Letter from the Chief Inspector of General Practice

We carried out an announced comprehensive inspection at Kingshurst Medical Practice on 22 September 2015. Overall the practice is rated as good.

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

• Staff understood and fulfilled their responsibilities to raise concerns, and to report incidents and near misses. Information about safety was recorded, monitored, appropriately reviewed and addressed.
• Risks to patients were assessed and well managed.
• Patients’ needs were assessed and care was planned and delivered following best practice guidance. Staff had received training appropriate to their roles and any further training needs had been identified and planned.

• 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.
• 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.

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

Importantly the provider should

• Develop systems to ensure that GPs are made aware when patients do not collect their prescriptions within a set timescale.

Professor Steve Field (CBE FRCP FFPH FRCGP) 

Chief Inspector of General Practice

We carried out an announced comprehensive inspection at Kingshurst Medical Practice on 26 November 2018 as part of our inspection programme. We had previously inspected this practice in September 2015 and had rated the practice as good.

We based our judgement of the quality of care at this service 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.

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

• Some performance data was significantly below local and national averages particularly in relation to the population groups of long term conditions, families, children and young people, and working age people. Actions taken to identify and implement improvement had not had a significant impact at the time of the inspection. We have therefore also rated the practice as requires improvement for providing effective services to these population groups.

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

• Survey results in relation to patient experience was below local and national averages. There was limited evidence of improvement by the practice in response to these results.

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

• Although some action had been taken in response to patient survey results there was no evidence to demonstrate that these had been effective or that they were embedded and would be sustained.

These areas affected all population groups so we rated the practice as requires improvement for providing responsive services to all these groups.

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

• Where changes and improvements had been made in response to incidents and significant events, they had not always been monitored and reviewed to ensure that learning was fully embedded.
• The management and oversight of systems, processes and quality monitoring within the practice was not effective. There was no practice manager in post at the time of the inspection and this had impacted on this area.
• There were systems of accountability to support effective governance although these were not effectively monitored and reviewed at all times.
• There were comprehensive policies and procedures although improvements were needed to support best practice.
• The processes for identifying and mitigating risks of health and safety needed improvement. Some risk assessments were not comprehensive enough to ensure all potential risks had been identified and mitigated.

We rated the practice as good for proving safe services because:

• There were defined and embedded systems, processes and practices in place to keep people safe and safeguarded from abuse.
• There was an open and transparent approach to safety and a system in place for recording, reporting and learning from significant events. When incidents happened, the practice learned from them and improved their processes.
• Appropriate standards of cleanliness and hygiene were met.

We rated the practice as good for providing effective services to the population groups of older people, people whose circumstances make them vulnerable and people experiencing poor mental health (including people with dementia) because:

• Staff had appropriate knowledge of treating older people including their psychological, mental and communication needs.
• Health checks were offered to patients over 75 years of age.
• End of life care was delivered in a coordinated way which took into account the needs of those whose circumstances may make them vulnerable.
• The practice assessed and monitored the physical health of people with mental illness, severe mental illness, and personality disorder by providing access to health checks, interventions for physical activity, obesity, diabetes, heart disease, cancer and access to ‘stop smoking’ services.
• Patients at risk of dementia were identified and offered an assessment to detect possible signs of dementia. When dementia was suspected there was an appropriate referral for diagnosis.

Whilst we found no breaches of regulations, the provider should:

• Ensure that all policies are practice specific and kept under review to reflect changes and best practice.
• Ensure that risk assessments are specific, comprehensive and kept under regular review in keeping with best practice.
• Review training to ensure relevant staff are aware of their responsibilities as chaperones.
• Continue to determine reasons for high exception rate reporting and take appropriate action to ensure patients received appropriate care.
• Improve the identification of carers to enable this group of patients to access the care and support they need.
• Take action to ensure that all complaints are responded to within the timescales given in the practices policy.
• Review all aspects of the feedback from the National GP Patient Survey to ensure that action is taken to address all areas where improvements are needed.

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