Letter from the Chief Inspector of General Practice

We carried out an announced comprehensive inspection at Kenyon Medical Centres on 13 December 2016. The practice was rated requires improvement for providing safe services with an overall rating of good. The full comprehensive report on the December 2016 inspection can be found by selecting the ‘all reports’ link for Kenyon Medical Centres on our website at www.cqc.org.uk.

This inspection was a follow up focused inspection carried out on 10 October 2017 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 13 December 2016. This report covers our findings in relation to those requirements and also additional improvements made since our last inspection.

We found the practice had reviewed the previous inspection findings and had made extensive changes which had resulted in significant improvements.

Our key findings were as follows:

• There was an open and transparent approach to safety and an effective system for reporting and recording significant events. The actions taken and learning from events were now documented, monitored and reviewed. Annual reviews of events were scheduled.
• Staff had been trained to ensure they had the skills, knowledge and experience to deliver effective care and treatment. All staff had completed infection control training since the previous inspection.
• Details about and learning from complaints were now shared with staff in full practice team meetings. Minutes were available on the practice’s computer for staff to access if they were unable to attend these meetings.
• The practice had improved the management of patient safety alerts such as those from the Medicines and Healthcare products Regulatory Agency (MHRA). Records demonstrated that action had been taken and had been reviewed accordingly. This included recording where no action had been required.
• Infection prevention control audits were carried out in accordance with nationally recognised guidelines and completed every six months.
• Significant improvements had been made to support patients with caring responsibilities. This included: routinely asking if patients were carers at registration; providing a notice board in reception which gave details of support for carers, including young carers; patients could be referred to local caring support agencies for help, for example with equipment and finances; and a carer advisor who was employed by the Carers Trust was assigned to the practice and attended the Brandon Road site on Thursdays from 12pm to 3pm. Patients that were carers could call in for information about advice and support that could be offered. At the time of this inspection the number of patients identified as carers had increased from 0.5% to 3.23% of the practice patient list.

The practice is now rated as good overall.

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 Kenyon Medical Centres on 13 December 2016. Overall the practice is rated as good.

• There was an open and transparent approach to safety and an effective system in place for reporting and recording significant events. However the actions taken and learning from the event were not always documented. The practice had not carried out a review of significant events at the time of the inspection.
• 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 although not all staff had completed infection control training which had been deemed mandatory.
• Patient survey figures showed patients rated the practice higher than others for most aspects of care.
• 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. Although complaints were not always shared with the full practice team.
• 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.
• National patient safety and medicine alerts were disseminated within the practice. However there was no evidence to show the actions taken or any searches relevant to alerts.

• Incoming mail including hospital letters were reviewed by non-clinical staff. On the day of the inspection staff involved were not clinically supervised and were not audited to ensure quality assurance. Audits and quality assurance processes were forwarded following the inspection. Letters that indicated changes to medicines or further actions would be passed to a GP.

• 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 meetings.
• The practice had identified 62 patients as carers (0.51% of the practice list).

The areas where the provider must make improvements are:

• Ensure recruitment arrangements include all necessary employment checks for all staff.

• Ensure staff that are reviewing clinical mail are clinically supervised and audits are completed to gain assurance.

• Ensure all staff complete training identified as mandatory, such as infection control.

The areas where the provider should make improvement are:

• Regularly review significant events including near misses and complaints to identify trends and themes and ensure that actions and lessons learned in relation to significant events are documented, appropriate and completed. Update action plans accordingly to evidence completed actions
• Review process and methods for identification of carers and the system for recording this to enable support and advice to be offered to those that require it.
• Review process for patient safety alerts to evidence actions taken and when completed.

Professor Steve Field (CBE FRCP FFPH FRCGP) 

Chief Inspector of General Practice