Letter from the Chief Inspector of General Practice
We carried out an announced comprehensive inspection at Kings Road Medical Centre on 17 December 2015. Overall the practice is rated as inadequate.
Our key findings across all the areas we inspected were as follows:
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Patients were at risk of harm because systems and processes were not in place to keep them safe. For example, when reviewing the electronic document management system, we observed that one GP had 293 letters outstanding since 4 October 2015. There was no systematic process or support mechanism to ensure that clinical information was reviewed in a timely manner.
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Staff were not clear about reporting incidents, near misses and concerns and there was no evidence of learning and communication with staff.
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Patient outcomes were hard to identify as little or no reference was made to audits or quality improvement and there was no evidence that the practice was comparing its performance to others; either locally or nationally.
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Patients were positive about their interactions with staff and said they were treated with compassion and dignity.
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Appointment systems were not working well so patients did not receive timely care when they needed it.
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The practice had no clear leadership structure, insufficient leadership capacity and limited formal governance arrangements.
The areas where the provider must make improvements are:
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Introduce robust processes for reporting, recording, acting on and monitoring significant events, incidents and near misses.
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Ensure recruitment arrangements include all necessary employment checks for all staff.
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Ensure there are sufficient staff available to meet demand and keep patients safe.
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Ensure there are systems that support staff with appraisals, supervision and training.
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Put systems in place to ensure all clinicians are kept up to date with national guidance and guidelines.
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Ensure there is a programme of quality improvement such as clinical audits including re-audits to drive improvements in outcomes for patients.
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Implement formal governance arrangements including systems for assessing and monitoring risks and the quality of the service provision.
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Provide staff with appropriate policies and guidance to carry out their roles in a safe and effective manner which are reflective of the requirements of the practice.
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Clarify the leadership structure and ensure there is leadership capacity to deliver all improvements.
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Ensure safe and proper storage of patients records to maintain information governance processes.
The areas where the provider should make improvement are:
- Improve processes for making appointments.
- Ensure the PPG is established to represent patients in the way services are delivered.
- Ensure carers are identified and enabled to access support and information.
I am placing this practice in special measures. Where a practice is rated as inadequate for one of the five key questions or one of the six population groups and after re-inspection has failed to make sufficient improvement, and is still rated as inadequate for any key question or population group, we place it into special measures.
Practices placed in special measures will be inspected again within six months. If insufficient improvements have been made so a rating of inadequate remains for any population group, key question or overall, we will take action in line with our enforcement procedures to begin the process of preventing the provider from operating the service. This will lead to cancelling their registration or varying the terms of their registration within six months if they do not improve.
The practice will be kept under review and if needed could be escalated to urgent enforcement action. Where necessary, another inspection will be conducted within a further six months, and if there is not enough improvement we will move to close the service..
Special measures will give people who use the practice the reassurance that the care they get should improve.
Professor Steve Field (CBE FRCP FFPH FRCGP)
Chief Inspector of General Practice