Letter from the Chief Inspector of General Practice

We carried out an announced comprehensive inspection at Knightsbridge Medical Centre on 23 September 2015. Overall the practice is rated as good.

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

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

• There was an open and transparent approach to safety but the system in place was not always effective for reporting and recording significant events.
• Risks to patients were assessed and well managed.
• Staff assessed patients’ needs and delivered care in line with current evidence based guidance. Staff had the skills, knowledge and experience 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.
• Information about services and how to complain was available and easy to understand.
• 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 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 provider was aware of and complied with the requirements of the Duty of Candour.

The areas where the provider should make improvement are:

• Ensure that breaches of confidential patient information are reported, and patients affected are informed.

• Ensure there are effective systems implemented to monitor the transfer of data from email accounts no longer in use.

Professor Steve Field (CBE FRCP FFPH FRCGP) 

Chief Inspector of General Practice

Knightsbridge Medical Centre provides GP led primary care services to around 8350 people living in the surrounding areas of Belgravia, Brompton, Knightsbridge and Kensington and Chelsea in South West London. The service is registered with the Care Quality Commission (CQC) to provide the following regulated activities: diagnostic and screening procedures; family planning; maternity and midwifery services; surgical procedures; and treatment of disease, disorder and/or injury.

We carried out an announced inspection on 11 June 2014. During the inspection we spoke with patients, the GP’s, practice manager, a district nurse, health visitor, administrative and reception staff. Following the inspection we also had contact with the practice nurse who was not available on the day of inspection.

Patients told us they were happy with the care, support and treatment provided by the practice and said they felt listened to and involved in any decision making. Staff told us the practice provided a supportive environment where learning was encouraged.

Good systems were in place to monitor and manage individual patient care and safety. Effective systems were in place to monitor health and safety, infection prevention and control and medicines management in the practice. Audits were completed and the results adequately analysed to inform improvements to the service.

We found that some areas of the service required improvement such as storage arrangements for used sharps boxes and arrangements for the disposal of urine samples to ensure the spread of infection was prevented. In addition to this we found that the keys for the controlled drugs store were not secure and therefore did not prevent unauthorised access to these drugs. We found that some clinical cases were not included in the significant events log which could enhance learning within the practice. Arrangements for the chaperone service offered did not make clear the expectations of staff or adequately inform them of what was appropriate during an examination. There was no sign alerting people to the presence of oxygen which is highly flammable, and gaps in staff employment history were not always explored prior to employment.

Good systems were in place to provide effective, care, support and treatment for older people. These took account of patients’ wishes and included joint working with other health and social care professionals.

Good systems were in place to identify and support patients with long term medical conditions. The practice was proactive in relation to offering appropriate health checks and patients were monitored to ensure their needs were met.

Mothers, babies, children and young people were effectively supported by the practice. There were systems in place to ensure children were immunised against childhood diseases and there was a baby clinic providing support to mothers and children under the age of five run by a local health visitor.

The practice had opening hours that made the service accessible to the working-age population. The practice was also in the process of offering set times for telephone consultations and was planning to provide an online appointment booking service which would also support working patients.

The practice worked effectively with multi-disciplinary teams to meet the needs of vulnerable patients. There were systems in place to monitor vulnerable individuals and to ensure appropriate information was shared with appropriate health and social care professionals to protect and support them.

Systems were in place to monitor and meet the needs of patients with a mental health diagnosis based on their individual needs and circumstances.