The Care Quality Commission
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  • GP practice

Archived: King Edward Street Medical Practice

Overall: Good read more about inspection ratings

9 King Edward Street, Oxford, Oxfordshire, OX1 4JA (01865) 242657

Provided and run by:
KES@Northgate

Important: This service is now registered at a different address - see new profile
Important: The provider of this service changed. See old profile

All Inspections

12 July 2019

During an annual regulatory review

We reviewed the information available to us about King Edward Street Medical Practice on 12 July 2019. We did not find evidence of significant changes to the quality of service being provided since the last inspection. As a result, we decided not to inspect the surgery at this time. We will continue to monitor this information about this service throughout the year and may inspect the surgery when we see evidence of potential changes.

13 July 2017 - desk based inspection

During an inspection looking at part of the service

Letter from the Chief Inspector of General Practice

We carried out an announced comprehensive inspection at King Edward Street Medical Practice on 14 November 2016. The overall rating for the practice was requires improvement. The full comprehensive report on the November 2016 inspection can be found by selecting the ‘all reports’ link for King Edward Street Medical Practice on our website at www.cqc.org.uk.

This inspection was a desk-based review carried out on 13 July 2017 to confirm that the practice had carried out their plan to meet the legal requirements in relation to the breaches in regulations that we identified in our previous inspection on 14 November 2016. This report covers our findings in relation to those requirements and also additional improvements made since our last inspection.

Overall the practice is now rated as Good.

Our key findings were as follows:

  • The practice had undertaken a fire risk assessment and a disability access audit which identified areas for improvement which the practice had begun to implement.
  • The practice had updated their vaccines protocol to ensure the cold chain was maintained in line with best practice.
  • The practice had undertaken a medicines review audit to improve the monitoring of patient care.
  • All patients with a learning disability had been invited for an annual health check.
  • An audit had been undertaken to review the use of the consent policy and showed consent had been obtained and documented where appropriate.
  • The practice had purchased a hearing loop to ensure patients who used hearing aids could access services.

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

The provider should:

  • Ensure the practice maintains oversight of cancer screening figures in order to monitor and improve patient outcomes.

At our previous inspection on November 2016, we identified that the practice should identify a means of improving breast cancer screening. At this inspection we found that the practice had taken steps to try and improve uptake of breast cancer screening and while data showed an increase in uptake of this service, the practice did not have oversight of this. Consequently, the practice should maintain oversight of cancer screening figures in order to monitor and improve patient outcomes.

Professor Steve Field (CBE FRCP FFPH FRCGP) 

Chief Inspector of General Practice

14 November 2016

During a routine inspection

Letter from the Chief Inspector of General Practice

We carried out an announced comprehensive inspection at King Edward Street Medical Practice on 14 November 2016. Overall the practice is rated as requires improvement. Specifically requirements were required in providing safe, effective and well led services. Our key findings were as follows:

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

  • There was a system in place for reporting and recording significant events and for learning to be circulated to staff and changes implemented where required. Reviews of complaints, incidents and other learning events were thorough.
  • Risks to patients were not all assessed and well managed. Fire risks were not fully identified and mitigated.
  • Staff assessed patients’ ongoing needs and when they delivered care to patients it was in line with current evidence based guidance.
  • The practice was performing above average on most clinical outcomes in terms of national data.
  • There was low exception reporting of patients indicating that the practice was reluctant not to include patients in their data even if they did not attend for health reviews.
  • Reviews of patients on repeat medicines were not always recorded properly to ensure this system was monitored properly. This was mainly caused by a recent transition to a new patient record system but the need to prioritise monitoring of certain patient groups, such as on high risk medicines, not been identified as an area for improvement.
  • The practice planned its services based on the needs and demographic of its patient population, particularly students from Oxford colleges.
  • The building was a converted Victorian house and was leased meaning alterations to the building were difficult. However, there was limited risk assessment on the means of access by prams, those with limited mobility or wheelchair users.
  • Patients’ feedback suggested they felt well cared for and supported.
  • Staff were trained in order to provide them with the skills, knowledge and experience to deliver effective care and treatment. Training was used to improve the service where possible.
  • The planning of care for vulnerable groups such as patients with mental health problems, dementia and complex health needs enabled responsive care. However, there was a risk due to the lack of planning in the care for patients with learning disabilities.
  • Patients said they were treated with compassion, dignity and respect and they were involved in their care and decisions about their treatment.
  • All patients deemed at high risk of admission to hospital had a home visit planned within three days of any admission to hospital, or if more appropriate, a phone call. This was supported by the fact the patient record system enabled quick information sharing with external services.
  • Information about services and how to complain was available. Improvements were made to the quality of care as a result of complaints and concerns.
  • Patient feedback on the appointment system was highly positive and where feedback showed improvements could be made this was acted upon.
  • The provider was aware of and complied with the requirements of the duty of candour.
  • There was an ethos of continuous learning and improvement.
  • There was a business plan underway to improve the service which had been implemented following the formation of the new partnership in 2015.

Areas the provide must make improvements are:

  • Improve the monitoring of patient care and welfare to ensure care is delivered safely and improvements are made where necessary. Specifically to ensure that that care policies and protocols are followed, improve the monitoring and recording of medicine reviews and the monitoring and care of patients with learning disabilities. Monitor the system for flagging of patients on the record system to enable identification of individual needs to staff.
  • Assess, monitor and mitigate risks relating to the health, safety and welfare of patients related to the premises and medicines management.

Areas the provide should make improvements are:

  • Consider implementing a hearing loop.
  • Review the use of the consent protocol.
  • Identify a means of improving breast cancer screening uptake.

Professor Steve Field (CBE FRCP FFPH FRCGP) 

Chief Inspector of General Practice