The practice operated a walk-in service for all eligible patients to undergo screening when convenient, and appropriate, for them.
  • The practice carried out specific searches to ensure women were being recalled in line with National Screening guidelines;
  • Recalls are carried out regularly, with women who failed to respond receiving text messages reminding them to attend for screening;
  • Staff had attended training carried out by Public Health England to enable them to carry out recalls.
  • The practice had a failsafe system staff followed to ensure patients were not missed from the screening programme;
  • Patients records were checked and appropriately coded to ensure eligible patients were included in the programme;
  • Since 2018 the practice had run Women's Health Events to promote its screening programmes, including cervical screening. The programme had also been attended by representatives from Public Health England and a local charity.
  • It had a large patient population from a group who were reluctant to engage with the programme. Accordingly, twice a year, it invited representatives of the community, and had interpreters available, to explain the importance of undergoing cervical screening.

Inspection areas

Safe

Good

Effective

Good

Caring

Good

Responsive

Good

Well-led

Good
Checks on specific services

People with long term conditions

Good

Updated 7 August 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.
  • 87% of patients on the diabetes register had a HbA1c blood test result of 64mmol/mol or less in the preceding 12 months compared to the CCG average and national average of 78%. There was an exception reporting rate of 3%, which was lower than the CCG average of 8% and the national average of 13%.
  • 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.
  • All these patients had a named GP and there was a system to recall patients for a structured annual review to check their health and medicines needs were being met. For those patients with the most complex needs, the named GP worked with relevant health and care professionals to deliver a multidisciplinary package of care.
  • The practice did not automatically allocate longer appointments for annual reviews for these patients.

Families, children and young people

Good

Updated 7 August 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.
  • Immunisation rates were comparable to the CCG and national averages for all standard childhood immunisations.
  • 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.
  • The practice provided support for premature babies and their families following discharge from hospital.
  • 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.
  • The practice had emergency processes for acutely ill children and young people and for acute pregnancy complications.

Older people

Good

Updated 7 August 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 identified at an early stage older patients who may need palliative care as they were approaching the end of life. It involved older patients in planning and making decisions about their care, including their end of life care.
  • 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.
  • Older patients were provided with health promotional advice and support to help them to maintain their health and independence for as long as possible.
  • The practice had identified 1% of its patient list as a carer, and offered them an annual review and directed them to support services as required.

Working age people (including those recently retired and students)

Good

Updated 7 August 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 one evening a week and Saturday appointments.
  • The practice was proactive in offering online services as well as a full range of health promotion and screening that reflects the needs for this age group.
  • Email consultations were available for non urgent symptoms and there were telephone consultations offered daily.
  • The practice was a part of a local HUB, which provided GP and nurse appointments to patients on weekday evenings and on weekends when the practice was closed.
  • Health promotion advice was offered and there was health promotional material available in other languages.

People experiencing poor mental health (including people with dementia)

Good

Updated 7 August 2017

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

  • The practice carried out advance care planning for patients living with dementia.
  • 83% of patients diagnosed with dementia had their care reviewed in a face to face meeting in the last 12 months, which was similar to the CCG and the national average of 84%. Exception reporting was 7% which was the same as the national average and similar to the CCG average of 6%.
  • The practice specifically considered the physical health needs of patients with poor mental health and dementia. For example, the practice was a part of a scheme called ‘team around the practice’ which supported these patients and provided joint consulations with the GP and a specialist.
  • The practice did not provide longer appointments for these patients unless they requested them.
  • The practice had a system for monitoring repeat prescribing for patients receiving medicines for mental health needs.
  • 92% of patients with schizophrenia, bipolar affective disorder and other psychoses had a comprehensive agreed care plan documented in their record in the preceding 12 months compared to the CCG average 88% and the national average of 89%. There was an exception reporting rate of 3%, which was below the CCG average of 5% and the national average of 10%.
  • The practice regularly worked with multi-disciplinary teams in the case management of patients experiencing poor mental health, including those living with dementia.
  • Patients at risk of dementia were identified and offered an assessment.
  • 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 accident and emergency 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.

People whose circumstances may make them vulnerable

Good

Updated 7 August 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 homeless people, travellers and 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 did not offer longer appointments for patients with a learning disability unless they requested it.
  • There was a full time male and female Bengali interpreter on the premises at all times.
  • 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.