Letter from the Chief Inspector of General Practice

We carried out an announced comprehensive inspection at Kingston Health Centre on 9 August 2016. Overall the practice is rated as Good.

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

• Overall, risks to patients were assessed and well managed; however, there were some areas where procedures should be more robust. For example, we observed that the room where medicines were kept was not always locked, and there was no process in place for monitoring the expiry dates for Patient Group Directions (the legal paperwork required for some staff to administer medicines); a new process was implemented by the practice immediately after the inspection, and we saw evidence that all necessary legal documents were immediately put in place.
• Staff understood and fulfilled their responsibilities to raise concerns and report incidents and near misses. All opportunities for learning from internal and external incidents were maximised.
• 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.
• The practice worked closely with other organisations and with the local community in planning how services were provided to ensure that they meet patients’ needs. For example, having identified gaps in the community services commissioned by the CCG, they had successfully campaigned for additional services to be provided, these included the provision of a paediatrician to be part of the eating disorders team in order to address the physical needs of these patients, and for the provision of a complex dressing service for patients with challenging wound care needs.
• Feedback from patients about their care was consistently positive.
• The practice implemented suggestions for improvements and made changes to the way it delivered services as a consequence of feedback from patients and from the patient participation group. For example, following feedback from patients they had introduced Saturday morning appointments.
• The practice had good facilities and was well equipped to treat patients and meet their needs.
• The practice actively reviewed complaints and how they are managed and responded to, and made improvements as a result. Information about making a complaint was available on the practice’s website and a complaints leaflet was available; however, there was no poster in the reception area informing patients about how they could complain.
• Patients said they found it easy to make an appointment with a named GP and there was continuity of care, with urgent appointments available the same day. The practice had a flexible approach to appointments; reception staff could over-ride the appointments system where necessary to meet demand and staff felt that clinical staff trusted their judgement on this.
• The practice had strong and visible clinical and managerial leadership and governance arrangements.
• 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.

We saw two areas of outstanding practice:

The practice was proactive in assessing the needs of their patient population and in adapting their service to meet the needs of their patients. For example, they had tailored their service to patients with learning difficulties by producing information in “easy read” for patients with learning difficulties, this included a “friends and family test” questionnaire and a care plan template, which allowed the patient to identify their support needs. They also worked closely with a local charity which supported homeless people, and as a result had developed a reputation for providing good quality and tailored service to these patients; they had registered 48 homeless patients in the past 12 months.

The practice had taken the initiative in several areas to provide services that were not available elsewhere in the locality, which in some cases involved staff undertaking additional training and completing further qualifications. For example, GPs at the practice had completed a diploma in mental health in order to offer an enhanced level of care to patients with mental health needs and to bridge the gap between the demand for counselling for patients with mental health needs and the limited provision available through the local community mental health team (CMHT); in particular, one of the GPs had qualified to offer psychosexual counselling, which was not available via the CMHT, and had provided this service to 31 patients in the past three years, with each patient receiving 6-8 sessions of 45-60 minutes each. This service is entirely funded by the practice and delivered outside of normal clinical hours.

The areas where the provider should make improvement are:

• Ensure that the new system for monitoring the use of PGDs is robust and effective, and ensure that arrangements for the safe storage of medicines are adhered to.
• They should review how patients with caring responsibilities are identified and recorded on the clinical system to ensure that all of these patients are identified so that information, advice and support can be made available to them.
• They should ensure that they are advertising to patients prior to their appointment that chaperones and translation services are available. They should also display information about their complaints procedure in the patient waiting area.

Professor Steve Field CBE FRCP FFPH FRCGP 

Chief Inspector of General Practice