Knights Hill Surgery

Background to this inspection

Updated 18 September 2017

Knights Hill Surgery has approximately 7900 patients and is in West Norwood, south London. The surgery is purpose built premises, in a building with a leisure centre and other health services. There is lift access to the floor where the surgery is. The area is well served by public transport.

Compared to the England average, the practice has more young children as patients (age up to four) and fewer older children and young adults (age 10 – 19). There are many more patients aged 20 – 44, and many fewer patients aged 45+ than at an average GP practice in England.

The surgery is based in an area with a deprivation score of four out of 10 (1 being the most deprived), and has a higher level of income deprivation affecting older people and children than the English average. Compared to the English average, fewer patients are unemployed or have a long-standing health condition.

Four doctors work at the practice: one male and three female. One of the doctors is a partner, with a non-clinical managing partner. Some of the GPs work part-time. Full time doctors work eight sessions per week. The practice provides 30 GP sessions per week.

The nursing team is made up of one practice nurse and two health care assistants. There are also two pharmacists employed by the practice.

The practice is open 8am to 6.30pm Monday to Friday and 9am to 5pm on Saturday. Appointments with GPs are available on Monday from 8.30am to 12.10pm and 3pm – 6pm, Tuesday from 9am to 12.30pm and 3.20pm to 6pm, Wednesday from 8.30am to 12.30pm and 3pm to 6pm, Thursday from 9am to 12.10pm and 3pm to 6pm, Friday from 9am to 12.30pm and 3pm to 6pm and Saturday 9am to 12pm and 2pm to 4.30pm.

When the practice is closed cover is provided by a local service that provides out-of-hours care.

The practice offers GP services under a General Medical Services contract in the Lambeth Clinical Commissioning Group area. The practice is registered with the CQC to provide family planning, surgical procedures, diagnostic and screening procedures, treatment of disease, disorder or injury and maternity and midwifery services.

Overall inspection

Good

Updated 18 September 2017

Letter from the Chief Inspector of General Practice

We carried out an announced comprehensive inspection at Knights Hill Surgery on 14 December 2016. The overall rating for the practice was requires improvement. The full comprehensive report on the December 2016 inspection can be found by selecting the ‘all reports’ link for Knights Hill Surgery on our website at www.cqc.org.uk.

This inspection was an announced focused inspection carried out on 5 September 2017 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 14 December 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.

At our previous inspection on 14 December 2016 we rated the practice as requires improvement for providing caring services as the results from the national GP patient survey showed patients were less satisfied than patients at other practices with GPs, nurses and reception staff. The practice had not carried out systematic analysis of the survey results.

We rated the practice as requires improvement for providing responsive services as evidence showed the practice responded to issues raised, but was not following their own policy or national guidance when responding, and information provided to patients about how to escalate complaints was incorrect. Data from the national GP patient survey showed patients rated the practice below average for ease of making an appointment, and for ease of access to preferred GPs.

We also highlighted in the original inspection other areas where the provider should take action:

Implement effective security and monitoring arrangements for prescription forms and pads, and ensure that mechanisms to monitor emergency medicines and prescriptions awaiting collection are effective.
Continue to monitor and take action to improve outcomes for patients with diabetes.
Monitor and take action to improve patient satisfaction with consultations with GPs, nurses and engagement with reception staff, and with making an appointment.
Review how patients with caring responsibilities are identified and recorded on the clinical system to ensure information, advice and support is made available to them.

Our key findings at this inspection were as follows:

The practice had reviewed its complaints procedure and now provided accurate information to patients and responded to complaints in line with its policy.
Results from the national patient survey 2017 indicated that patient satisfaction with how they were treated and their involvement in their care had increased, and was now similar to CCG and national averages.
Results from the national GP patient survey 2017 showed that patients’ satisfaction with how they could access care and treatment remained mixed, with satisfaction with making an appointment and with access to a preferred GP still below local and national averages although they had improved.

We also found that the provider had taken the following action to address the areas where we suggested they should make improvements:

The practice had reviewed the security and monitoring arrangements for prescription forms and pads. Blank prescription pads were now locked in a cupboard within a lockable room to which only certain staff had access. An additional security camera had been placed outside the door. A record of prescription pad serial numbers was being maintained and the practice had put a specific policy into place for storage and handling of prescription pads. Any prescriptions in printers were removed and locked away at the end of each day. The practice had also reviewed it system regarding prescriptions awaiting collection. A member of staff checked on a monthly basis to ensure there were no prescriptions awaiting collection for more than two months. If there were they were passed to the pharmacist who would liaise with the patient and, where necessary, the GP. We checked the emergency medicines and found they were all in date.
The GP partner had taken on the oversight of the diabetic patient register, and told us they were reviewing this in a monthly basis. They had put into place a plan and procedure for improving diabetic care. This included booking a first appointment with the health care assistant who would collect bio-data such as body weight, height, BMI and carry out a urinalysis. They would also arrange for a blood test. A virtual clinic was available for patients to consult with specialists. Data provided by the practice indicated the practice’s Quality and Outcomes Framework (QOF) performance has improved from 67 points to 81 (out of a possible 86). (QOF is a system intended to improve the quality of general practice and reward good practice.) The practice pharmacists carried out medicines reviews and liaised directly with patients where appropriate.
The practice had reviewed the outcomes of the national patient survey and had taken steps to address the areas where they had fallen below average. For example, permanent GPs had been appointed as had an additional pharmacist and reception staff had undergone customer care training. Patient feedback had improved in most areas.
The practice had a pack containing information for carers, and at every new patient registration reception staff were expected to ask if the patient was also a carer. The practice had identified it had 157 patients who were also carers. Whilst this number had increased since the last inspection so had the patient list size, so the percentage of identified carers remained at just under 2%.

Professor Steve Field CBE FRCP FFPH FRCGP

Chief Inspector of General Practice