We carried out an announced comprehensive inspection at Kings Heath Practice on 16 May 2018. The overall rating for the practice was inadequate and the practice was placed in special measures.

From the inspection in May 2018 the practice was told they must:

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

In addition, the practice was told they should:

• Continue with efforts to invite patients for annual reviews where needed, including patients with a learning disability.
• Explore how the uptake of cancer screening could be improved.
• Continue to establish a patient participation group in order to gather and act on patient feedback and improve services.

The full comprehensive report on the May 2018 inspection can be found by selecting the ‘all reports’ link for Kings Heath Practice on our website at www.cqc.org.uk.

This inspection was an announced comprehensive inspection carried out on 11 February 2019, to confirm that the practice had made the recommended improvements that we identified in our previous inspection on 18 May 2018. Prior to the May 2018 inspection the practice had been rated as requires improvement in October 2017. The practice had failed to make the required improvements following the October 2017 inspection which led to the practice being rated as inadequate and placed into special measures in May 2018.

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, patients, the public and other organisations.

The practice is rated as requires improvement overall.

The overall rating for this practice is requires improvement due to concerns in providing safe and well-led services. However, the population groups have been rated as requires improvement or good due to some improvement with effective and responsive care and treatment being delivered at the practice.

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

• Staff were not always clear on who to report safeguarding concerns to.
• The practice needed to provide more information and guidance to staff in relation to recognising and managing sepsis.

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

• Improvement was needed in relation to patient screening, diabetes and asthma reviews.

• Staff were trained and supported in their roles, however, clinical supervision and oversight was not always in place.

We rated the practice as good for providing caring and responsive services because:

• Staff dealt with patients with kindness and respect and involved them in decisions about their care.
• The practice organised and delivered services to meet patients’ needs. Patients could access care and treatment in a timely way.

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

• The lack of consistent practice management presence was impacting on the quality of care and treatment.
• Quality monitoring across the practice needed to be strengthened to ensure areas such as unplanned admissions and patient follow ups were fully audited.
• Although we found the practice to be improved since our last inspection, we did not yet have evidence that the improvements would be sustainable over time and we found further issues which had not been identified at the last inspection.

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:

• Improve training and guidance for staff in relation to recognising and managing sepsis.
• Continue to work to improve the uptake of patients for the national cancer screening programme.
• Continue to work to improve the uptake of child immunisations.

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

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

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

Previous inspection 04/10/2017 – Comprehensive inspection rated as Requires improvement

This inspection 16/05/2018 – Comprehensive inspection

The practice is now rated as inadequate

The key questions are rated as:

Are services safe? – Inadequate

Are services effective? – Inadequate

Are services caring? – Good

Are services responsive? – Requires improvement

Are services well-led? – Inadequate

We undertook a comprehensive inspection of Kings Heath Practice on 4 October 2017 under Section 60 of the Health and Social Care Act 2008 as part of our regulatory functions. The practice was rated as requires improvement for providing safe, effective and responsive services. The full comprehensive report on the October 2017 inspection can be found by selecting the ‘all reports’ link for Kings Heath Practice on our website at www.cqc.org.uk.

This inspection was an announced comprehensive inspection carried out on 16 May 2018 to confirm that the practice had carried out the required improvements we identified during our previous inspection on 4 October 2017 and re-rate the practice. Overall the practice is rated as inadequate.

Our key findings are as follows:

• The practice had failed to respond to previously identified concerns.
• Evidence of improvement was not consistently demonstrated. In particular there was no evidence of actions taken to improve telephone access or to increase uptake of cancer screening.
• Staff we spoke with said they felt well supported in their roles, however there were no systems for formal supervision of clinical staff to provide assurance on competencies.
• We found that there was no formal programme of multi-disciplinary team (MDT) meetings in place to help deliver a co-ordinated approach to patients needing end of life care. The practice informed us that clinicians contacted appropriate services and professionals as needed on an individual basis to co-ordinate care for their patients.
• There was no active patient participation group to engage with patients to improve services. The practice was making continued efforts to recruit through ongoing advertising and discussions.
• The practice had some systems to reduce the risks to patient safety, however we identified some gaps. In particular, processes for ensuring consistent management of safety alerts needed expanding.
• Recruitment checks had been undertaken prior to employment for permanent staff. However, checks for locum staff were incomplete.
• We found that there were some pathology test results that had not been actioned and some of these were for patients who were not registered with the practice. There was no system in place to ensure that these patients results were reassigned correctly.
• The practice maintained appropriate standards of cleanliness and hygiene.
• The practice had good facilities and was well equipped to treat patients and meet their needs.
• Results from the national GP patient survey, published in July 2017 showed patient satisfaction with GP consultations and appointment access were below local and national averages.
• Patients we spoke with on the day of inspection said that staff them with compassion, kindness, dignity and respect.
• Clinicians knew how to identify and manage patients with severe infections such as sepsis.
• There was a clear leadership structure and staff felt supported by the management team.
• The provider was aware of the requirements of the duty of candour. Examples we reviewed showed the practice complied with these requirements.

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. (Please refer to the requirement notice at the end of the report for further detail).

In addition the provider should:

• Continue with efforts to invite patients for annual reviews where needed, including patients with a learning disability.
• Explore how the uptake rates for cancer screening could be improved.
• Continue to establish a patient participation group in order to gather and act on patient feedback and improve services.

Special measures statement

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.

Professor Steve Field CBE FRCP FFPH FRCGPChief Inspector of General Practice

Letter from the Chief Inspector of General Practice

We carried out an announced comprehensive inspection at Kings Heath Practice on 4 October 2017. Overall the practice is rated as requires improvement.

Kings Heath Practice was previously part of Kings Heath and Lings Brook Practice until the provider withdrew from the contract in March 2017. A change of provider took place in April 2017. The new provider was established as Kings Heath Practice under the caretaker management of a local GP federation, General Practice Alliance (GPA).

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.
• Staff were aware of current evidence based guidance and had been trained to provide them with the skills and knowledge to deliver effective care and treatment.
• The practice maintained appropriate standards of cleanliness and hygiene.
• Information about services and how to complain was available and the practice proactively acted on complaints posted on the national website, NHS Choices. Improvements were made to the quality of care as a result of complaints and concerns.
• 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 the management team.
• The provider was aware of the requirements of the duty of candour. Examples we reviewed showed the practice complied with these requirements.
• The practice had some systems to assess and monitor health and safety, but they were not wide ranging enough to minimise risks to patient and staff safety.
• Some recruitment checks had been undertaken prior to employment but there were some gaps.
• Results from the national GP patient survey published in July 2017 showed feedback scored the practice below local and national averages for most aspects of care. However, the practice demonstrated a proactive approach to identifying and acting on the main issues, and more recent patient feedback indicated that patients felt improvements had been made.
• Patient feedback on the ease of securing an appointment was mixed. The most recent feedback highlighted that improvements had been made and there was continuity of care with urgent appointments available the same day.

The areas where the provider must make improvement are:

Assessments of the risks to the health and safety of service users of receiving care or treatment were not being carried out. In particular:

• The practice systems to minimise risks to patient safety were not comprehensive. Some risk assessments had been carried out but we identified areas of risk that had not been assessed or mitigated.

The registered person had not ensured that all the information specified in Schedule 3 of the Health and Social Care Act 2008 (Regulated Activities) Regulations 2014 was available for each person employed. In particular:

• Satisfactory information about any physical or mental health conditions relevant to a person’s ability to carry out their role had not been obtained for all staff and no Disclosure and Barring Service (DBS) check had been carried out on the Advanced Nurse Practitioner (ANP). There was no evidence of any checks done on a locum GP who had recently worked at the practice.

The areas where the provider should make improvement are:

• Review the process for managing uncollected repeat prescriptions.
• Review the storage arrangements for emergency equipment and medication.
• Review the induction arrangements for newly appointed staff.
• Explore how the uptake rates for cancer screening could be improved and ensure improvement.
• Consider how information for carers could be more accessible to patients when visiting the premises.
• Consider implementing a protocol to support non-clinical staff identify those patients who have contacted the practice by telephone and may be in need of urgent treatment.
• Continue to monitor and ensure improvement to national GP patient survey results in particular the patient feedback on telephone access and review the clinical capacity meets patient needs.
• Include on the complaints letter information on what the complainant can do if not satisfied with the response or outcome.
• Revise the procedure for repeat prescribing for requests from secondary care to ensure authorisation is given by a suitable clinician prior to the issue of the prescription.
• Establish a process to seek and act on patient feedback, for example establish a patient participation group
• Continue to review patient recall systems and processes in relation to the Quality and Outcomes Framework (QOF).

We discussed with the current provider the use of Quality and Outcomes Framework (QOF) submissions data for the practice given the service was under the previous provider. It was agreed that it was applicable and relevant.

Professor Steve Field CBE FRCP FFPH FRCGPChief Inspector of General Practice

Professor Steve Field (CBE FRCP FFPH FRCGP) 

Chief Inspector of General Practice