Letter from the Chief Inspector of General Practice
We carried out an announced comprehensive inspection at Kenton Clinic on 21 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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There was insufficient assurance to demonstrate clinical staff were up to date with current clinical guidance and that people received effective care and treatment which reflected current evidence-based practice specifically chronic disease management and prescribing.
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We were not assured there were effective processes and systems in place for the dissemination of and acting upon safety alerts to staff who worked within the practice.
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There was no programme of continuous quality improvement, for example, through clinical audit
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Although risks to patients who used services were assessed, the systems and processes to address these risks were not implemented well enough to ensure patients were kept safe specifically in relation to medicine management, recruitment and confidentiality.
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The practice had a vision to deliver quality care but no formal strategy or business plan in place to support this.
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There was a clear leadership structure and all staff felt supported.
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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. Specifically patients spoke highly about the access to appointments for children.
- The practice provides a two-hour Saturday morning walk-in clinic for emergencies as well as being open on Christmas Day, Boxing Day and New Year’s Day for two hours.
- Patients we spoke to on the day of the inspection and all of the 46 patient Care Quality Commission comment cards we received were positive about the service experienced. Members of the patient participation group we spoke with told us they were satisfied with the care provided by the practice and said they provided a personalised service.
- Staff understood and fulfilled their responsibilities to raise concerns, and to report incidents and near misses and when there were unexpected or unintended safety incidents the practice gave affected people reasonable support and truthful information.
- Patients said they were treated with compassion, dignity and respect.
- The practice sought feedback from patients and had a patient participation group.
The areas where the provider must make improvements are:
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Implement a system to ensure all clinicians are kept up to date with NICE and national guidance.
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Ensure there is an effective system in place for the receipt and distribution of safety alerts to all staff.
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Undertake a programme of continuous quality improvement, for example, clinical audits and re-audits to drive improvement.
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Ensure there are formal arrangements in place for reviewing patients with long-term conditions which includes an effective recall system.
- Ensure arrangements are in place for the effective management of medicines including vaccines and that there is an effective system for recording prescription pad serial numbers.
- Ensure staff understand their role and responsibility when chaperoning.
- Review arrangements for handling emergencies, for example, availability and use of panic alarms.
- Ensure recruitment arrangements include all necessary pre-employment checks for all staff including locums.
- Ensure confidential medical records are not on view and securely locked away.
In addition the provider should:
- Advertise within the practice the provision of formal translation services and review the current use of a bank of patients to help with translation.
- Formulate a written strategy to deliver the practice’s vision.
I am placing this practice in 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 to 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