Letter from the Chief Inspector of General Practice

We carried out an announced comprehensive inspection at King Street Health Centre on 12 April 2016. Overall the practice is rated as good.

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

• The provider was not registered with the Care Quality Commission for all of the regulated activities carried out at the practice. When this was pointed out to the provider they took immediate steps to rectify this, and applications for additional regulated activities to be added to the location have been made.

• Staff understood and fulfilled their responsibilities to raise concerns, and to report incidents and near misses.
• Risks to patients were assessed and well managed.
• Results from the national GP patient survey showed the practice was rated below average for its satisfaction scores on consultations with GPs and nurses.
• 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 GP and there was continuity of care, with urgent appointments available the same day.

• Overall the practice had good facilities and was well equipped to treat patients and meet their needs.

• Child immunisation rates were significantly below the Clinical Commissioning Group average for five year olds.

There were areas where the provider should make improvement:

• The provider should review their stock control processes and make certain that all staff are aware of the location of emergency medicines within the practice.

• The provider should continue to take steps to ensure they are registered with the Care Quality Commission for the appropriate regulated activities before these are carried out on site, in line with the current arrangements.

Professor Steve Field (CBE FRCP FFPH FRCGP) 

Chief Inspector of General Practice

We spoke with three patients who were accessing the service on the day of our inspection.

Positive feedback was given to us by all three patients. All patients stated that staff worked with them in a collaborative manner and always obtained their permission before examining them, providing them with a treatment or referring them elsewhere.

One patient described the service as being "quick and efficient" and that staff had "made me feel comfortable". This patient described staff as being "great". A different patient gave "full marks for this place" and spoke of the service being "convenient". Another patient described the service as usually being "perfect" with the staff being "brilliant".

We saw that the service worked closely with other agencies and professionals to help drive service improvements and the delivery of care.

We found that the premises were well maintained; a range of risk assessments had been carried out, and checks undertaken, to ensure the building was kept safe.

The provider had in place staff appraisals and were in the process of introducing a more formal supervision process. Training was available to staff; some of this training was mandatory. We found that some staffs' mandatory training had expired by several months; we found this lapse to be unacceptable.

We carried out an announced focused inspection at King Street Health Centre on 31 January 2019 as part of our inspection programme.

At the last inspection in June 2018 we rated the practice as good overall, with a rating of requires improvement for providing safe services. The full comprehensive report regarding the June 2018 inspection can be found by selecting the ‘all reports’ link for King Street Health Centre on our website at www.cqc.org.uk.

The practice was rated as requires improvement for providing safe services because:

• The provider was not able to give full assurance that all Patient Group Directions and updates had been fully authorised.
• The provider had not checked or recorded the immunity status of applicable staff with regard to measles, mumps and rubella, and chickenpox.
• There was only limited assurance regarding the system for checking emergency medicines and equipment.
• All relevant staff were not aware of the symptoms of sepsis.

In addition to the areas for improvement identified under the key question of providing safe services, at the inspection in June 2018 we also said the practice should consider improving the following area:

• Review and improve communication activities with staff.

At this inspection, we found that the provider had satisfactorily addressed these areas.

Our judgement of the quality of care at this service is based on a combination of what we found when we inspected, information from our ongoing monitoring of data about services and information from the provider and other organisations.

Overall the practice is now rated as good overall, with the practice rated as good for providing safe services.

Our key findings were as follows:

• The provider had adopted practices and processes which ensured Patient Group Directions had been fully authorised, and that staff were fully competent to deliver vaccinations and immunisations.
• The provider had made, or was in the process of making, the necessary checks to assure themselves of the immunity status of all relevant staff members. This included status checks in relation the measles, mumps and rubella, and chickenpox.
• We saw that the provider had developed and implemented processes for the checking of emergency medicines and equipment.
• Staff had introduced processes and procedures, and raised staff awareness, to enable them to identify and manage patients with severe infections including sepsis.
• The provider had improved communication with staff members. We saw for example, that staff bulletins were circulated and there were mechanisms in place for staff to cascade feedback to managers.

Professor Steve Field CBE FRCP FFPH FRCGP

Chief Inspector of General Practice