You are here

Kings Lane Medical Practice - Dr D Kershaw Good

Inspection Summary


Overall summary & rating

Good

Updated 4 May 2016

Letter from the Chief Inspector of General Practice

We carried out an announced comprehensive inspection at Kings Lane Medical Practice - Dr D Kershaw on 5 April 2016. Overall the practice is rated as good.

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

  • There was an open and transparent approach to safety. Systems were in place for reporting, recording and learning from accidents, significant events and untoward incidents. Staff understood and fulfilled their responsibilities to raise concerns and to report incidents and near misses.
  • Staff were trained in safeguarding and protection of children and vulnerable adults and understood their roles and responsibilities. Local authority guidance and protocols were accessible and staff were aware of how to raise concerns.
  • Patients’ needs were assessed and care was planned and delivered following best practice guidance. Staff had been trained to provide them with the skills, knowledge and experience to deliver effective care and treatment.
  • Patients were treated with care, compassion, dignity and respect and they were involved in their care and decisions about their treatment. They were given time at appointments and full explanations of their treatment were given. They valued their practice and felt confident with the skills and abilities of staff.

  • We observed a strong patient-centred culture from dedicated staff.

  • The practice proactively sought feedback from staff and patients, which it acted on. For example, amending the appointment system following surveys and patient participation group (PPG) feedback.
  • Information about services and how to complain was available and easy to understand.
  • Patients were able to access convenient appointments; however comments indicated there was a lack of continuity of care with GPs.
  • The practice had good, modern facilities and was well equipped to treat patients and meet their needs.
  • There was a clear leadership structure and staff felt supported by management.
  • The provider was aware of and complied with the requirements of the Duty of Candour.

The areas where the provider should make improvement are:

  • Review the audit program to include infection control audits being undertaken regularly and where local prescribing issues are identified, that these are audited to establish adherence to the local prescribing guidance.

  • Review the practice’s policies and procedures including infection control policies and procedures to make them accessible to staff and up to date with current guidance and legislation.

  • Review the process for learning from significant events and complaints to include regular reviews to learn from themes and trends and to monitor completion of action plans.

Professor Steve Field (CBE FRCP FFPH FRCGP) 

Chief Inspector of General Practice

Inspection areas

Safe

Good

Updated 4 May 2016

The practice is rated as good for providing safe services.

  • Staff understood and fulfilled their responsibilities to raise concerns and report incidents and near misses. There were systems in place for reporting and recording accidents, incidents and significant events

  • Lessons were shared to make sure action was taken to improve safety in the practice, however overall themes and trends were not identified and shared.

  • 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.

  • Risks to patients were assessed and managed. Infection control policies and procedures needed updating and accessible. Infection control audits should be undertaken on a more regular basis.

Effective

Good

Updated 4 May 2016

The practice is rated as good for providing effective services.

  • Data from the Quality and Outcomes Framework (QOF) showed patient outcomes were at or above average compared to the national average.

  • Staff assessed needs and delivered care in line with current evidence based guidance.

  • Clinical audits demonstrated quality improvement; however some, such as infection control audits, should be undertaken on a more frequent basis.

  • 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 4 May 2016

The practice is rated as good for providing caring services.

  • Data showed that patients rated the practice around average and in some cases higher than average for aspects of care rated. For example, 89% of respondents to the National GP Patient’s survey said they found the receptionists helpful compared to a local CCG average of 91% and a national average of 87% and 91% said the last GP they saw or spoke to was good at treating them with care and concern (compared to a national average of 85%).

  • 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.

  • Staff were motivated and inspired to offer kind and compassionate care and we saw staff treated patients with kindness and respect, and maintained patient and information confidentiality.

Responsive

Good

Updated 4 May 2016

The practice is rated as good for providing responsive services.

  • It 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.

  • Patients said they were able to access convenient appointments. However, there was a lack of continuity of care with patients telling us they found it difficult to make an appointment with a GP of their choice or the same GP.

  • 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. Evidence showed that the practice responded quickly to issues raised.

Well-led

Good

Updated 4 May 2016

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 were clear about the vision and their responsibilities in relation to it.

  • There was a clear leadership structure and staff felt supported by management.

  • The practice had policies and procedures to govern activity however these were not easily accessible to staff. Some were not dated with issue and review date and some, for example, in the case of infection control and safeguarding policies and related procedures were lacking in detail and were not up to date.

  • There were arrangements in place to monitor and improve quality and identify risk. Practice meetings and clinical meetings were held however these could be improved in order to promote dissemination of learning from audits, significant events and complaints.

  • 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 knowing about notifiable safety incidents.

  • The practice proactively sought feedback from staff and patients, which it acted on. There was an active patient participation group who were involved in practice developments.

Checks on specific services

People with long term conditions

Good

Updated 4 May 2016

The practice is rated as good for the care of people with long-term conditions.

The practice maintained and monitored registers of patients with long term conditions for example, cardiovascular disease, diabetes, chronic obstructive pulmonary disease and heart failure. These registers enabled the practice to monitor and review patients with long term conditions effectively.

  • GPs, supported by practice nurses, had lead roles in chronic disease management and patients at risk of hospital admission were identified as a priority.

  • Annual reviews for all patients with long term conditions such as diabetes and asthma were offered.

  • Performance indicators for the management of diabetes were around or above national average.

  • Longer appointments and home visits were available when needed.

  • All patients had a named GP and a structured annual review to check that their health and medicines needs were being met. Systems in place ensured patient recalls were highlighted.

  • The GPs and nurses worked with relevant health and care professionals to deliver a multidisciplinary package of care.

  • Medical records for vulnerable patients with long term conditions were highlighted so that all staff knew their needs and arranged appointments and care accordingly.

Families, children and young people

Good

Updated 4 May 2016

The practice is rated as good 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 vulnerable, for example, children and young people who had a high number of A&E attendances and those who did not attend for appointments.

  • Immunisation rates were high for all standard childhood immunisations with immunisations uptake for all children aged five and under around 95%.

  • 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.

  • Unwell children under the age of five were offered same day/urgent appointments.

  • The percentage of women aged 25-64 whose notes recorded that a cervical screening test had been performed in the preceding five years was higher than the national average at 86%.

  • We saw positive examples of joint working with midwives and health visitors.

Older people

Good

Updated 4 May 2016

The practice is rated as good for the care of older people.

The practice had a higher than national and local clinical commissioning group (CCG) average number of elderly patients with 34% over the age of 65. Nationally reported data showed that outcomes for patients were good 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 avoiding unplanned admissions, dementia, nursing and residential care home support and end of life care.

  • It was responsive to the needs of older people, and offered home visits and urgent appointments for those with enhanced needs.

  • Nursing and care home visits were undertaken. The practice was a member of the local elderly care network and liaised closely with community integrated care teams.

Working age people (including those recently retired and students)

Good

Updated 4 May 2016

The practice is rated as good 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. For example, following patient feedback, the practice altered its appointment system and now offered telephone consultations.

  • The practice offered Tele dermatology and Tele ECG. Tele medicine is the use of telecommunication and information technologies to provide clinical health care at a distance, including monitoring and assessments without the need for GP visits.

  • 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 for example well person checks for those aged 40 to 75 years old.

People experiencing poor mental health (including people with dementia)

Good

Updated 4 May 2016

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 with dementia and 87% of people diagnosed with dementia had had their care reviewed in a face to face meeting in the last 12 months (higher than the national average of 84%).

  • 97% of people experiencing poor mental health (higher national average of 88%) had a comprehensive documented care plan in place.

  • The practice regularly worked with multi-disciplinary teams in the case management of people experiencing poor mental health, including those with dementia.

  • It had a system in place to follow up patients where they may have been experiencing poor mental health. Systems were also in place to recall patients with dementia and poor mental health when they did not attend for appointments.

People whose circumstances may make them vulnerable

Good

Updated 4 May 2016

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 those at risk of hospital admissions, those at the end of their life, those with a learning disability and children at risk.

  • It offered longer appointments for people with a learning disability.

  • It was able to inform vulnerable patients about how to access various support groups and worked with voluntary organisations.

  • Staff were familiar with patients from this group and knew and understood family dynamics.

  • Staff knew how to recognise signs of abuse in vulnerable adults and children. Staff 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.