Letter from the Chief Inspector of General Practice

We carried out an announced comprehensive inspection at GP Practice at Riverside on 3 May 2017. The overall rating for the practice was good but the practice was rated as requires improvement for ensuring safe services. The full comprehensive report on the May 2017 inspection can be found by selecting the ‘all reports’ link for GP Practice at Riverside on our website at www.cqc.org.uk.

This inspection was an announced focused inspection carried out on 6 February 2018 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 3 May 2017. 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 registered provider had reviewed the overall governance structure of the practice including staff roles and communications. New team and operational meetings were taking place. Key senior team members had developed leadership roles to support governance arrangements.

• Clearer systems were in place to manage risk so that safety incidents were less likely to happen. When incidents did happen, the practice learned from them and improved their processes. Risk assessments, monitoring and audit systems were improved to mitigate safety risks, in particular with regard to safety alerts and guidance, staffing, emergency medication and prescriptions and safety of the premises and equipment.

• Practice specific policies and standard operating procedures were available to all staff.

• There were clear methods of communication across the staff team. Records showed that regular meetings were carried out as part of the quality improvement process to improve the service and patient care.

• New systems and monitoring responsibilities had been put into place to ensure that records relating to the practice, including policies, staff recruitment and training documentation were completed. A staff training matrix was used by the practice to monitor staff training.

• A complaints policy and procedure was in place and information was available to help patients understand the complaints procedure and how they could expect their complaint to be dealt with.

• An improved system for cascading NICE guidelines and patient safety alerts had been put in place.

• New procedures were in place to monitor the emergency medicines, doctors’ bags and emergency equipment.

In addition the provider should:

• Review how information collected by the practice could improve the support available for carers.

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 GP Practice at Riverside on 3 May 2017. Overall the practice is rated as Good. 

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

• There was an open and transparent approach to safety and a system in place for reporting and recording significant events. Staff learning from significant events was shared across the practice, however the record keeping of such events required improvement.
• The practice had systems to minimise risks to patient safety but improvements were required for the monitoring of risks related to the premises.
• The practice maintained appropriate standards of cleanliness and hygiene and we observed the premises to be clean and tidy.
• There were arrangements for managing medicines, including emergency medicines and vaccines in the practice. However, we found that safe systems for the destruction of unused prescription forms was not in place. 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.
• Audits of clinical practice were undertaken and discussed.
• The practice demonstrated how they ensured role-specific training and updating for relevant staff.
• 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.
• The practice reviewed the needs of the local population and worked in collaboration with the NHS England Area Team, Clinical Commissioning Group (CCG), other GP practices, and partner agencies to secure improvements to services where these were identified and to improve outcomes for patients.
• Information about services and how to complain was available but improvements were needed to the records made of these.
• 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 provider was aware of the requirements of the duty of candour. Examples we reviewed showed the practice complied with these requirements.

However, there were areas where the provider must make improvements. The provider must:

Review the overall governance structure of the practice including staff roles and communications and in particular:-

• Ensure all records relating to the practice, including policies, staff recruitment and training documentation, actions taken as a result of incidents or complaints, monitoring records and action plans, are appropriately maintained.

• Ensure appropriate risk assessments, monitoring and audit systems are in place to mitigate safety risks in particular with regard to safety alerts and guidance, staffing, emergency medication and prescriptions and safety of the premises and equipment.

There were areas also where the provider should make improvement. The provider should:

• Implement a system to ensure that NICE guidelines are followed up by clinical staff.

• Develop a staff training matrix to ensure accurate records are kept for the full training undertaken by staff.

• Review how information collected by the practice could improve the support available for carers.

• Review the numbers of staff trained and able to undertake chaperoning duties.

• Consider the inclusion of reception staff to regular practice meetings so that communications can improve.

• Monitor the contents of GPs bags and medicines.

• Undertake a risk assessment to ensure that the movement of staff across each of the providers GP practices does not compromise the health, safety and welfare of patients and staff.

• Review the management and leadership structure of the practice. This should include a risk assessment and needs analysis as the basis for deciding sufficient management and leadership roles are in place at all times.

• Ensure that minutes of meetings with reception staff are recorded.

Professor Steve Field (CBE FRCP FFPH FRCGP) 

Chief Inspector of General Practice