We carried out a focussed inspection at The Kings Norton Surgery on 27 February 2019. During our previous inspection in April 2018 we rated the practice as good for providing effective, caring, responsive and well-led services. Consequently, the practice was rated as good overall. However, we rated the practice requires improvement for providing safe services because:

• The practice was unable to fully demonstrate care and treatment was provided in a safe way to patients. This included effective systems to mitigate risk for high risk medicines, prescription management and monitoring of Patient Group Directions (PGDs).

At this inspection, we found that the provider had satisfactorily addressed these areas.

We based our judgement of the quality of care at this service is on a combination of:

• what we found when we inspected
• information from our ongoing monitoring of data about services and
• information from the provider, patients, the public and other organisations.

We have rated this practice as good overall.

We rated the practice as good for providing safe, services because:

• The practice had reviewed its system for managing patients on high risk medicines to ensure it was effective.
• Appropriate systems were in place to ensure emergency medicines were checked regularly including medical gasses.
• There was a process in place to ensure Patient Group Directions (PGDs) were monitored and authorised by a practice representative.
• There was a process in place to ensure prescription stationery was secure and their usage monitored.
• The practice had made arrangements to ensure waste storage containers were kept securely.
• The complaints process had been reviewed to ensure it contained the appropriate information for the patient should they wish to escalate their complaint.

Details of our findings and the evidence supporting our ratings are set out in the evidence tables.

Professor Steve Field CBE FRCP FFPH FRCGPChief Inspector of General Practice

Letter from the Chief Inspector of General Practice

We carried out an announced comprehensive inspection at Kings Norton Surgery on 16 December 2015. Overall the practice is rated as good.

Our key findings were as follows:

• Staff understood and fulfilled their responsibilities to raise concerns and to report incidents and near misses. Information about safety was recorded, monitored, appropriately reviewed and addressed. The practice had good network meetings with the Clinical Commissioning Group (CCG) to improve outcomes for patients.

• Patients’ needs were assessed and care was planned and delivered following best practice guidance. The GPs each took responsibility in different areas and had regular clinical leads meetings to discuss concerns and share learning. They met daily to deal with immediate issues.

• There was a clear leadership structure and staff felt supported by management.

• Risks to patients were assessed and well managed although this was not always documented.

• Patients described staff as professional, efficient and helpful.

However there was an area of practice where the provider should make improvements.

Action the provider should take to improve:

• Ensure that systems are in place so that risk assessments and equipment checks are documented.

Professor Steve Field (CBE FRCP FFPH FRCGP) 

Chief Inspector of General Practice

During our inspection we spoke with six patients face to face and communicated with two by email. We spoke with seven members of staff.

When patients received care or treatment they were asked for their consent and their wishes were listened to. One patient told us: "They always ask if it's alright." We found that when minor surgery had been carried out written consent had been requested from patients before the surgery had commenced.

We saw that patients' views and experiences were taken into account in the way the service was provided. The patients we spoke with said they were satisfied with their care. A patient told us: "I am satisfied with the care and they are always respectful." Patients received their medicines when they needed them.

Staff had received training in safeguarding children and vulnerable adults. They were aware of the appropriate agencies to refer safeguarding concerns to. This ensured that patients were protected from harm.

All areas of the practice that we visited were clean and well organised. Patients we spoke with told us the practice was always clean. There were effective systems in place to minimise the risk of infections from occurring.

The provider had a system in place for monitoring the quality of service provision. They regularly obtained opinions from patients about the standards of the services they received. This meant that on-going improvements could be made by practice staff.

This practice is rated as Good overall; we carried out an announced comprehensive inspection at The Kings Norton Surgery as part of our regular inspection programme on the 20th April 2018.

For this inspection the key questions are rated as:

Are services safe? – Requires Improvement

Are services effective? – Good

Are services caring? – Good

Are services responsive? – Good

Are services well-led? - Good

At this inspection we found:

• The practice was unable to fully demonstrate effective systems to mitigate risk within the practice including high risk medicines, prescription management and monitoring of Patient Group Directions (PGDs).
• The clinical team met daily to discuss any issues arising from the day including safety issue.
• The practice demonstrated good infection control and safeguarding procedures.
• The practice’s GP national survey results were higher than local and national averages. The practice demonstrated that they were consistent in their efforts to continue to improve in all areas,
• The practice’s achievement in performance related indicators (Quality Outcomes Framework QOF) was higher than local and national averages.
• The practice were involved in the local community and with domestic violence services, charities tackling local poverty and were able to demonstrate that they were able to care for the homeless, travellers and local boating communities.
• There was a strong focus on continuous learning and improvement at all levels of the organisation.

The areas where the provider must make improvements are:

• Ensure care and treatment is provided in a safe way to patients.

The areas where the provider should make improvements are:

• Consider ways to ensure that checks of medical gases are documented and monitored.
• Ensure policies and procedures are operating as intended and adhered to.
• Consider ways to ensure that all complaint responses contain information in line with guidance.
• Ensure that clinical waste is stored securely.

Professor Steve Field CBE FRCP FFPH FRCGP
Chief Inspector of General Practice