Archived: Kington Medical Practice

Letter from the Chief Inspector of General Practice

We carried out an announced comprehensive inspection at Kington Medical Practice on 26 November 2015. Overall the practice is rated as good

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, not all risks were assessed and managed. Some significant events had not been recorded and the practice had no evidence of the learning and action that had taken place as a result.
• Risks to patients were assessed and generally well managed and the practice had a number of policies and procedures to govern activity.
• Not all required employment checks were completed for non-clinical staff carrying out chaperone duties or for staff who had unsupervised access to patients and there was no risk assessment to show how the practice reached these decisions.
• A programme of clinical audits was underway. One completed audit cycle showed how the practice had used the results to make improvements. The GPs had prioritised direct patient care due to their recruitment problems which reduced the time available for structured clinical meetings.
• Urgent appointments were available on the day they were requested and unwell children under the age of two were seen as soon as they arrived at the practice. A nurse practitioner ran a walk in service four days a week (increased to five shortly after the inspection) for patients with minor illnesses. The practice established this to help maintain a responsive service to the practice population by increasing the number of appointments.
• The practice provided a responsive service to large numbers of older patients living in local care homes; many of these patients had complex care and treatment needs which needed frequent GP input. At the time of the inspection the practice also provided a service to a 10 bed intermediate care unit to enable patients to be discharged from hospital in a timely way.
• National data showed that the practice worked in line with national guidance to provide an effective service for patients experiencing poor mental health and patients living with dementia.
• The practice responded constructively to support families living in circumstances which might make them vulnerable.
• Patients spoke highly of the practice team and were complimentary about the care and treatment they received. They said they were treated with compassion, dignity and respect but had concerns about the GP recruitment problem and the impact of this on continuity of care and the future of the practice.

• The practice team were open about the challenges they faced at the practice and had sought solutions to help them maintain the service. In September 2015 they entered into an arrangement with an external healthcare company to gain support with administration, governance and GP recruitment. Two GPs from this organisation planned to become executive partners at the practice.

The areas where the provider must make improvements are:

• Improve recruitment arrangements, including written policies and procedures to ensure all necessary employment and ongoing checks are completed for staff.

• Ensure that all significant events are recorded to show any remedial action taken and to provide for the foundations for shared learning and implementation of improvements. Where necessary the practice must also inform CQC of significant events.

• Formally review and risk assess security arrangements for the dispensary.

In addition the provider should:

• Review the provision of regular clinical meetings, training and shared learning opportunities.
• Continue to use the results of the national GP patient survey and other patient feedback to consider how further improvements could be made in respect of access to the service.
• Effectively communicate the role and responsibilities of the external healthcare organisation in supporting the practice.

Professor Steve Field (CBE FRCP FFPH FRCGP) 

Chief Inspector of General Practice