Letter from the Chief Inspector of General Practice

We carried out an announced comprehensive inspection at Kingsnorth Medical Practice on 17 November 2016. Overall the practice is rated as outstanding.

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

• The practice implemented suggestions for improvements and made changes to the way it delivered services as a consequence of feedback from patients and from the patient participation group (PPG).
• A proactive approach to anticipating and managing risks to people who use services was embedded and was recognised as the responsibility of all staff.
• There was an open and transparent approach to safety and an effective system for reporting and recording significant events. Staff understood and fulfilled their responsibilities to raise safeguarding concerns and report incidents and near misses. All opportunities for learning from internal and external incidents were maximised.
• Risks to patients were assessed and well managed.
• Staff were committed to working collaboratively and people who had complex needs were supported to receive coordinated care. There were innovative, proactive and efficient ways to deliver more joined-up care to people who used services. For example, the introduction of the Community Practitioner and the weight management programme.
• Staff assessed patients’ needs and delivered care in line with current evidence based guidance. Staff had been trained to provide them with the skills and knowledge to deliver effective care and treatment.
• Patients said they were treated with compassion, dignity and respect and they were involved in their care and decisions about their treatment. Feedback from patients about their care was consistently positive.
• Information about services and how to complain was available and easy to understand. Improvements were made to the quality of care as a result of complaints and concerns.
• Patients said they found it easy to make an appointment with a named GP and there was continuity of care, with urgent and non-urgent appointments available the same day.
• The practice had good facilities and was well equipped 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 practice had strong and visible clinical and managerial leadership and governance arrangements.
• The provider was aware of and complied with the requirements of the duty of candour.

We saw several examples of outstanding practice:

• The practice offered an extensive range of additional services, providing secondary care closer to home, achieving significant auditable results, benefits and improved outcomes for patients. It reached out to the community and worked in close and constructive partnership with local hospital consultants. Services included a full muscular skeletal service, Cardiology, Ear, Nose and Throat, (including Paediatrics) and Vasectomy. In January 2017, Orthopaedic outpatient clinics were also introduced. The practice ethos of delivering care closer to home had achieved a lower rate of referrals to secondary care. The rate achieved was 41 per 1,000 patients compared to the CCG average of 52 per 1,000 patients. The practice also offered a minor injury service, which was available to registered and non-registered patients. This service had resulted in the practice achieving the second lowest rate within the CCG area for children up to 17 years attending accident and emergency due to injury. The practice worked closely with its Patient Participation Group (PPG) to promote the services offered. It ensured that local schools, sports clubs and children’s clubs were made aware of the minor injuries and other services. They also advertised on community notice boards.

The areas where the provider should make improvement are:

• Ensure that minutes and records of investigations into complaints and significant events are fully auditable and provide accountability.

Professor Steve Field CBE FRCP FFPH FRCGPChief Inspector of General Practice