Letter from the Chief Inspector of General Practice

We carried out an announced comprehensive inspection at Dr Michael McKeown on 9 July 2015. The overall rating for the practice was requires improvement. The full comprehensive report on the July 2015 inspection can be found by selecting the ‘all reports’ link for Dr Michael McKeown on our website at www.cqc.org.uk.

This inspection was undertaken to check the provider had taken the action we said they must and should take and was an announced comprehensive inspection on 8 June 2017. Overall the practice is now rated as good.

Our key findings were as follows:

• There was an open and transparent approach to safety and a system in place for reporting and recording significant events. The practice had taken the action we said it must take at our July 2015 inspection to ensure safety incidents were recorded, reviewed and shared with staff.
• The practice now had clearly defined and embedded systems to minimise risks to patient safety. It had taken the action we said it must take at our July 2015 inspection to ensure staff had access to medical oxygen in the event of a medical emergency and confidential patient records were stored securely.
• Staff were aware of current evidence based guidance. Staff had been trained to provide them with the skills and knowledge to deliver effective care and treatment. The practice had taken the action we said it must take at our July 2015 inspection to ensure staff received up to date training relevant to their roles.
• Results from the national GP patient survey showed patients were treated with compassion, dignity and respect and were involved in their care and decisions about their treatment.
• Information about services and how to complain was available and, in response to action we said it should take at our July 2015 inspection, the complaints procedure was now easily accessible to patients. Improvements were made to the quality of care as a result of complaints and concerns.
• Patients we spoke with 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.
• The practice had adequate facilities and equipment to treat patients and meet their needs.
• There was a clear leadership structure and staff felt supported by management. The practice proactively sought feedback from staff and patients, which it acted on.
• The provider was aware of the requirements of the duty of candour. Examples we reviewed showed the practice complied with these requirements.

However, there were also areas of practice where the provider needs to make improvements.

The provider should:

• Consider including external safeguarding contact details within the practice’s safeguarding policy documents.

• Continue action to improve QOF performance in areas where performance has been below CCG and national averages.

• Monitor understanding of Gillick and Fraser guidelines to ensure staff knowledge remains up to date.

• Continue to monitor uptake of cervical screening and childhood immunisations to secure improved uptake performance.

• Promote the system for identifying and supporting carers to ensure it is fully embedded and maintained within the practice.

• Consider the introduction of a more structured, planned programme of clinical audit to drive improvement in patient outcomes.

Professor Steve Field (CBE FRCP FFPH FRCGP) 

Chief Inspector of General Practice

Letter from the Chief Inspector of General Practice

We carried out an announced comprehensive inspection at ‘Dr Michael McKeown’, also known as Kynance Practice, on 9 July 2015. Overall the practice is rated as requires improvement.

Please note that when referring to information throughout this report, for example any reference to the Quality and Outcomes Framework data, this relates to the most recent information available to the CQC at that time.

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

• Systems were in place to report and record significant events, incidents, and near misses, however information about safety was not recorded or appropriately reviewed to demonstrate what learning had occurred as a result of these events.
• Most risks to patients were assessed and well managed, with the exception of dealing with emergencies and the secure storage of patients’ paper records.
• Some staff had not received training appropriate to their roles.
• Data showed that outcomes for patients were mixed, when compared to local and national averages.
• Patients said they were treated with compassion, dignity and respect and they were involved in their care and decisions about their treatment.
• Information about services was available and easy to understand, however information on how to complain was only available on the website as the practice leaflet was being updated.
• Patients said 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.
• The practice had a number of policies and procedures to govern activity, but some of these were not dated to identify when they had last been reviewed.
• There was a clear leadership structure and staff felt supported by management. The practice sought feedback from staff and patients, which it acted on.

The areas where the provider must make improvements are:

• Ensure staff have access to medical oxygen in the event of a medical emergency.
• Ensure safety incidents are recorded, reviewed and shared with staff.
• Ensure confidential patient records are stored securely.
• Ensure staff receive appropriate training relevant to their roles.

In addition the provider should:

• Ensure information on the chaperone policy is available to patients, and formalise which staff will carry out chaperoning duties.
• Have systems in place to ensure cleaning in the practice is carried out to appropriate standards.
• Have systems in place to monitor and recall patients who require cervical screening or childhood immunisations.
• Ensure patients have easy access to the practice’s complaints procedure.

Professor Steve Field (CBE FRCP FFPH FRCGP) 

Chief Inspector of General Practice