Archived: Family Medical Centre - Kirkby

Letter from the Chief Inspector of General Practice

We carried out an announced comprehensive inspection at Family medical centre - Kirkby on 14 July 2015. Overall the practice is rated as requires improvement.

Specifically, we found the practice to require improvement for providing safe, effective and well led services. It also required improvement for providing services for all the population groups we inspected. It was good for providing caring and responsive services.

Our key findings across all the areas we inspected were as follows:

• Staff understood and fulfilled their responsibilities to raise concerns, and to report incidents and near misses. However, information about safety was not sufficiently recorded to ensure incidents had been appropriately reviewed, addressed and there was shared learning with staff.
• Risks to patients were not well assessed and managed, with some areas of medicines management, risk management plans and arrangements for dealing with emergencies needing strengthening to ensure people using the service received safe care.
• Performance data showed most patient outcomes were comparable to the local average; with the exception of health promotion and screening.
• Although some clinical audits had been carried out audits were not driving improvement in performance and patient outcomes.
• Patients told us they were treated with compassion, dignity and respect and they were involved in their care and decisions about their treatment.
• Nationally published and practice supplied data showed most patients were happy with the telephone access and appointment system. Patients told us they found it easy to make an appointment with a named GP and that there was continuity of care, with urgent appointments available the same day.
• Information about services and how to complain was available and easy to understand and records showed the practice responded quickly to written complaints received. Learning from verbal complaints was not always recorded to evidence improvements made and shared learning with staff.
• The practice had suitable facilities to treat patients and meet their needs.
• Although there was a clear leadership structure and staff felt supported by management, the practice was not proactive in seeking feedback from staff and patients to improve the quality of services.

The areas where the provider must make improvements are:

• Ensure there are robust governance arrangements in place ensuring accurate, complete and detailed records are kept in respect of the management of the regulated activities. This includes: information on significant events, incidents and near misses, verbal complaints and information on when complaints should be escalated to other appropriate bodies and their contact details.
• Ensure effective systems are in place to enable the provider to identify, assess and mitigate risks to the health and welfare of patients and others. This includes ensuring: the immunisation status for clinical staff is obtained; the issue and tracking of blank prescription forms kept in the doctor’s bag for home visits meets national guidance; and effective systems are in place to follow-up on secondary care information such as out of hour’s reports, 111 reports and pathology results in the absence of the lead GP.
• Ensure views of staff and patients are proactively sought to inform the delivery of care and that staff are fully engaged and aware of the practice vision.

The areas where the provider should make improvement are:

• Provide accessible information for carers and those experiencing bereavement to enable them to access support.
• Be more proactive in respect of care planning for older people living in long term accommodation (care homes) and where appropriate advance care planning and engaging patients in health promotion and screening programmes.
• The practice should have a PPG in place or an alternative mechanism for obtaining patient feedback to enable them to improve the quality of services provided.
• Ensure audits complete their full audit cycle to demonstrate improvements made to practice.
• Ensure procedures for following up uncollected prescriptions are implemented in line with practice policy.

Professor Steve Field CBE FRCP FFPH FRCGP

Chief Inspector of General Practice