You are here

Kings Road Medical Centre Outstanding

Inspection Summary


Overall summary & rating

Outstanding

Updated 19 November 2015

Letter from the Chief Inspector of General Practice

We carried out an announced comprehensive inspection at 9.00am on 15 September 2015. Overall the practice is rated as outstanding.

Please note that when referring to information throughout this report, for example any reference to the Quality and Outcomes Framework data, this relates to the most recent information available to the CQC at that time.

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

  • Staff understood and fulfilled their responsibilities to raise concerns and report incidents and near misses. All opportunities for learning from internal and external incidents were maximised.

  • The practice used innovative and proactive methods to improve patient outcomes, working with other local providers to share best practice. For example, the practice had teamed up with a social enterprise to tackle immediate health and social issues affecting Muslim communities such as mental health.

  • Patients said they were treated with compassion, dignity and respect and they were involved in their care and decisions about their treatment. Information was provided to help patients understand the care available to them.

  • The practice worked closely with other organisations and with the local community in planning how services were provided to ensure that they meet people’s needs.

  • The practice implemented suggestions for improvements and made changes to the way it delivered services as a consequence of feedback from patients and from the Patient Participation Group (PPG).

  • The practice had good facilities and was well equipped to treat patients and meet their needs. Information about how to complain was available and easy to understand.

  • The practice had a clear vision which had quality and safety as its top priority. A business plan was in place, was monitored and regularly reviewed and discussed with all staff. High standards were promoted and owned by all practice staff with evidence of team working across all roles.

We saw several areas of outstanding practice including:

  • The practice had a daily ‘frontline’ GP who provided both telephone / email consultations, urgent prescriptions and a triage service. The practice said this provided expert care at the point of contact. This had reduced the need for patients to have an appointment with a GP.

  • The chief executive sent all staff a weekly ‘staff matters’ bulletin by email. This provided them with any information about the practice including clinical updates, staffing matters, training opportunities and any changes within the practice group.

  • The provider had developed two training packages. One for clinicians, which entailed fortnightly consultant-led training for GPs via webinars in a collaborative learning environment designed to enhance clinical knowledge and delivering excellent patient services and another for receptionists training as Healthcare Assistants (HCAs). The training was used by other local practices.

  • The practice had maximised their Quality and Outcomes Framework (QOF) performance over the previous six years and flu vaccination rates for over 65s and at risk groups were consistently above the Clinical Commissioning Group (CCG) for the previous five years.

  • The practice had teamed up with a social enterprise to tackle immediate health and social issues affecting Muslim communities such as mental health. They had co-produced a short film with patients, clinicians and faith groups called “Talking from the heart” exploring mental health diagnosis and therapy by combining medical and faith advice.

Professor Steve Field (CBE FRCP FFPH FRCGP) 

Chief Inspector of General Practice

Inspection areas

Safe

Good

Updated 19 November 2015

The practice is rated as good for providing safe services. Staff understood and fulfilled their responsibilities to raise concerns, and to report incidents and near misses. Lessons were learned and communicated widely to support improvement. Information about safety was recorded, monitored, appropriately reviewed and addressed. Risks to patients were assessed and well managed.

Effective

Good

Updated 19 November 2015

The practice is rated as good for providing effective services. Data showed patient outcomes were at or above average for the locality. Staff referred to guidance from the National Institute for Health and Care Excellence and used it routinely. Patients’ needs were assessed and care was planned and delivered in line with current legislation. This included assessing capacity and promoting good health. Staff had received training appropriate to their roles and any further training needs had been identified and appropriate training planned to meet these needs. There was evidence of appraisals and personal development plans for all staff. Staff worked with multidisciplinary teams.

Caring

Good

Updated 19 November 2015

The practice is rated as good for providing caring services. Although data showed that patients rated the practice lower than others for several aspects of care, action plans were in place to address this. Patients said they were treated with compassion, dignity and respect and they were involved in decisions about their care and treatment. Information for patients about the services available was easy to understand and accessible. We also saw that staff treated patients with kindness and respect, and maintained confidentiality.

Responsive

Outstanding

Updated 19 November 2015

The practice is rated as outstanding for providing responsive services. The practice had initiated positive service improvements for its patients that were over and above its contractual obligations. It acted on suggestions for improvements and changed the way it delivered services in response to feedback from the patient participation group (PPG). The practice reviewed the needs of its local population and engaged with the NHS England Area Team and Clinical Commissioning Group (CCG) to secure service improvements where these had been identified.

Patients said they found it easy to make an appointment with a named GP and that there was continuity of care, with urgent appointments available the same day. The practice had good facilities and was well equipped to treat patients and meet their needs. Information about how to complain was available and easy to understand and evidence showed that the practice responded quickly to issues raised. Learning from complaints was shared with staff and other stakeholders.

Well-led

Outstanding

Updated 19 November 2015

The practice is rated as outstanding for being well-led. It had a clear vision with quality and safety as its top priority. The strategy to deliver this vision had been produced with stakeholders and was regularly reviewed and discussed with staff. High standards were promoted and owned by all practice staff and teams worked together across all roles. Governance and performance management arrangements had been proactively reviewed and took account of current models of best practice. The practice carried out proactive succession planning. There was a high level of constructive engagement with staff and a high level of staff satisfaction. The practice gathered feedback from patients using new technology, and it had a very active patient participation group (PPG) which influenced practice development.

Checks on specific services

People with long term conditions

Outstanding

Updated 19 November 2015

The practice is rated as outstanding for the care of people with long-term conditions. Nursing staff had lead roles in chronic disease management and patients at risk of hospital admission were identified as a priority. Longer appointments and home visits were available when needed. All these patients had a named GP and a structured annual review to check that their health and medication needs were being met. For those people with the most complex needs, the named GP worked with relevant health and care professionals to deliver a multidisciplinary package of care.

Working with a local charity the practice provided the Expert Patients Programme (EPP) (a self-management programme for people living with a long-term condition with an aim to support people by increasing their confidence, improving their quality of life and helping them manage their condition more effectively).

The practice had maximised their Quality and Outcomes Framework (QOF) performance over the previous six years for chronic disease indicators.

Families, children and young people

Outstanding

Updated 19 November 2015

The practice is rated as outstanding for the care of families, children and young people. There were systems in place 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 A&E attendances. Immunisation rates were relatively high for all standard childhood immunisations. Patients told us that children and young people were treated in an age-appropriate way and were recognised as individuals, and we saw evidence to confirm this. Appointments were available outside of school hours and the premises were suitable for children and babies. We saw good examples of joint working with midwives, health visitors and school nurses.

The practice held a monthly Paediatric Hub Clinic in partnership with consultant paediatricians from the local hospital. The clinic had proved successful in reducing the number of referrals to secondary care and had allowed patients to see a consultant quickly within the community.

Older people

Outstanding

Updated 19 November 2015

The practice is rated as outstanding for the care of older people. Nationally reported data showed that outcomes for patients were above average for conditions commonly found in older people. The practice offered proactive, personalised care to meet the needs of the older people in its population and had a range of enhanced services, for example, in dementia and end of life care. It was responsive to the needs of older people, and offered home visits and rapid access appointments for those with enhanced needs.

A Primary Care Navigator was based at the practice three days a week, to support older patients and their carers to access timely care and community support. Their role included befriending, attending patients’ homes, liaising with social services and acting as advocates.

Flu vaccination rates for over 65s and at risk groups were consistently above the Clinical Commissioning Group (CCG) average for the previous five years.

Working age people (including those recently retired and students)

Outstanding

Updated 19 November 2015

The practice is rated as outstanding for the care of working-age people (including those recently retired and students). The needs of the working age population, those recently retired and students had been identified and the practice had adjusted the services it offered to ensure these were accessible, flexible and offered continuity of care. 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.

The practice had a daily ‘frontline’ GP who was based behind the reception desk and provided both telephone / email consultations, urgent prescriptions and a triage service. The practice said this provided expert care at the point of contact. This had reduced the need for patients to have an appointment with a GP. This service was particularly useful for working age people.

People experiencing poor mental health (including people with dementia)

Outstanding

Updated 19 November 2015

The practice is rated as outstanding for the care of people experiencing poor mental health (including people with dementia). Out of 125 patients on the mental health register 90% had received an annual physical health check. The practice regularly worked with multi-disciplinary teams in the case management of people experiencing poor mental health, including those with dementia. It carried out advance care planning for patients with dementia.

The practice had told patients experiencing poor mental health about how to access various support groups and voluntary organisations. It had a system in place to follow up patients who had attended accident and emergency (A&E) where they may have been experiencing poor mental health. Staff had received training on how to care for people with mental health needs and dementia.

The practice had teamed up with a local charity to tackle immediate health and social issues affecting Muslim communities such as mental health. They had co-produced a short film with patients, clinicians and faith groups called “Talking from the heart” exploring mental health diagnosis and therapy by combining medical and faith advice.

People whose circumstances may make them vulnerable

Outstanding

Updated 19 November 2015

The practice is rated as outstanding 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. It had carried out annual health checks for people with a learning disability and 87% of these patients had received a follow-up. It offered longer appointments for people with a learning disability.

The practice had a register of patients with no fixed abode and those who were victims of domestic violence. The practice proactively contacted patients on the register for health checks and to identify any additional needs. Patients with no fixed abode were offered free health checks.