We carried out an announced inspection at Kumar Family Practice on 19 October 2022. Overall, the practice is rated as Good with the following key question ratings:
Safe -Good
Effective -Good
Caring – Good (rating awarded at the inspection 14 April 2016).
Responsive – Good (rating awarded at the inspection 14 April 2016)
Well-led -Outstanding
The full reports for previous inspections can be found by selecting the ‘all reports’ link for Kumar Family Practice on our website at www.cqc.org.uk
Why we carried out this inspection
We undertook this inspection as part of a random selection of services rated Good and Outstanding to test the reliability of our new monitoring approach.
How we carried out the inspection
Throughout the pandemic CQC has continued to regulate and respond to risk. However, taking into account the circumstances arising as a result of the pandemic, and in order to reduce risk, we have conducted our inspections differently.
This inspection was carried out in a way which enabled us to spend a minimum amount of time on site. This was with consent from the provider and in line with all data protection and information governance requirements.
This inspection included:
- A site visit by the lead inspector.
- Conducting staff interviews remotely and on site.
- Completing clinical searches remotely on the practice’s patient records system and discussing findings with the provider.
- Reviewing patient records remotely to identify issues and clarify actions taken by the provider.
- Requesting evidence from the provider.
- Gaining feedback from staff by using staff questionnaires.
Our findings
We based our judgement of the quality of care at this service 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 outstanding for providing a well-led service because:
- The practice management team were motivating, forward thinking, organised and innovative with a sensible approach and clear goals. Staff told us they received excellent support and encouragement from the leadership team to do this. The practice management team were compassionate and caring. Quality and integrity were a high priority resulting in a caring culture within a strong practice. There were opportunities provided for all staff for their personal development.
- The leadership, governance and culture were used to drive and improve the delivery of high-quality person-centred care.
- There was strong collaboration across all staff and a common focus on engaging with patients and other services to improve quality of care and the patient experience.
- The practice embraced social prescribing for the community to ensure patients received timely intervention when they needed it most, signposted them to services that could help them and ensured support was offered locally so the patient population could easily attend appointments.
We have rated this practice as good for providing safe and effective services, and caring and responsive services from the historic ratings because:
We found in the key questions effective and well-led and of caring and responsive that:
- The practice provided care in a way that kept patients safe and protected them from avoidable harm.
- Patients received effective care and treatment that met their needs.
- Staff dealt with patients with kindness and respect and involved them in decisions about their care.
- The practice adjusted how it delivered services to meet the needs of patients during the COVID-19 pandemic. Patients could access care and treatment in a timely way.
We saw areas of outstanding practice:
- Pride in Practice - Practice Accreditation: The practice recognised they were a diverse team catering to a diverse population. They wanted to ensure they were accessible to meet the needs of the LGBTQ population and embraced diversity. They undertook pride in practice accreditation, instituted staff training and received a pride in practice gold level award. They had introduced systems in place to ensure those digitally excluded from cervical cancer screening due to gender change were included in the recall system.
- The practice demonstrated their commitment to becoming a greener practice and to reduce their carbon footprint. In support of sustainability the practice introduced an inhaler recycling initiative. This was to reduce the number of inhalers which end up in landfill which were prescribed to the practice population, and to encourage inhaler recycling instead. Within a two month period the recycling receptacle was full and returned to the local pharmacy for recycling. Patients were made aware of this scheme through text messaging.This was one of the measures they had introduced to improve sustainability.
Whilst we found no breaches of regulations, the provider should:
- Continue to work with patients to encourage the uptake of cervical screening.
Details of our findings and the evidence supporting our ratings are set out in the evidence tables.
Dr Sean O’Kelly BSc MB ChB MSc DCH FRCA
Chief Inspector of Hospitals and Interim Chief Inspector of Primary Medical Services