Letter from the Chief Inspector of General Practice
Cross Keys Practice is located in a converted listed building in Princes Risborough. The practice has three registered locations. This practice has approximately 14,500 patients. We carried out an announced comprehensive inspection of the practice on 4 December 2014 and we visited Cross Keys Practice, 60 High Street, Princes Risborough, HP27 0AX. This was the first inspection of the practice since registration with the CQC.
Adaptations have been made to ensure the practice is accessible. The local community has a high proportion of older patients, low deprivation and low ethnic diversity. The appointment system allows advanced appointments to be booked. Urgent appointment slots were also available. Patients told us they were able to make appointments when they needed them, although some patients told us booking an appointment could be difficult. Patients told us staff were caring, friendly and considerate. We found concerns regarding safety, particularly protecting patients from abuse.
We spoke with eight patients during the inspection. We spoke with three GPs, a trainee GP the practice manager, five members of the nursing team, receptionists and the prescribing clerk.
Cross Keys Practice was rated requires improvement overall.
Our key findings were as follows:
The practice was clean and medicines were stored safely.
Clinical care was managed effectively. Patients with health conditions were well cared for and national data placed the practice close to the national average for caring for long term conditions.
The practice did not maintain a safe environment for patients due to a lack of processes and training including chaperoning and the Mental Capacity Act 2005. There were concerns about staff recruitment.
Patient records were up to date to ensure safety in the delivery of medical care.
Patients told us the practice was caring and they felt well supported.
Physical access to the practice was poor in the older part of the building, with steps inhibiting the access for patients with buggies and prams. Level access from the car park was provided for wheelchair users and consultations were in wheelchair friendly rooms.
The leadership were not always proactive in ensuring there was a strategic plan for the practice to meet the changing needs of its patient population. The practice sought the feedback of its patients.
There were areas of improvement for the provider:
The provider must
-undertake all staff checks including DBS checks in line with DBS guidance and a risk assessment undertaken by the practice (this must include staff performing chaperoning) and health checks such as Hepatitis B immunity status.
-identify and monitor the training needs of staff to ensure they have an appropriate awareness in key areas of health provision including; the Mental Capacity Act 2005, information governance, equality and diversity and safeguarding vulnerable adults and children.
-effectively monitor the quality of the service and identify, assess and manage risks to patients and others including; the appointment system, control of substances hazardous to health assessments, information security, staff training and consistently identify, record and investigate incidents and disseminate learning from significant events to staff.
Additionally the provider should:
-consider all patients needs and respond appropriately to ensure they can access the practice safely and where possible independently, including phone translation services and supporting reception staff to identify patients who require additional support
-Involve nurses in clinical governance including audits and meetings
-improve its strategic and clinical leadership to ensure that the statement of purpose is reflected in practice. Potential changes to demands, staffing and other contingencies should be planned for and managed.
We have issued compliance actions for Safety and Suitability of Premises, Monitoring and Assessing the Quality of the Service, Requirements Related to Workers and Supporting Workers.
Professor Steve Field (CBE FRCP FFPH FRCGP)
Chief Inspector of General Practice