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Inspection Summary


Overall summary & rating

Good

Updated 14 January 2016

Letter from the Chief Inspector of General Practice

We carried out an announced comprehensive inspection at Knightsbridge Medical Centre on 23 September 2015. Overall the practice is rated as good.

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

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

  • There was an open and transparent approach to safety but the system in place was not always effective for reporting and recording significant events.
  • Risks to patients were assessed and well managed.
  • Staff assessed patients’ needs and delivered care in line with current evidence based guidance. Staff had the skills, knowledge and experience to deliver effective care and treatment.
  • Patients said they were treated with compassion, dignity and respect and they were involved in their care and decisions about their treatment.
  • Information about services and how to complain was available and easy to understand.
  • 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.
  • There was a clear leadership structure and staff felt supported by management. The practice proactively sought feedback from staff and patients, which it acted on.
  • The provider was aware of and complied with the requirements of the Duty of Candour.

The areas where the provider should make improvement are:

  • Ensure that breaches of confidential patient information are reported, and patients affected are informed.

  • Ensure there are effective systems implemented to monitor the transfer of data from email accounts no longer in use.

Professor Steve Field (CBE FRCP FFPH FRCGP) 

Chief Inspector of General Practice

Inspection areas

Safe

Good

Updated 14 January 2016

The practice is rated as good for providing safe services.

  • Staff understood their responsibilities to raise concerns, and to report incidents and near misses. However, when there were unintended or unexpected safety incidents, reviews and investigations were not thorough enough and lessons learned were not communicated widely enough to support improvement.

Although risks to patients who used services were assessed, the systems and processes to address these risks were not implemented well enough to ensure patients were kept safe. For example, a patient was given the wrong blood results due to reception staff incorrectly identifying them as another patient with the same date of birth. The patient had returned the results and received a verbal apology from the receptionist manager. The practice manager was informed and the event recorded. The reception staff were reminded verbally and by email of the process for giving out patients results, to ensure that confidentiality was not breached. We could see no evidence that the patient whose results had been given out, in error had been informed about the event.

Effective

Good

Updated 14 January 2016

The practice is rated as good for providing effective services. Data showed patient outcomes were at or above average for the locality.

  • 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 multidisciplinary teams to understand and meet the range and complexity of people’s needs.

Caring

Good

Updated 14 January 2016

The practice is rated as good for providing caring services.

  • Data showed that patients rated the practice higher than others for several aspects of care.

  • 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

Good

Updated 14 January 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 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.

  • The practice had listened and responded to patient feedback about access to appointments and taken action to improve this.

Well-led

Good

Updated 14 January 2016

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

  • It 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 this.

  • 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.

  • 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.

  • 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. The patient participation group was active.

  • There was a strong focus on continuous learning and improvement at all levels. Staff had received inductions, regular performance reviews and attended staff meetings.

Checks on specific services

People with long term conditions

Good

Updated 14 January 2016

The practice is rated as good for the care of people with long-term conditions. The practice maintained a long term risks register. Patients were identified for review by the practice nurse team; on a daily basis repeat prescriptions were scrutinised identifying patients with long term conditions (LTC). Patient’s notes were reviewed to manage outstanding tests or examinations they needed. Patient’s accessed assessments and blood tests in the chronic disease management clinic which was nurse lead.  They were reviewed by the relevant Clinical Lead GP in an extended appointment clinic who reviewed the clinical condition, changed medication where necessary and agreed a management plan with the patient on an individual basis

Families, children and young people

Good

Updated 14 January 2016

The practice is rated as good for the care of families, children and young people. Arrangements were in place to safeguard children from abuse that reflected relevant legislation and local requirements. There were systems in place to identify and follow up children living in disadvantaged circumstances and who were at risk for example, children who were frequent attenders at A&E. Clinical staff held a monthly multidisciplinary team meeting with health visitors to ensure good professional links and regular discussion of at risk children, families of concern and chronically sick children.  There was a weekly on site health visiting clinic, for all children under the age of five. Childhood immunisation rates for the vaccinations given were above comparable  CCG rates in 2014/15. Appointments were available outside of school hours for older children who were able to access three evening surgeries or at the weekend. 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. The practice offered easy access to advice and appointments with urgent problems via a telephone and triage appointment system

Older people

Good

Updated 14 January 2016

The practice is rated as good for the care of older people. The practice carried out proactive care planning with an accountable GP offering continuity of care to patients over the age of 65 and worked closely with district nurses who case managed patients with complex needs. The practice used the BIRT2 and Frailty Index tools to identify patients at risk. Patients categorised as being high risk were managed by the accountable GP who carried out medical reviews and, care plans were agreed with the patients in conjunction with carers where necessary. There was a primary care navigator on site to support vulnerable older patients and facilitate access to a range of services. The practice had monthly multidisciplinary team meetings with social workers, district nurses, all the practice clinical staff and the primary care navigator to discuss at risk patients. The accountable GP was responsible for reviewing any emergency admissions on their case list to see if it was avoidable.

Working age people (including those recently retired and students)

Good

Updated 14 January 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. Patients were able to access late evening commuter surgeries three evenings per week.  The practice was proactive in offering online services as well as a full range of health promotion and screening that reflected the needs for this age group. This included a wide range of on-site services such as minor surgery, phlebotomy and smoking cessation appointments for patient convenience and accessibility, and health checks for eligible adults.

People experiencing poor mental health (including people with dementia)

Good

Updated 14 January 2016

The practice is rated as good for the care of people experiencing poor mental health (including people with dementia). 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 good links with the memory assessment services. Eighty seven percent of people diagnosed with dementia had had their care reviewed in a face to face meeting in the last 12 months. A practice attached local consultant psychiatrist visited the practice annually. Management plans for patients with severe mental health were reviewed, ensuring that shared care prescribing protocols were in place, and patients were complying with their medicines. The practice had regular meetings with the community psychiatric nurse (CPN), who worked with patients referred by the practice in acute crisis. Patients with mild to moderate mental health issues, were referred to local IAPS (Improving Access to Psychological Therapies), and talking therapies, which provided rapid assessment and treatment.

People whose circumstances may make them vulnerable

Good

Updated 14 January 2016

The practice is rated as good for the care of people whose circumstances may make them vulnerable. The practice regularly worked with multi-disciplinary teams in the case management of vulnerable people. Patients were discussed at the weekly clinical meeting; a responsible GP was nominated to review patients who were placed on a case management register for discussion at the multi-disciplinary team (MDT) meeting. The case management plan was entered contemporaneously in the meeting to ensure that it is fully accessible to all healthcare professionals and Out of Hours (OOH) doctors to review. The primary care navigator attached to the practice, acted as the patient care co-ordinator and ensured that the agreed care plan was actioned. Patients and their carers had a single contact number at the practice if they had any questions. 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.