Letter from the Chief Inspector of General Practice

We carried out an announced comprehensive inspection at The Medical Centre – Dr Kukar on 17 May 2016. The overall rating for the practice was good but required improvement for providing caring services. This was specifically in relation to concerns about the low number of patients the practice had identified as carers and low patient satisfaction scores for several aspects of care in the GP patient survey results 2014/15.

The full comprehensive report on the 17 May 2016 inspection can be found by selecting the ‘all reports’ link for The Medical Centre – Dr Kukar on our website at www.cqc.org.uk.

This inspection was a follow up desk based focused inspection carried out on 16 June 2017 to confirm that the practice had addressed the concerns that we identified in our previous inspection on 17 May 2016. This report covers our findings in relation to those requirements and also additional improvements made since our last inspection.

The practice is now rated good for providing caring services and the overall rating remains as good.

Our key findings were as follows:

• Results from the GP survey 2015/16 showed that patient’s satisfaction scores were consistently similar to local and national averages to questions about GP and nurse consultations and with patient involvement This was an improvement from the previous patient survey in 2014/15 when patient satisfaction was consistently below local and national averages in the same question areas.
• The practice had since our last inspection increased the number of patients identified as carers from ten and currently had a carers’ register of 52 patients (0.8% of the practice list size).

We also reviewed the actions taken since the last inspection to the areas where we identified the practice should make improvement and saw that most had been addressed.

Our findings were as follows;

• Information informing patients about interpreting services was now displayed in the waiting room which at the time of the last inspection had not been in place.
• The practice had installed a hearing loop in the reception area to assist any patients with hearing impairment.
• Data from the quality and outcome framework (QOF) 2015/16 demonstrated improved achievement rates for mental health indicators that were significantly below the national average in 2014/15. QOF data 2015/16 showed that the percentage of patients with schizophrenia, bipolar affective disorder and other psychoses who had a comprehensive, agreed care plan had increased from 38% to 76%, which was comparable to the national average of 88%.
• Since our last inspection no improvement had been made to the practice’s cervical screening uptake rates which still remained significantly below local and national averages (30%, 71% and 81% respectively). The practice was aware and endeavoured to improve their cervical screening uptake rates through active call and re-call of non-attendees, opportunistic encouragement of patients to attend cervical screening with female GPs and attempt to secure a part-time female practice nurse with CCG involvement. The practice considered that lower achievement rates may be attributed to cultural beliefs and refusal by patients to cervical screening.

The areas where the provider should make improvement are;

• Continue to monitor and improve cervical screening up take rates to align with local and national averages.
• Continue to identify and support more patients who are carers.

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 Dr Kukar, The Medical Centre on 17 May 2016. Overall the practice is 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.

• 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.

• 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:

• Consider ways to improve the practice uptake for cervical screening.

• Review the practice’s processes for developing agreed care plans for patients with schizophrenia, bipolar affective disorder and other psychoses.

• Develop a system for monitoring the process of seeking patient consent within patient records.

• The provider should improve its identification of patients who are carers and the support offered to them by the practice.

• Develop an action plan to improve the practice satisfaction scores from the national GP patient survey.

• Consider improving communication with patients who have a hearing impairment.

• Advertise the translation services within the practice to inform patients this service is available to them.

Professor Steve Field (CBE FRCP FFPH FRCGP) 

Chief Inspector of General Practice

A broad selection of information leaflets about particular medical conditions and treatments were available to people. We spoke to people using the service who told us that they felt well supported by the practice and they understood their care and treatment. Staff at the practice spoke a variety of languages but translators could be arranged if necessary. They people we spoke to described staff as "caring" and "helpful".

When people first attended the centre they were asked to complete a registration form which asked questions about their background, lifestyle, medical history and any existing medical conditions. Follow-up appointments were arranged at the centre or, where necessary, people were referred to other hospital or community services for ongoing treatment or care. People we spoke with said they were "happy" with the service and that they underwent regular check-ups.

People who use the service were protected from the risk of abuse, because the provider had taken reasonable steps to identify the possibility of abuse and knew how to respond to signs of possible abuse.

Staff undertook appropriate training and development activities on an annual basis. They received annual appraisals.

The provider had an effective system to regularly assess and monitor the quality of service that people receive.