Letter from the Chief Inspector of General Practice

We carried out an announced comprehensive inspection at Knowle Green Medical on 20 July 2016. The overall rating for the practice was requires improvement. The full comprehensive report on the July 2016 inspection can be found by selecting the ‘all reports’ link for Knowle Green Medical on our website at www.cqc.org.uk.

During the inspection we found breaches of legal requirements and the provider was rated as requires improvement under the safe, effective and well led domain. Following this inspection the practice sent to us an action plan detailing what they would do to meet the legal requirements in relation to the following:-

• Ensuring recruitment arrangements include all necessary employment checks for all staff.
• Ensuring that training appropriate to job role is completed for all staff.
• Ensuring that policies and procedures are reviewed and up to date.
• Ensuring the proper management of clinical waste.
• Ensuring that prescription paper is stored securely.
• Ensuring that comprehensive risks assessments are completed where required.
• Ensuring that all staff know the locations of emergency equipment and medicines.
• Ensuring that information for patients about how to complain includes signposting information should the patient not be satisfied with the practice’s response and that learning from all complaints is shared appropriately.

This inspection was an announced focused inspection carried out on 07 March 2017 to confirm that the practice had carried out their plans to meet the legal requirements in relation to the breaches in regulations that we identified in our previous inspection on 20 July 2016. This report covers our findings in relation to those requirements and also additional improvements made since our last inspection.

Overall the practice is now rated as good.

Our key findings at this inspection, 07 March 2017, were as follows:

• A system to monitor training had been put in place and staff had been trained to provide them with the skills, knowledge and experience to deliver effective care and treatment.
• All policies and procedures had been reviewed and were up to date.
• Risks to patients were assessed and managed, including those related to recruitment checks, risk assessments, infection control, storage of clinical waste, security of prescription paper and training.
• Information about services and how to complain was available and easy to understand and improvements were made to the quality of care as a result of complaints and concerns.
• The locations of emergency medicines and equipment were clearly signed and all GPs and staff had been made aware of their location.

Our previous report also highlighted the following areas where the practice should improve:

• Review confidentiality arrangements with other services who share communal areas.
• Review exception reporting within the practice.
• Develop methods to increase the uptake of cervical screening and childhood immunisations.

During our inspection 07 March 2017 we saw evidence that a confidentiality sharing agreement was in place with the other services who share communal areas, and that the uptake of childhood immunisations in two year olds and cervical screening had improved. We noted that the immunisation rates for five year olds was still below local and national averages. We also noted that although overall exception reporting was comparable to local and national averages there were some areas where exception reporting was still high.

However, the areas of practice where the provider should make improvements are.

• Continue to review and improve where possible exception reporting within the practice.
• Continue to develop methods to increase the uptake of childhood immunisations.

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 Knowle Green Medical on 20 July 2016. The overall rating for the practice was requires improvement. The full comprehensive report on the July 2016 inspection can be found by selecting the ‘all reports’ link for Knowle Green Medical on our website at www.cqc.org.uk.

During the inspection we found breaches of legal requirements and the provider was rated as requires improvement under the safe, effective and well led domain. Following this inspection the practice sent to us an action plan detailing what they would do to meet the legal requirements in relation to the following:-

• Ensuring recruitment arrangements include all necessary employment checks for all staff.
• Ensuring that training appropriate to job role is completed for all staff.
• Ensuring that policies and procedures are reviewed and up to date.
• Ensuring the proper management of clinical waste.
• Ensuring that prescription paper is stored securely.
• Ensuring that comprehensive risks assessments are completed where required.
• Ensuring that all staff know the locations of emergency equipment and medicines.
• Ensuring that information for patients about how to complain includes signposting information should the patient not be satisfied with the practice’s response and that learning from all complaints is shared appropriately.

This inspection was an announced focused inspection carried out on 07 March 2017 to confirm that the practice had carried out their plans to meet the legal requirements in relation to the breaches in regulations that we identified in our previous inspection on 20 July 2016. This report covers our findings in relation to those requirements and also additional improvements made since our last inspection.

Overall the practice is now rated as good.

Our key findings at this inspection, 07 March 2017, were as follows:

• A system to monitor training had been put in place and staff had been trained to provide them with the skills, knowledge and experience to deliver effective care and treatment.
• All policies and procedures had been reviewed and were up to date.
• Risks to patients were assessed and managed, including those related to recruitment checks, risk assessments, infection control, storage of clinical waste, security of prescription paper and training.
• Information about services and how to complain was available and easy to understand and improvements were made to the quality of care as a result of complaints and concerns.
• The locations of emergency medicines and equipment were clearly signed and all GPs and staff had been made aware of their location.

Our previous report also highlighted the following areas where the practice should improve:

• Review confidentiality arrangements with other services who share communal areas.
• Review exception reporting within the practice.
• Develop methods to increase the uptake of cervical screening and childhood immunisations.

During our inspection 07 March 2017 we saw evidence that a confidentiality sharing agreement was in place with the other services who share communal areas, and that the uptake of childhood immunisations in two year olds and cervical screening had improved. We noted that the immunisation rates for five year olds was still below local and national averages. We also noted that although overall exception reporting was comparable to local and national averages there were some areas where exception reporting was still high.

However, the areas of practice where the provider should make improvements are.

• Continue to review and improve where possible exception reporting within the practice.
• Continue to develop methods to increase the uptake of childhood immunisations.

Professor Steve Field (CBE FRCP FFPH FRCGP) 

Chief Inspector of General Practice

We spoke with five patients and five staff including the Registered Manager.

People told us that they were treated with dignity and respect. One person said “They’re like old friends here, everyone is so nice.”

Comments we received from patients about the care they received were generally positive. Comments included; “On the whole very good” and staff “Always give me the time I need.”

People told us that they felt involved in the treatment and we saw that records were updated and treatment choices recorded.

We found that staff were aware of procedures around safeguarding vulnerable adults and

children.

Most staff felt supported, although some concerns were raised, for example, in relation to access to immediate supervision. We saw that there was opportunity for regular appraisal.

Patients were positive about the quality of the service. Two patients who spoke with us told us that “The service is brilliant.”

The practice had systems in place that monitored the quality of the service.