All inspections: The Medical Centre - Dr Kukar

We carried out an unannounced inspection at The Medical Centre – Dr Kukar on 25 May 2022. Overall, the practice is rated as Good.

Safe - Good

Effective - Good

Caring - Good

Responsive - Good

Well-led – Requires improvement

Following our previous inspection on 27 April 2021, the practice was rated requires improvement overall. At that time, it was rated as good for providing safe and caring services and requires improvement for providing effective, responsive and well-led services.

The full reports for previous inspections can be found by selecting the ‘all reports’ link for The Medical Centre – Dr Kukar on our website at www.cqc.org.uk

Why we carried out this inspection

This inspection was carried out to follow up on a breach of regulation 17 of HSCA (RA) Regulations 2014 (Good governance). At the previous inspection we found that uptake rates of cervical cancer screening and childhood immunisations were below target and that the practice had not responded to negative patient feedback about access to the service. We also followed up on information of concern received by CQC about the practice, specifically in relation to the clinical staffing rota and completion of required training. We carried out an unannounced, comprehensive inspection and covered the five key questions in their entirety.

How we carried out the inspection

This inspection was carried out on site. The site visit included:

Manager and staff interviews
Telephone interviews with staff who were unavailable during the site visit
Telephone interview with patient representatives
Completing clinical searches on the practice’s patient records system and discussing findings with the provider
Reviewing patient records to identify issues and clarify actions taken by the provider
Review of documentary evidence
Observation of the practice premises and equipment

Our findings

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

what we found when we inspected
information from our ongoing monitoring of data about services and
information from the provider, patients, the public and other organisations.

We have rated this practice as Good overall

We found that:

The specific concerns reported to CQC about this practice were not supported by the evidence we reviewed during the inspection.
The practice provided care in a way that kept patients safe and protected them from avoidable harm.
Patients received effective care and treatment that met their needs.
Staff dealt with patients with kindness and respect and involved them in decisions about their care.
The practice adjusted how it delivered services to meet the needs of patients during the COVID-19 pandemic.
Patients could access care and treatment in a timely way.
While we saw evidence that the practice had sustained and embedded the improvements noted at the previous inspection, progress in improving published cancer screening uptake rates was variable and limited.
The practice stored key organisational records on a single laptop which was inaccessible on the day of the inspection visit and posed an unnecessary risk to information governance.

We found a breach of regulations. The provider must:

Establish effective systems and processes to ensure good governance in accordance with the fundamental standards of care.

In addition, the provider should:

Review its DNACPR process to ensure this is being initiated, with the involvement of patients and their families, as appropriate.

Details of our findings and the evidence supporting our ratings are set out in the evidence tables.

Dr Sean O’Kelly BSc MB ChB MSc DCH FRCA

Chief Inspector of Hospitals and Interim Chief Inspector of Primary Medical Services

We carried out an announced inspection of The Medical Centre – Dr Kukar on 27 April 2021. We then undertook a remote clinical records assessment on 29 April 2021 and interviews with staff remotely on 28 April, 5 May, 8 May 2021.

Overall, the practice is rated as Requires improvement.

Safe - good

Effective – requires improvement

Caring – good (carried forward from previous inspection. Not inspected at this inspection)

Responsive - requires improvement

Well-led – requires improvement

At our earlier inspection on 25 November 2020, the practice was rated requires improvement overall and for safe, effective, responsive and well led. The practice was rated good for caring. The service was rated as inadequate for the care provided to working age people and requires improvement for all other population groups. This is why the practice remained in special measures. The practice was first placed into special measures following an inspection undertaken 27 June 2019.

The full reports for previous inspections can be found by selecting the ‘all reports’ link for The Medical Centre – Dr Kukar on our website at www.cqc.org.uk

Why we carried out this inspection

This inspection was a focused follow up inspection to follow up on breaches of regulations 9, 12 & 17 of HSCA (RA) Regulations 2014. As the service was in special measures, we looked at each of the key questions and population, where a breach of regulation was identified, in its entirety.

Breaches related to:

The safe management of medicines.
Systems and processes related to infection prevention and control.
Lack of nursing staff and below average performance against some performance targets in a range of areas including cancer screening and childhood immunisation take up.
Lack of a functional patient participation group (PPG).
Below average patient survey feedback in relation to the practice’s ability to meet patient need.
Lack of population needs analysis.

How we carried out the inspection

Throughout the pandemic CQC has continued to regulate and respond to risk. However, taking into account the circumstances arising as a result of the pandemic, and in order to reduce risk, we have conducted our inspections differently.

This inspection was carried out in a way which enabled us to spend a minimum amount of time on site. This was with consent from the provider and in line with all data protection and information governance requirements.

This included:

Conducting staff and patient interviews using video conferencing and questionnaires.
Completing clinical searches on the practice’s patient records system and discussing findings with the provider.
Reviewing patient records to identify issues and clarify actions taken by the provider
Requesting evidence from the provider.
A short site visit.

Our findings

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

what we found when we inspected
information from our ongoing monitoring of data about services and
information from the provider, patients, the public and other organisations.

We have rated this practice as Requires Improvement overall and Requires Improvement for all population groups.

We found that:

The practice had taken action to address concerns related to infection prevention and control.
There was an improvement in the systems to monitor people prescribed certain medicines.
The practice had systems in place to ensure that patients remained safe.
The records we reviewed showed that clinical guidelines were followed when delivering care and treatment.
Since our last inspection in November 2020, no new data was available regarding update of childhood immunisations and cervical screening. Although the practice had drafted action plans which aimed to address this issue and there were now nursing staff working on site; the number of nursing hours remained low and figures from the practice’s own system showed a significant number of patients who still required screening.
National GP patient survey scores were below average in respect of patient access. The practice had drafted an action plan and had taken some actions to address below average patient feedback. However, some patients we spoke with told us that access was a concern and the number of GP sessions was low relative to the practice list size.
Leadership in the practice had taken action to improve the quality of care for patient; particularly around areas of risk and safety. However, action taken to improve patient satisfaction around access and meet targets had yet to demonstrate sufficient improvement.

We found breaches of regulation. The provider must:

Establish effective systems and processes to ensure good governance in accordance with fundamental standards of care.

Details of our findings and the evidence supporting our ratings are set out in the evidence tables.

I am taking this service out of special measures. This recognises the significant improvements that have been made to the quality of care provided by this service

Dr Rosie Benneyworth BM BS BMedSci MRCGP

Chief Inspector of Primary Medical Services and Integrated Care

We carried out an announced comprehensive inspection at The Medical Centre – Dr Kukar on 25 November 2020 to follow up on breaches of regulations.

The practice was previously inspected on 5 March 2020. Following that inspection, the practice was rated inadequate overall (inadequate in effective and well-led and requires improvement in safe, caring and responsive) and placed in special measures. We issued a warning notice for breaches of Regulation 17 (Good governance). Following this we carried out an announced focused inspection at The Medical Centre – Dr Kukar on 1 October 2020 to follow-up on the warning notice and found that the provider had made improvements.

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

what we found when we inspected
information from our ongoing monitoring of data about services and
information from the provider, patients, the public and other organisations.

At this inspection we rated the practice as requires improvement for providing services that were safe.

Despite the provider continuing to make improvements in relation to the management of high risk areas, we found that the premises were not cleaned to a satisfactory standard, not all staff were aware of the infection control lead or what to do when patients presented with symptoms of sepsis and risks around prescribing certain medicines had not been adequately considered, documented in the patient’s record or communicated to patients. After the inspection the provider told us that they had taken action to address some of the issues related to infection control and that they had reviewed the patient records we had looked at on inspection and found that some of these records contained appropriate consideration of risk. The provider submitted evidence as part of their response to our warning notice. We found that upon reviewing the evidence concerns remained about the management of these patients and/or record keeping.

At this inspection we rated the provider at requires improvement for providing an effective service.

We found that the healthcare assistant now had appropriate role specific training in place and there was evidence of clinical supervision being undertaken. There were no concerns regarding processes around consent. However, we also found that uptake for childhood immunisations and a clinical indicator for diabetes were below local and national averages. We also found that uptake of cervical, bowel and breast screening were significantly below average and there were no practice nurses working at the practice.

At this inspection we rated the provider as good for proving a caring service.

We found that although the provider had enabled people to express their views by carrying out patient surveys and making changes where necessary, national GP patient survey scores were below local and national averages.

At this inspection we rated the provider as requires improvement for providing a responsive service

National GP patient survey scores were below the local and national average. However, the provider had undertaken surveys related to access and had implemented changes in an effort to improve this. Although the provider had not done any specific needs assessment of their population, they were making efforts to improve in most of the areas where they were below local and national targets.

At this inspection we rated the provider as requires improvement for providing a well led service.

The provider had made significant improvement in relation to their governance arrangements, particularly around areas of risk and there were examples of learning and improvement work. However, there were still some aspects of medicines management systems that required refinement, the lack of nursing staff impacted on the practice’s capacity to meet patient needs and achieve their vision, there was no active PPG group and there were concerns about the arrangements for clinical meetings. Some non-clinical staff were not aware of the lead for infection control and the practice’s governance arrangements around cleaning were unsatisfactory.

We have rated this practice as requires improvement overall and requires improvement for all population groups except working age people which was rated as inadequate.

The areas where the provider must make improvements are:

Ensure that care and treatment is provided in a safe way.
Ensure that care and treatment meet the needs of patients.
Establish effective systems and processes to ensure good governance in accordance with fundamental standards of care.

(Please see the specific details on action required at the end of this report).

The areas where the provider should make improvements are:

Address patients accessing online services in safeguarding policies.
Invest in paediatric defibrillator pads.
Improve non-clinical staff awareness of sepsis and identifying deteriorating patient.

The service was placed in special measures in 4 October 2019 on publication of June 2019 report. Insufficient improvements have been made such that there remains a rating of inadequate in the population group working age people and the service remains in special measures. The service will be kept under review and if needed could be escalated to urgent enforcement action. Where necessary, another inspection will be conducted within six months, and if there is not enough improvement we will move to close the service by adopting our proposal to vary the provider’s registration to remove this location or cancel the provider’s registration.

Details of our findings and the evidence supporting our ratings are set out in the evidence tables.

Dr Rosie Benneyworth BM BS BMedSci MRCGP

Chief Inspector of Primary Medical Services and Integrated Care

We carried out an announced desk-based focused inspection of The Medical Centre (Dr Kukar) on 1 October 2020.

The practice was previously inspected on 27 June 2019, when they were rated inadequate overall (inadequate in safe, effective and well-led) and placed in special measures. At that inspection we issued warning notices for breaches of Regulation 12 (Safe care and treatment) and Regulation 17 (Good governance).

A focused follow-up inspection was undertaken on 4 November 2019 to review the warning notices issued at our inspection on 27 June 2019. At this inspection we issued a further warning notice for breach of Regulation 17 (Good governance).

A comprehensive inspection was undertaken on 5 March 2020. At this inspection the practice was rated inadequate overall (inadequate in effective and well-led). The practice remained in special measures. At this inspection we issued a further warning notice for breach of Regulation 17 (Good governance).

The reports of the previous inspections can be found by selecting the ‘all reports’ link for The Medical Centre - Dr Kukar on our website at www.cqc.org.uk.

This desk-based inspection, on 1 October 2020, was to follow-up on a warning notice in relation to Regulation 17 (Good governance) issued to the provider on 27 March 2020 following a comprehensive inspection on 5 March 2020. At that inspection we found concerns regarding safeguarding, recruitment, infection prevention and control (IPC), medication reviews for high-risk medicines, storage of patients’ records, premises risk assessment and patient group directions (PGDs).

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

what we found when we inspected
information from our ongoing monitoring of data about services and
information from the provider, patients, the public and other organisations.

This report was created as part of a pilot which looked at new and innovative ways of fulfilling CQC’s regulatory obligations and responding to risk in light of the Covid-19 pandemic. This was conducted with the consent of the provider. Unless the report says otherwise, we obtained the information in it without visiting the provider.

This was an unrated inspection.

We found the provider had made improvements in providing safe services. In particular we found that the provider had made improvements to their systems and processes in relation to safeguarding, recruitment, infection prevent and control, medication reviews for high-risk medicines, storage of patients’ records, premises risk assessments and patient group directions.

We found the provider had made improvements in providing well-led services in relation to good governance and had implemented systems and processes in response to the findings of our previous inspection outlined on the warning notice for Regulation 17 (Good governance).

The areas where the provider should make improvements are:

Complete the action plan of the findings of the Infection Prevention and Control (IPC) audit within the stated timeframe.

The service will remain in special measures and this will be reviewed at a follow-up comprehensive inspection in line with our current inspection criteria. This will be kept under review and if needed could be escalated to urgent enforcement action. Where necessary, another inspection will be conducted within a further six months, and if there is not enough improvement we will move to close the service by adopting our proposal to remove this location or cancel the provider’s registration. Special measures will give people who use the service the reassurance that the care they get should improve.

Details of our findings are set out in the evidence table.

Dr Rosie Benneyworth BM BS BMedSci MRCGP

Chief Inspector of Primary Medical Services and Integrated Care

We carried out an announced comprehensive inspection at The Medical Centre-Dr Kukar on 05 March 2020.

The practice was previously inspected on 27 June 2019. Following this inspection, the practice was rated Inadequate overall and in safe, effective and well-led domains and placed in special measures. We issued warning notices for breaches of Regulation 12 (Safe care and treatment) and Regulation 17 (Good governance).

We undertook a warning notice follow up inspection on 04 November 2019. Following that inspection, we issued a further warning notice regarding Regulation 17 ‘Good governance’. The practice was required to address these concerns by 31 January 2020. This inspection combined the warning notice follow up inspection and a comprehensive six-months special measures follow up inspection.

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

what we found when we inspected
information from our ongoing monitoring of data about services and
information from the provider, patients, the public and other organisations.

We have rated this practice as inadequate overall.

We rated the practice as requires improvement for providing safe services because:

We found the provider had made improvements in providing safe services regarding:

High risk medicines.
Patient safety alerts.
Emergency medicines and equipment system.
The system regarding clinical supervision for the practice nurse and healthcare assistant (HCA).

We found the provider had not made sufficient improvements in providing safe services regarding:

Safeguarding processes and DBS checks for clinical staff (a concern at our June 2019 inspection).
Recruitment checks (a concern at our June and November 2019 inspections).
Infection prevention and control (IPC), in particular, staff immunisations and immunity (a concern at our June and November 2019 inspections).
Safe premises (a concern at our June and November 2019 inspections).
Patient Group Directions.

We rated the practice as inadequate for providing effective services because:

We found the provider had made improvements for providing effective services regarding:

Clinical supervision and appraisals for the practice nurse and healthcare assistants.

We found the provider had not made improvements for providing effective services regarding:

They had not made sufficient improvements to several patient clinical indicators.
The practice was unable to show that it always obtained consent to care and treatment.
Some performance data was significantly below local and national averages.
Appropriate core specific training and competency checking for the practice nurse and healthcare assistants.

We rated the practice as requires improvement for providing caring services because:

There was a deterioration in patient satisfaction indicators in the caring domain in the National GP Survey for patients.

We rated the practice as requires improvement for providing responsive services because:

Patients described difficulties with making appointments.
There was limited continuity of care for patients.
There was a deterioration in patient satisfaction indicators in the responsive domain in the National GP Survey for patients.

We rated the practice as inadequate for providing well-led services because:

We found the provider had made some improvements to concerns we found in the well led domain:

They had developed a system to monitor and manage patients who had been referred by the urgent referral pathway.
They had developed a system to monitor and manage female patients who had undertaken cervical screening.

We found the provider had not made sufficient improvements to concerns we found in the well led domain. They could not demonstrate they had:

Effective processes in place for managing risks, issues and performance.
Medicines reviews for patients who are prescribed high risk medicines and other medicines that require additional monitoring.
Undertaken regular auditing for patients who had been referred via the urgent two week-wait referral system.
Undertaken regular auditing to safely manage and monitor cervical smear screening.

We found a new concern regarding the well led domain. The provider could not demonstrate they had:

Safely stored patients’ paper records.

The areas where the provider must make improvements are:

Establish effective systems and processes to ensure good governance in accordance with the fundamental standards of care.

The areas where the provider should make improvements are:

Continue to embed a comprehensive programme of clinical quality improvement.
Continue to improve the identification of carers to enable this group of patients to access the care and support they need.
Facilitate access for all staff to have access to a “Freedom to Speak-Up Guardian.”

The service will remain in special measures until we have undertaken the next inspection and this will be reviewed at that time. This will be kept under review and if needed could be escalated to urgent enforcement action. Where necessary, another inspection will be conducted within a

further six months, and if there is not enough improvement we will move to close the service by adopting our proposal to remove this location or cancel the provider’s registration. Special measures will give people who use the service the reassurance that the care they get should improve.

Details of our findings are set out in the evidence table.

Dr Rosie Benneyworth BM BS BMedSci MRCGP

Chief Inspector of Primary Medical Services and Integrated Care

We carried out an announced focused inspection at The Medical Centre-Dr Kukar on 04 November 2019.

The practice was previously inspected on 27 June 2019. Following this inspection, the practice was rated Inadequate overall and in safe, effective and well-led domains and placed in special measures. We issued warning notices for breaches of Regulation 12 (Safe care and treatment) and Regulation 17 (Good governance). The practice was required to address these concerns by 11 September 2019.

We did not review the ratings awarded to this practice at this inspection.

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

what we found when we inspected
information from our ongoing monitoring of data about services and
information from the provider, patients, the public and other organisations.

We found the provider had made improvements in providing safe services regarding:

Safeguarding systems.
Fire safety practices.
Premises management.
Premises risk assessments.
Cold chain.
Electrical systems.

We found the provider had not made sufficient improvements in providing safe services regarding:

Safeguarding processes and DBS checks for clinical staff.

We found the provider had made improvements for providing effective services regarding:

Appraisals for the practice nurse and healthcare assistants.

We found the provider had not made improvements for providing effective services regarding:

Staff did not have the skills, knowledge and experience to deliver effective care, support and treatment.
Clinical supervision for the practice nurse and healthcare assistants.

We found the provider had made some improvements to concerns we found in the well led domain:

All staff had completed regular training regarding infection control, basic life support, fire safety and information governance.

We found the provider had not made sufficient improvements to concerns we found in the well led domain. They could not demonstrate they had:

Effective processes in place for managing risks, issues and performance.
A safe system to monitor and manage patients who had been prescribed high-risk medicines.
A fail-safe system to monitor and manage patients who had been referred via the urgent two week-wait referral system.
A fail-safe system to monitor and manage patient safety alerts.
A fail-safe system in place to safely manage and monitor cervical smear screening.

The areas where the provider must make improvements are:

Establish effective systems and processes to ensure good governance in accordance with the fundamental standards of care.

The service will remain in special measures until we have undertaken the next inspection and this will be reviewed at that time. This will be kept under review and if needed could be escalated to urgent enforcement action. Where necessary, another inspection will be conducted within a

further six months, and if there is not enough improvement we will move to close the service by adopting our proposal to remove this location or cancel the provider’s registration. Special measures will give people who use the service the reassurance that the care they get should improve.

Details of our findings are set out in the evidence table.

Dr Rosie Benneyworth BM BS BMedSci MRCGP

Chief Inspector of Primary Medical Services and Integrated Care

We carried out an announced comprehensive inspection at The Medical Centre Dr Kukar on 27 June 2019 as part of our inspection programme.

We decided to undertake an inspection of this service following our annual review of the information available to us.

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

what we found when we inspected
information from our ongoing monitoring of data about services and
information from the provider, patients, the public and other organisations.

We have rated this practice as inadequate overall.

We rated the practice as inadequate for providing safe services because:

The practice did not have clear systems and processes to keep patients safe.
The practice did not have safe systems regarding the management of high risk medicines in place.
The practice did not have appropriate safeguarding training in place for all staff.
The practice did not have appropriate fire safety systems in place.
The practice did not have safe infection prevention and control practices in place.
The practice did not have safe health and safety and premises practices in place.

We rated the practice as inadequate for providing effective services because:

There was limited monitoring of the outcomes of care and treatment.
The practice was unable to show that staff had the skills, knowledge and experience to carry out their roles.
The practice was unable to show that it monitored consent to care and treatment.
Some performance data was significantly below local and national averages.

We rated the practice as requires improvement for providing caring services because:

•The practice had limited systems in place to identify carers and provide relevant support.

•Staff dealt with patients with kindness and respect and involved them in decisions about their care.

We rated the practice as inadequate for providing responsive services because:

Patients consistently described difficulties with making appointments.
The provider had not fully considered the needs of all patient population groups and developed an action plan to effectively address patients’ needs.

These areas affected all population groups, so we rated all population groups as inadequate.

We rated the practice as inadequate for providing well-led services because:

Leaders could not show that they had the capacity and skills to deliver high quality, sustainable care.
The practice did not have appropriate systems in place for the safe management of patients who had been referred via the two-week wait urgent referral system.
While the practice had a clear vision, that vision was not supported by a credible strategy.
The practice culture did not effectively support high quality sustainable care.
The overall governance arrangements were ineffective.
The practice did not have clear and effective processes for managing risks, issues and performance.
The practice did not always act on appropriate and accurate information.
We saw limited evidence of systems and processes for learning, continuous improvement and innovation.

These areas affected all population groups, so we rated all population groups as inadequate.

The areas where the provider must make improvements are:

Ensure that care and treatment is provided in a safe way.
Establish effective systems and processes to ensure good governance in accordance with the fundamental standards of care.

(Please see the specific details on action required at the end of this report).

The areas where the provider should make improvements are:

Embed a process of systematic clinical quality improvement.
Improve the identification of carers to enable this group of patients to access the care and support they need.
Ensure that all staff have an understanding of Duty of Candour.

I am placing this service in special measures. Services placed in special measures will be inspected again within six months. If insufficient improvements have been made such that there remains a rating of inadequate for any population group, key question or overall, we will take action in line with our enforcement procedures to begin the process of preventing the provider from operating the service. This will lead to cancelling their registration or to varying the terms of their registration within six months if they do not improve.

The service will be kept under review and if needed could be escalated to urgent enforcement action. Where necessary, another inspection will be conducted within a further six months, and if there is not enough improvement we will move to close the service by adopting our proposal to remove this location or cancel the provider’s registration.

Special measures will give people who use the service the reassurance that the care they get should improve.

Details of our findings and the evidence supporting our ratings are set out in the evidence tables.

Dr Rosie Benneyworth BM BS BMedSci MRCGP

Chief Inspector of Primary Medical Services and Integrated Care

Letter from the Chief Inspector of General Practice

We carried out an announced comprehensive inspection at The Medical Centre – Dr Kukar on 17 May 2016. The overall rating for the practice was good but required improvement for providing caring services. This was specifically in relation to concerns about the low number of patients the practice had identified as carers and low patient satisfaction scores for several aspects of care in the GP patient survey results 2014/15.

The full comprehensive report on the 17 May 2016 inspection can be found by selecting the ‘all reports’ link for The Medical Centre – Dr Kukar on our website at www.cqc.org.uk.

This inspection was a follow up desk based focused inspection carried out on 16 June 2017 to confirm that the practice had addressed the concerns that we identified in our previous inspection on 17 May 2016. This report covers our findings in relation to those requirements and also additional improvements made since our last inspection.

The practice is now rated good for providing caring services and the overall rating remains as good.

Our key findings were as follows:

Results from the GP survey 2015/16 showed that patient’s satisfaction scores were consistently similar to local and national averages to questions about GP and nurse consultations and with patient involvement This was an improvement from the previous patient survey in 2014/15 when patient satisfaction was consistently below local and national averages in the same question areas.
The practice had since our last inspection increased the number of patients identified as carers from ten and currently had a carers’ register of 52 patients (0.8% of the practice list size).

We also reviewed the actions taken since the last inspection to the areas where we identified the practice should make improvement and saw that most had been addressed.

Our findings were as follows;

Information informing patients about interpreting services was now displayed in the waiting room which at the time of the last inspection had not been in place.
The practice had installed a hearing loop in the reception area to assist any patients with hearing impairment.
Data from the quality and outcome framework (QOF) 2015/16 demonstrated improved achievement rates for mental health indicators that were significantly below the national average in 2014/15. QOF data 2015/16 showed that the percentage of patients with schizophrenia, bipolar affective disorder and other psychoses who had a comprehensive, agreed care plan had increased from 38% to 76%, which was comparable to the national average of 88%.
Since our last inspection no improvement had been made to the practice’s cervical screening uptake rates which still remained significantly below local and national averages (30%, 71% and 81% respectively). The practice was aware and endeavoured to improve their cervical screening uptake rates through active call and re-call of non-attendees, opportunistic encouragement of patients to attend cervical screening with female GPs and attempt to secure a part-time female practice nurse with CCG involvement. The practice considered that lower achievement rates may be attributed to cultural beliefs and refusal by patients to cervical screening.

The areas where the provider should make improvement are;

Continue to monitor and improve cervical screening up take rates to align with local and national averages.
Continue to identify and support more patients who are carers.

Professor Steve Field (CBE FRCP FFPH FRCGP)

Chief Inspector of General Practice

Letter from the Chief Inspector of General Practice

We carried out an announced comprehensive inspection at Dr Kukar, The Medical Centre on 17 May 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 and an effective system in place 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 been trained to provide them with the skills, knowledge and experience to deliver effective care and treatment.

Information about services and how to complain was available and easy to understand. Improvements were made to the quality of care as a result of complaints and concerns.

Patients said they found it easy to make an appointment with a named GP and 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:

Consider ways to improve the practice uptake for cervical screening.
Review the practice’s processes for developing agreed care plans for patients with schizophrenia, bipolar affective disorder and other psychoses.
Develop a system for monitoring the process of seeking patient consent within patient records.
The provider should improve its identification of patients who are carers and the support offered to them by the practice.
Develop an action plan to improve the practice satisfaction scores from the national GP patient survey.
Consider improving communication with patients who have a hearing impairment.
Advertise the translation services within the practice to inform patients this service is available to them.

Professor Steve Field (CBE FRCP FFPH FRCGP)

Chief Inspector of General Practice

A broad selection of information leaflets about particular medical conditions and treatments were available to people. We spoke to people using the service who told us that they felt well supported by the practice and they understood their care and treatment. Staff at the practice spoke a variety of languages but translators could be arranged if necessary. They people we spoke to described staff as "caring" and "helpful".

When people first attended the centre they were asked to complete a registration form which asked questions about their background, lifestyle, medical history and any existing medical conditions. Follow-up appointments were arranged at the centre or, where necessary, people were referred to other hospital or community services for ongoing treatment or care. People we spoke with said they were "happy" with the service and that they underwent regular check-ups.

People who use the service were protected from the risk of abuse, because the provider had taken reasonable steps to identify the possibility of abuse and knew how to respond to signs of possible abuse.

Staff undertook appropriate training and development activities on an annual basis. They received annual appraisals.

The provider had an effective system to regularly assess and monitor the quality of service that people receive.

The Medical Centre - Dr Kukar

All Inspections

25 May 2022

During a routine inspection

27 April 21 Clinical records review: 29 April 21 Interviews with staff:28 April, 5 May, 8 May 21

During a routine inspection

25 November 2020

During a routine inspection

1 October 2020

During an inspection looking at part of the service

5 March 2020

During a routine inspection

4 November 2019

During an inspection looking at part of the service

27 June 2019

During a routine inspection

16 June 2017

During an inspection looking at part of the service

Letter from the Chief Inspector of General Practice

Professor Steve Field (CBE FRCP FFPH FRCGP)

17 May 2016

During a routine inspection

Letter from the Chief Inspector of General Practice

Professor Steve Field (CBE FRCP FFPH FRCGP)

7 November 2013

During a routine inspection