This practice is rated as Good overall. (Previous rating August 2016– Good)

The key questions at this inspection are rated as:

Are services safe? – Good

Are services effective? – Good

Are services caring? – Good

Are services responsive? – Good

Are services well-led? - Good

We carried out an announced inspection at Kingsway Surgery on 8 November 2018 as part of our inspection programme.

At this inspection we found:

•The practice had clear systems to manage risk so that safety incidents were less likely to happen. When incidents did happen, the practice learned from them and improved their processes.

•The practice routinely reviewed the effectiveness and appropriateness of the care it provided. It ensured that care and treatment was delivered according to evidence- based guidelines.

•Staff involved and treated patients with compassion, kindness, dignity and respect.

•The practice had acted since our August 2016 to improve patient satisfaction on the extent to which clinicians treated patients with care and concern. Latest comparable patient survey results showed performance was still below local and national averages but had significantly narrowed.

•Patients found the appointment system easy to use and reported they could access care when they needed it.

•There was a strong focus on continuous learning and improvement at all levels of the organisation including clinical audit, analyses of referral data and participation in local pilot projects.

•Structures, processes and systems supported good governance and effective practice management.

We saw two areas of outstanding practice:

•The practice participated in a local Clinical Commissioning Group (CCG) initiative which aimed to empower patients who are diabetic Asthmatic or at risk of diabetes to take control of their health. In August 2018, Kingsway Surgery made the highest number of referrals of all the practices in the CCG locality.

•The practice participated in a primary care based paediatric pilot project which gave clinicians confidence in managing paediatric conditions which in the past would have been referred to a hospital setting.

The areas where the provider should make improvements are:

•Continue to act to improve patient satisfaction scores on the extent to which clinicians treated patients with care and concern.

•Review arrangements to improve cancer screening uptake rates.

Professor Steve Field CBE FRCP FFPH FRCGP

Chief Inspector of General Practice

Please refer to the detailed report and the evidence tables for further information.

Letter from the Chief Inspector of General Practice

We carried out an announced comprehensive inspection at Kingsway Surgery on 24 August 2016. Overall the practice is rated as good.

We carried out this inspection to check that the practice was meeting regulations. Our previous comprehensive inspection carried out in November 2015 found breaches of regulations relating to the safe, effective, responsive and well led domains.

In addition all population groups were rated as inadequate due to the concerns found in safe, effective, responsive and well led. The overall rating from the inspection in November 2015 was inadequate and the practice was placed into special measures for six months.

Following the inspection we took action to cancel the registration of the registered manager at the practice who was also one of the senior partners. The practice has since appointed a new registered manager who is the principal GP and has also recruited a salaried GP who is currently applying to become a GP partner.

The inspection carried out on 24 August 2016 found that the practice had made significant improvements and they were meeting all three regulations they were previously in breach of.

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.
• 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 named GP and there was continuity of care, with urgent appointments available the same day.
• 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.
• The provider was aware of and complied with the requirements of the duty of candour.

The areas where the provider should make improvement are:

• Review and improve the process of identifying carers.

• Ensure the practice improves and responds to the national GP patient survey results in areas they have scored low including responses related to nursing care at the practice.

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 unannounced comprehensive inspection at Kingsway Surgery on 11 November 2015.

Overall the practice is rated as inadequate.

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

Specifically, we found the practice to be inadequate for providing safe, effective, responsive and well-led services.

The concerns which led to a rating of inadequate in safe, effective, responsive and well-led apply to all population groups using the practice. Therefore, all population groups have been rated as inadequate.

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

• Systems, processes and practices did not keep people safe. As a result, patients were at risk of harm. Staff did not assess, monitor or manage risks to people who use the service. People received care from inappropriately qualified staff. The practice had employed an overseas trained doctor to work as a health care assistant and practice manager. This person did not have UK accredited training and competencies to work as a health care assistant. The partners were aware of this but had failed to recognise the risk associated with it. Furthermore, recruitment checks had not been carried out on this member of staff.

• 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. The practice did not have adequate systems for medicines and infection control management.

• 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.

• Patients we spoke with were positive about their interactions with staff and said they were treated with compassion and dignity. However, national GP survey data showed the practice was below local / national average for most caring indicators.

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

Following the inspection on 11 November 2015; we issued a Warning Notice for Regulation 19 of the Health and Social Care Act 2008 (Regulated Activities) on 23 November 2015. The provider was told to suspend all clinics and clinical work undertaken by the healthcare assistant. This was because of the concerns we found regarding the clinical work the health care assistant was undertaking without UK accredited training and lack of supervision. Following this, we visited the practice unannounced on 1 December 2015 to check that the provider had taken action as required. On this visit we found that the provider had taken the required action and had suspended the health care assistant from undertaking all clinical work.

The areas where the provider must make improvements are:

• Introduce effective processes for reporting, recording, acting on and monitoring significant events, incidents and near misses.

• Take action to address identified concerns with infection prevention and control practice.

• Ensure recruitment arrangements include all necessary employment checks for all staff.

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

• Carry out clinical audits including re-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.

• Actively seek to involve patients in developing and improving the service.

• Ensure systems are implemented for the safe management of prescription pads.

• Ensure accessible availability of medical emergency equipment and a system must be in place to ensure that this equipment is checked on a regular basis

• Ensure they have effective arrangements in place to safeguard children and vulnerable adults .

However there were areas of practice where the provider should make improvements:

• The practice should ensure that information relating to the availability of language translation services is advertised to patients.

I am placing this practice in special measures. Practices 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 practice 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 vary the provider’s registration to remove this location or cancel the provider’s registration.

Professor Steve Field (CBE FRCP FFPH FRCGP) 

Chief Inspector of General Practice