Kingsbury Court Surgery

We carried out an announced comprehensive inspection at Kingsbury Court Surgery on 09 January 2019. The overall rating for the practice was requires improvement and warning notices were issued. We carried out an announced follow up inspection on 27 March 2019 and found that the practice had made sufficient improvements and was compliant with the warning notices.

The full comprehensive report on the January / March 2019 inspections can be found by selecting the ‘all reports’ link for Kingsbury Court Surgery on our website at .

We carried out an announced comprehensive inspection at Kingsbury Court Surgery on 19 June 2019.

Our judgement of the quality of care at this service is based 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.

The practice is rated as good overall.

(previously rated as requires improvement in January 2019)

We rated the practice as good for providing safe care because:

• The practice did not hold a record of staff immunisations. Shortly after the inspection, we received evidence of an action plan to ensure clinicians were appropriately immunised.
• The practice did not ensure blank prescriptions were held securely overnight. Shortly after the inspection we received a revised protocol to ensure all blank prescriptions were removed from printers overnight.
• Safety alerts were appropriately managed however, we saw evidence that a safety alert regarding antidepressant medicine had not been appropriately acted on. Shortly after the inspection, we received evidence that the affected patients had been identified and booked appointments to review their treatment.
• People who used the service were protected from avoidable harm and abuse, and legal requirements were met.
• The practice ensured appropriate a review of medicines was completed prior to prescribing.
• The practice had adequately assessed risks that affected patient safety, such as fire, health and safety and infection prevention and control. We saw evidence of action plans and remedial work being completed.

We rated the practice as good for providing effective care because:

• Monthly audits of children who did not attend or were not brought to appointments were completed and each case was discussed individually, and appropriate actions taken.
• The practice regularly met with community teams to discuss and coordinate care for vulnerable patients or patients with complex needs.

We rated the practice as good for providing caring services because:

• Patients were supported, treated with dignity and respect and were involved as partners in their care.

We rated the practice as good for providing responsive care because:

• The practice had employed a further salaried GP and used regular locum staff to ensure consistency of care and increased clinical capacity.
• Patients told us they could get appointments when they needed.

We rated the practice as good for providing well-led services because:

• Patients’ needs were met by the way in which services were organised and delivered.
• Key policies had been reviewed and embedded into practice.
• The leadership, governance and culture of the practice promoted the delivery of high-quality person-centred care.

There were areas where the provider should make improvements are:

• Continue to identify and support carers
• Complete the identified plan to maintain a record of staff immunisations and vaccinations.

Details of our findings and the evidence supporting our ratings are set out in the evidence tables.

Dr Rosie Benneyworth BS BM BMedSci MRCGP

Chief Inspector of Primary Medical Services and Integrated Care

We carried out an announced focused inspection of Kingsbury Court Surgery on 27 March 2019. This inspection was undertaken to confirm that the practice had carried out their plan to meet the legal requirements in relation to the breaches in regulation set out in warning notices we issued to the provider in relation to Regulation 12 Safe care and treatment.

The practice received an overall rating of requires improvement at our inspection on 9 January 2019 and this will remain unchanged until we undertake a further full comprehensive inspection within six months of the publication date of the initial report.

The full comprehensive report from the January 2019 inspection can be found by selecting the ‘all reports’ link for Kingsbury Court Surgery on our website at .

Our key findings were as follows:

• The practice had complied with the warning notices we issued and had taken the action needed to comply with the legal requirements.
• The system for prescribing medicines that require additional monitoring was safe and patients received medicine reviews prior to prescribing.
• The practice held all recommended emergency medicines with risk assessments for those medicines which it did not hold.
• The practice had implemented a system to ensure that patients in vulnerable groups were taking their medicines.
• Children who attended A&E departments or were not brought to appointments were routinely followed up and discussed.
• Infection prevention and control systems had been strengthened.
• Audits had been completed for the prescribing practices of independent nurse prescribers.
• Patient Group Directions had been appropriately signed by a clinician and were available to all relevant staff.
• A risk assessment had been completed for the security of the premises
• The fire risk assessment had been strengthened and fire drills had been completed.
• The practice had ensured there was oversight of safety alerts and ensured these had been actioned.

Details of our findings and the evidence supporting our ratings are set out in the evidence tables.

Dr Rosie Benneyworth BS BM BMedSci MRCGP

Chief Inspector of Primary Medical Services and Integrated Care

We carried out an announced comprehensive inspection at Kingsbury Court Surgery on 9 January 2019 as part of our inspection programme. Our inspection team was led by a CQC inspector and included a GP specialist advisor and practice manager specialist advisor.

At the last inspection in August 2016 we rated the practice as good overall.

Our judgement of the quality of care at this service is based 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.

The practice is rated as requires improvement overall.

We rated the practice as inadequate for providing safe services because:

• There were insufficient systems around the prescribing of medicines that required additional monitoring.
• The practice did not hold all recommended emergency medicines needed to deal with a range of medical emergencies.
• Infection control procedures needed strengthening.
• Children who attended A&E did not routinely receive follow up from the practice. This could mean safeguarding concerns were not identified.
• A security risk assessment had not been completed. There was no evidence that fire drills had been conducted. A fire risk assessment had been completed however, this required strengthening.

We rated the practice as requires improvement for providing effective services because:

• There was no evidence of regular medicine reviews for patients requiring repeat prescriptions.
• Childhood immunisation uptake rates were below the World Health Organisation (WHO) targets.

We rated the practice as good for providing caring services because:

• Patients were supported, treated with dignity and respect and were involved as partners in their care.

We rated the practice as requires improvement for providing responsive services because:

• The practice was aware of the limited availability of GP appointments and had some plans in place to address this. However, some plans had not been implemented at the time of inspection such as recruitment of a further advanced nurse practitioner.
• Patients told us there was sometimes difficulty in making an appointment.
• The practice learnt from complaints and when things went wrong. However, written responses were not given to complaints and patients were not given information to enable them to escalate complaints to the Parliamentary and Health Service Ombudsman.

We rated the practice as requires improvement for providing well led services because:

• The leadership, governance and culture of the practice promoted the delivery of high quality person-centred care, however some systems were ineffective.
• Clinicians did not receive formal clinical supervision. There was no evidence of audits of prescribing for non-medical prescribers.
• Key policies, such as a whistleblowing policy, were not in place or had not been reviewed.

The areas where the provider must make improvements as they are in breach of regulations are:

• Ensure care and treatment is provided in a safe way to patients.

• Establish effective systems and processes to ensure good governance in accordance with the fundamental standards of care.

There were areas where the provider should make improvements are:

• Proactively identify carers and ensure they are given appropriate support.

Details of our findings and the evidence supporting our ratings are set out in the evidence tables.

Professor Steve Field CBE FRCP FFPH FRCGP Chief Inspector of General Practice