We carried out an announced comprehensive inspection at Dr Kumaran & Partners, also known as Queens Park Medical Centre on 24 July 2017. The practice was rated as requires improvement for providing caring services as the practice had not reviewed or taken action on

results from the national GP patient survey 2016 and 2017. The overall rating for the practice was good. The full comprehensive report on the July 2017 inspection can be found by selecting the ‘all reports’ link for Dr Kumaran & Partners on our website at www.cqc.org.uk.

This inspection was a desk-based review carried out on 21 August 2018 to confirm that the practice had carried out their plan to meet the legal requirements in relation to the breaches in regulations that we identified in our previous inspection on 24 July 2017. This report covers our findings in relation to those requirements and also additional improvements made since our last inspection.

The practice is now rated as good for providing caring services. Overall the practice remains rated as good.

Our key findings were as follows:

• The practice had reviewed and taken action on results from the national GP patient survey 2016 and 2017. They had also reviewed data from the 2018 survey.
• The practices GP patient survey results 2018 were mostly in line with local and national averages. The practice had reviewed this data and created an action plan to improve patient satisfaction.
• There was now a system to identify how often training should be completed to ensure staff were up-to-date.
• The practice now acted on and learned from external safety events as well as patient and medicine safety alerts.
• The business continuity plan was now more accessible to staff.
• There was now a system to record verbal references for new staff.
• Interpretation services were available for patients who did not have English as a first language and this was now advertised in the waiting area.
• The practice had a realistic strategy and supporting business plans to achieve priorities.

Professor Steve Field CBE FRCP FFPH FRCGP
Chief Inspector of General Practice

Please refer to the detailed report and the evidence tables for further information.

Letter from the Chief Inspector of General Practice

We carried out an announced comprehensive inspection at Dr Kumaran & Partners on 6 October 2015. The practice was rated as requires improvement for providing safe and well-led services and the overall rating for the practice was requires improvement. The full comprehensive report on the October 2015 inspection can be found by selecting the ‘all reports’ link for Dr Kumaran & Partners on our website at www.cqc.org.uk.

This inspection was an announced comprehensive follow up inspection on 24 July 2017 to check for improvements since our previous inspection. Overall the practice is now rated as good.

Our key findings were as follows:

• There was an open and transparent approach to safety and a system in place for reporting and recording significant events.
• The practice had clearly defined and embedded systems to minimise risks to patient safety.
• Staff were aware of current evidence based guidance. Staff had been trained to provide them with the skills and knowledge to deliver effective care and treatment. However, there was no system to identify how often training should be completed to ensure staff were kept up to date.
• Results from the national GP patient survey 2016 and 2017 showed patients rated the practice below average for satisfaction scores on consultations with the GPs and for several other aspects of care. We did not see evidence that the practice had acted on this feedback to improve outcomes for patients.
• Information about services and how to complain was available. Improvements were made to the quality of care as a result of complaints and concerns.
• Patients we spoke with 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 the requirements of the duty of candour. Examples we reviewed showed the practice complied with these requirements.

However, there were also areas of practice where the provider needs to make improvements.

Importantly, 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 the system in place to ensure patient safety alerts are shared with relevant staff.
• Implement a system to ensure staff training is kept up to date.
• Review recruitment arrangements to include records of all necessary employment checks for all staff.
• Consider ways to improve cervical screening uptake to bring in line with local and national averages.
• Advertise that a translation service is available to patients on request.
• Raise staff awareness of the practice’s strategy and business continuity plan.

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 Kumaran & Partners, also known as Queens Park Medical Practice on 6 October 2015. Overall the practice is rated as requires improvement.

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

• Systems were in place to report and record significant events and incidents, however information about safety and lessons learned were not always documented.
• Some risks to patients were assessed and well managed, however improvements were required with those relating to dealing with medical emergencies and managing patients on high risk medicines.
• Most staff had received training appropriate to their roles, although further training relating to infection control and using emergency equipment required planning.
• Patients’ needs were assessed and care was planned and mostly delivered following best practice guidance.
• Data showed patient outcomes were average for the locality. Some audits had been carried out to improve patient outcomes.
• 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.
• Urgent appointments were usually available on the day they were requested, and children were prioritised.
• Most patients said they found it easy to access the service and make an appointment, although some patients commented on waiting for long periods after their appointment time to be seen.
• The practice had good facilities and was well equipped to treat patients and meet their needs.
• The practice had a number of policies and procedures to govern activity. Regular practice meetings took place, although minutes and actions from meetings were not always documented.
• 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 areas where the provider must make improvements are:

• Ensure all safety incidents are recorded and reviewed.
• Review the protocols for managing all patients on any high risk medicines.
• Ensure staff receive training in how to use the emergency equipment.

In addition the provider should:

• Review and risk assess what emergency medicines should be kept in the practice.
• Ensure that clinical staff are familiar with the practice’s consent policy.
• Ensure the GPs receive infection control training in line with their roles.
• Advertise that a chaperone service and translation services are available to patients on request.
• Formalise the practice’s vision and values and ensure staff are made aware of this.
• Maintain a record of decisions and actions arising from practice meetings.

Professor Steve Field (CBE FRCP FFPH FRCGP) 

Chief Inspector of General Practice

During our visit to the practice we spoke with five people who use the service. We also enabled people to complete comments cards to tell us about their experience of the service, and we received ten of these completed by people who use the service. The feedback we received from people was that they felt they received a good service, they said that the majority of staff were helpful and treated them with respect. Some comments received were “very happy with the care, service and hygiene“, “the staff are attentive” and “the nurse put me at ease.”

All the people we spoke with said that they felt they were given enough time during their appointment to be able to discuss their needs with the GP or practice nurse. They felt informed about different treatment options available to them and involved in decisions about their care.

We looked at the feedback forms that the practice asked people to complete, as well as the log of complaints received. We also looked at feedback people had put onto the NHS Choices website. This information helped us to gain an overview of people’s experiences of the service.

We spoke with the GP partners, practice nurse, the practice manager, project manager and a receptionist. They all said they enjoyed working at the practice, that there was good teamwork and they felt supported by the provider and the other staff.

There were systems in place to minimise the spread of infection to people who use the service.

The provider monitored the quality of service provided and people's views and opinions were taken into consideration in relation to how the service was run.