Letter from the Chief Inspector of General Practice

We carried out an announced comprehensive inspection at Seven Kings Practice on 6 December 2016. The overall rating for the practice was good. Within that overall rating the practice was rated as requires improvement for providing safe services. This was because we had concerns about systems in place to hold and monitor supplies of emergency medicines. We also asked the practice to review arrangements around repeat prescribing, to develop a quality improvement programme which identified where practice specific improvements could be made and to review the complaints system to ensure that complaints made verbally were effectively recorded and used to improve care.

The full comprehensive report on the December 2016 inspection can be found by selecting the ‘all reports’ link for Seven Kings Practice on our website at www.cqc.org.uk/location/1-564529110.

This inspection was an announced focused inspection carried out on 5 September 2017 to confirm that the practice had carried out their plan to bring about improvements in the areas identified in our previous inspection on 6 December 2016. This report covers our findings in relation to improvements made since our last inspection. We found that the practice had taken appropriate action to bring about improvements relating to providing a safe service.

We have revised the rating in safe to good. Overall the practice is still rated as good.

Our key findings were as follows:

• The practice had put systems in place to monitor supplies of emergency medicines and maintained records to demonstrate this was happening. Emergency medicines held at the practice reflected the regulated activities undertaken at the practice.

• The practice had introduced a protocol to manage repeat prescriptions, including steps to undertake earlier reviews of uncollected prescriptions.

• The practice was able to provide evidence of a quality improvement programme, including clinical audits, which identifies where practice specific improvements could be made.

• The practice had reviewed the complaints system and had put a process in place to ensure that all complaints, including those made verbally were effectively recorded and used to improve care.

Professor Steve Field CBE FRCP FFPH FRCGP 

Chief Inspector of General Practice

We carried out an announced comprehensive inspection at Seven Kings Practice on 6 December 2016. Overall the practice is rated as good.

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

• Most risks to patients were assessed and well managed although on the day of the inspection, the only emergency medicine available at the practice was adrenalin. However a suitable range of emergency medicines had been delivered to the practice within three days of the inspection.

• There was an open and transparent approach to safety and a system in place for reporting and recording significant events.
• The practice had clearly defined and embedded systems to minimise risks to patient safety.
• Staff were aware of current evidence based guidance. Staff had been trained to provide them with the skills and knowledge to deliver effective care and treatment.
• Results from the national GP patient survey showed patients were treated with compassion, dignity and respect and were involved in their care and decisions about their treatment.
• Information about services and how to complain was available. Improvements were made to the quality of care as a result of complaints and concerns.
• Patients we spoke with 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 the requirements of the duty of candour. Examples we reviewed showed the practice complied with these requirements.

The areas where the provider should make improvement are:

• Continue to monitor supplies of emergency medicines and ensure these reflect the regulated activities undertaken at the practice.

• Review procedures for managing repeat prescriptions, including steps to undertake earlier reviews of uncollected prescriptions.
• Consider developing a quality improvement programme which identifies where practice specific improvements can be made.
• Review the complaints system to ensure that all complaints, including those made verbally are effectively recorded and used to improve care.

Professor Steve Field CBE FRCP FFPH FRCGP 

Chief Inspector of General Practice

People who used the service were given appropriate information and support regarding their care or treatment. People we spoke with told us that the GP or nurse would take the time to listen to what they had to say. One patient told us, ‘I was worried about the side effects for one of the medicines, so the doctor said I could take something else instead.’ Another person told us, ‘they said I could go to hospital for physiotherapy or have it here’.

People we spoke with were positive about the surgery. One person told us ‘they are wonderful here. I don’t think there is anything they could do to improve’. Another person said ‘I am very happy with the surgery, things are really good’. We found that care and treatment was planned and delivered in a way that was intended to ensure people’s safety and welfare. Care plans we looked at were person centred and were developed around individual needs.

People who used the service were protected from the risk of abuse, because the provider had taken reasonable steps to identify the possibility of abuse and prevent abuse from happening. The surgery had an up to date safeguarding policy in place. People told us that they felt safe at the surgery and felt comfortable with reporting any concerns they had to staff.

There were effective recruitment and selection processes in place. The practice carried out employment checks to verify qualifications and references.

People who used the service, their representatives and staff were asked for their views about their care and treatment and they were acted on. We saw that learning from incidents and investigations took place and appropriate changes were implemented.