Letter from the Chief Inspector of General Practice

We carried out an announced comprehensive inspection of Kings Edge Medical Centre on 19 February 2016 under Section 60 of the Health and Social Care Act 2008 as part of our regulatory functions. The practice was rated inadequate for providing safe, effective, caring, responsive and well-led services and was placed into special measures for a period of six months. Due to serious concerns about patient safety we served a Section 31 of the Health and Social Care Act 2008 notice to suspend the registration of the provider for a period of three months from 23 February 2016.

We then carried out a focused follow up inspection on 17 May 2016 to assess whether sufficient improvements had been made to allow the practice to re-open or if further enforcement action was required.

Following the inspection in May 2016 we found some improvements had been made however we still had concerns about the ability of the leadership to deliver high quality care. As a result we served a Section 31 of the Health and Social Care Act 2008 notice to impose additional conditions on the registration of the provider in respect of the regulated activities for a period of three months. The additional conditions were that Kings Edge Medical Centre could not register any new patients apart from new born babies, newly fostered or adopted children to patients already registered with the practice.

The full reports on the February and May 2016 inspections can be found by selecting the ‘all reports’ link for Kings Edge Medical Centre on our website at www.cqc.org.uk.

We undertook a further announced comprehensive inspection of Kings Edge Medical Centre on 07 February 2017. This inspection was carried out following the period of special measures to ensure improvements had been made and to assess whether the practice could come out of special measures. Overall the practice is now rated as requires improvement.

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.
• Patients said they were treated with compassion, dignity and respect and they were involved in their care and decisions about their treatment.
• Data from the national GP patient survey showed patients rated the practice lower than others for most aspects of care.
• 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.
• The practice had adequate facilities and was 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.
• Clinical leadership arrangements were only formalised at the time of the inspection and therefore we were not assured that the improvements to date would be sustained.

The provider must:

• Monitor progress against plans to improve the quality and safety of services, and take appropriate action without delay where progress is not achieved as expected.

In addition the provider should:

• Continue to improve patient satisfaction with the service in response to feedback.
• Identify and support more patients who are also carers.
• Encourage more patients to attend the national bowel and breast cancer screening programme.

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

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 of Kings Edge Medical Centre on 19 February 2016. The practice was rated as inadequate and placed into special measures. Because of the concerns found at the inspection we served the provider with a Section 31 of the Health and Social Care Act 2008 (“the Act”) notice to impose an urgent suspension of the regulated activities from the location for a period of three months from 23 February 2016 to 18 May 2016.

We undertook a focused inspection on 17 May 2016 to check whether the provider had made sufficient improvements to allow the suspension to end and if further enforcement action was necessary.

This report covers our findings in relation to our focused inspection. You can read our findings from our last comprehensive inspection by selecting the 'all reports' link for Kings Edge Medical Centre on our website at www.cqc.org.uk

Following our focused inspection we found the provider had implemented sufficient improvements to allow the period of suspension to end, however we still had concerns with regard to the provider's ability to implement the systems and effectively govern the practice. Because of the new concerns we made a decision under Section 31 of the Health and Social Care Act 2008 ("Act") to impose an additional condition on the registration of the provider in respect of the regulated activities. The additional conditions are that Kings Edge Medical Centre must not register any new patients apart from new born babies, newly fostered or adopted children to patients already registered with the practice for a period of three months from 23 May 2016.

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 Kings Edge Medical Centre on 19 February 2016. Overall the practice is rated as Inadequate.

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

• Patients were at risk of harm because systems and processes were not in place to keep them safe. For example appropriate recruitment checks on staff had not been undertaken prior to their employment and actions identified to address concerns with infection control practice had not been taken.

• There were also serious concerns relating to incident reporting, safeguarding, chaperoning, infection control, vaccines and medicines management, recruitment, health and safety, staffing, dealing with emergencies, emergency medicines, risk monitoring and actioning referrals in a timely way.

• Staff were not clear about reporting incidents, near misses and concerns and there was no evidence of learning and communication with staff.

• Patient outcomes were hard to identify as little or no reference was made to audits or quality improvement and there was no evidence that the practice was comparing its performance to others, either locally or nationally.

• Patient feedback was mostly negative about their interactions with staff and said they were not always treated with dignity and compassion.

• The appointment system was not working well so patients did not receive timely care when they needed it.

• The practice was unable to demonstrate how they handled complaints within the practice.

• The practice had no clear leadership structure, insufficient leadership capacity and limited formal governance arrangements.

The areas where the provider must make improvements are:

• Develop and implement a vision and strategy to improve services for patients and ensure governance processes are in place to monitor safety and risk.

• Introduce robust processes for reporting, recording, acting on and monitoring significant events, incidents and near misses. Ensure staff are aware of and comply with the requirements of the Duty of Candour in the event of a notifiable safety incident.

• Ensure robust systems and processes are established and operated effectively to safeguard children and vulnerable adults from abuse.

• Ensure recruitment arrangements include all necessary employment checks for all staff, for example, Disclosure and Barring Service (DBS) checks or risk assessments for all staff providing a chaperone service for patients.

• Take action to ensure premises and equipment are kept clean, properly maintained and comply with the guidance from legislation about the prevention and control of infections.

• Put systems in place to ensure all clinicians are kept up to date with national guidance and guidelines.

• Carry out continuous quality improvement processes for example two cycle clinical audits to ensure improvements have been achieved.

• Implement formal governance arrangements including systems for assessing and monitoring risks and the quality of the service provision.

• Provide staff with appropriate policies and guidance to carry out their roles in a safe and effective manner which are reflective of the requirements of the practice.

• Clarify the leadership structure and ensure there is leadership capacity to deliver all improvements.

• Ensure staff understand the Mental Capacity Act 2005 and related guidance.

The areas where the provider should make improvement are:

• Consider improving communication with patients who have a hearing impairment.

• Advertise within the practice the provision of the translation service for patients.

• Improve processes for making appointments.

• Proactively identify and support patients who are carers

On the basis of the ratings given to this practice at this inspection, I am placing the provider into special measures. If we find that the provider is still providing inadequate care we will take steps to cancel its registration with CQC.

On 23 February 2016 we served the practice a Section 31 of the Health and Social Care Act 2008 (“the Act”) notice to impose these conditions in relation to their registration as a service provider. Kings Edge Medical Centre are not to carry out any regulated activities at the location for a period of three months. We will inspect the practice again in three months to consider whether sufficient improvements have been made.

Professor Steve Field (CBE FRCP FFPH FRCGP) 

Chief Inspector of General Practice

We reviewed the information available to us about Kings Edge Medical Centre on 1 June 2019. We did not find evidence of significant changes to the quality of service being provided since the last inspection. As a result, we decided not to inspect the surgery at this time. We will continue to monitor this information about this service throughout the year and may inspect the surgery when we see evidence of potential changes.