Letter from the Chief Inspector of General Practice

We carried out an announced comprehensive inspection at Park View Centre for Health and Wellbeing (Dr R K Kukar & Partner) on 19 January 2016. The overall rating for the practice was requires improvement. The full comprehensive report on the 19 January 2016 inspection can be found by selecting the ‘all reports’ link for Park View Centre for Health and Wellbeing on our website at www.cqc.org.uk.

This inspection was an announced comprehensive inspection carried out on 28 November 2016 to confirm that the practice had carried out their plan to meet the legal requirements in relation to the breaches in regulations that we identified in our previous inspection on 19 January 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 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 and the practice had acted upon the findings of our previous inspection in relation to patient safety.
• 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.
• Data from the Quality and Outcomes Framework (QOF) showed the practice had made some improvements to patient outcomes. However, some clinical indicators continued to show a negative variation from local and national averages.
• 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 in a purpose-built primary health care centre shared with three other GP practices and community services and was well equipped to treat patients and meet their needs.
• There was a leadership structure and staff felt supported by management.
• 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 the process in place for the receipt, dissemination, reviewing and acting upon patient safety alerts.
• Monitor performance of the Quality and Outcome Framework (QOF) indicators specifically in relation to the cervical screening programme and patient outcomes in relation to the childhood immunisation programme.
• Develop an on-going quality improvement programme to improve patient care.
• Ensure all staff, including those undertaking revalidation through a professional body, have had an appraisal.
• Evidence completion of training in the Mental Capacity Act and The Deprivation of Liberty Safeguards (DoLS) for all clinical staff.
• Continue the drive to recruit patients to join the Patient Participation Group (PPG).

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 Parkview Centre for Health & Wellbeing (Dr R K Kukar & Partner) on 19 January 2016. Overall the practice is rated as requires improvement.

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

• The practice had good facilities in a new purpose built primary health care centre shared with three other GP practices and community services and was well equipped to treat patients and meet their needs.
• Although risks to patients who used services were assessed, the systems and processes to address these risks were not implemented well enough to ensure patients were kept safe.
• Data showed patient outcomes in relation to diabetes, mental health and cervical smears were significantly lower compared to the local and national averages.
• We saw no evidence that quality performance measures, such as clinical audits, were driving improvement in performance to improve patient outcomes.
• Patients said they were treated with compassion, dignity and respect and they were involved in their care and decisions about their treatment. Staff understood and fulfilled their responsibilities to raise concerns, and to report incidents and near misses but not all staff were included in the learning or distribution of minutes.
• There was a clear leadership structure and staff felt supported by management.

The areas where the provider must make improvements are:

• Undertake fire and environmental risk assessments and ensure staff participate in regular fire drills and know the location of the assembly point.

• Ensure staff receive appraisal as is necessary to enable them to carry out the duties they are employed to perform.

• Continue to work on sustaining and improving outcomes for patients with diabetes and increase the uptake of cervical screening and flu vaccinations for the over-65s.

• Develop quality improvement processes, such as clinical audits, to drive improvement in performance to improve patient outcomes.

• Evaluate the competence of a non-clinical member of staff reviewing and summarising patient hospital discharge letters, making amendments to medicines on the clinical system and managing repeat prescription requests and ensure appropriate training, written protocols and an auditable system of supervision is in place.

In addition the provider should:

• Formulate a written strategy to deliver the practice’s vision.

• Put in place a business continuity plan to deal with major incidents such as power failure or building damage.

• Proceed with efforts to increase the patient participation group and meet more regularly to increase patients’ involvement in discussions and decisions relating to service provision.

• Record verbal complaints in order to ensure shared learning from action taken and outcomes.

• Ensure consistent and clear information for patients regarding the availability of clinical appointments and how to access them.

• Ensure all clinical staff, especially those working outside core hours, are included in the dissemination of evidence based guidance, safety alerts and practice minutes.

• Ensure all clinical staff have the appropriate IT knowledge and skills to effectively use the patient clinical system.

Where a service is rated as inadequate for one of the five key questions or one of the six population groups or overall, it will be re-inspected within six months after the report is published. If, after re-inspection, the service has failed to make sufficient improvement, and is still rated as inadequate for any key question or population group or overall, we will place the service into special measures. Being placed into special measures represents a decision by CQC that a service has to improve within six months to avoid CQC taking steps to cancel the provider’s registration.

Professor Steve Field (CBE FRCP FFPH FRCGP) 

Chief Inspector of General Practice

This was a follow up inspection from our last inspection visit on 13 September 2013 where we found concerns. Since our last inspection the practice has moved locations but the registered person's and the staff team remain the same.

We spoke to eight patients and five staff members during our visit. Patients were very complimentary about the practice and staff felt they had a good relationship with their patients. Patients said they felt their doctor was caring, patient and understood their needs.

At our last inspection we had been concerned that the practice did not have adequate arrangements in place to deal with a medical emergency. At this inspection we found appropriate arrangements were in place for dealing with a medical emergency.

There was evidence of appropriate multi-agency working and the sharing of information for those patients in receipt of end of life and palliative care. All staff had received safeguarding adults training. Staff were aware of how to recognise and report any concerns or allegation of abuse.