We previously carried out an announced comprehensive inspection at Radbrook Green Surgery on 6 November 2014. The overall rating for the practice was outstanding. The practice was rated as outstanding for providing caring and responsive services and rated good for providing safe, effective and well-led services. The full comprehensive report on the November 2014 inspection can be found by selecting the ‘all reports’ link for Radbrook Green Surgery on our website at .

This inspection was an announced comprehensive inspection carried out on 20 November 2018.

This practice is rated as Good overall.

The key questions at this inspection are rated as:

Are services safe? – Requires improvement

Are services effective? – Good

Are services caring? – Outstanding

Are services responsive? – Good

Are services well-led? - Good

At this inspection we found:

• The practice had clear systems 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.
• There were systems in place for identifying, assessing and mitigating risks to the health and safety of patients and staff.
• The practice had systems, processes and practices in place to protect people from potential abuse. Staff were aware of how to raise a safeguarding concern and most staff had received safeguarding training appropriate to their role. However, not all of the required staff recruitment checks had been obtained prior to employment.
• The practice routinely reviewed the effectiveness and appropriateness of the care it provided. It ensured that care and treatment was delivered according to evidence-based guidelines.
• Staff involved and treated patients with compassion, kindness, dignity and respect. Patients felt genuinely cared for and spoke very highly of the care and treatment they received.
• The practice had good facilities and was equipped to treat patients and meet their needs.
• Some patients reported difficulties contacting the practice by telephone. The practice acknowledged the difficulties and were taking action to improve their systems and patient experiences.
• The practice worked closely with outside agencies such as nursing homes and charities in the local area to improve the care delivered.
• The practice actively worked with the patient participation group (PPG) to meet the needs of their patients. They told us that the practice leaders were very receptive, always listened to them and took any suggestions on board to improve the service for patients.
• Information to support patients with making a complaint was readily available.
• There was a focus on continuous learning and improvement at all levels of the organisation.

We saw an area of outstanding practice:

The practice provided several support groups and were involved in a number of social initiatives. These included a support group for carers of people with dementia, a bereavement group and a support group for people with chronic fatigue and Myalgic Encephalopathy (M.E). Patients had access to a community and care co-ordinator who assisted patients of any age in need of help, support and advice by offering a signposting service. This included advice regarding care, transport, benefits, financial support, local support groups, housing and social isolation. A befriending service was also available to those most vulnerable to loneliness and isolation and at risk of being admitted to hospital and losing their independence.

The areas where the provider should make improvements are:

• Ensure all staff complete outstanding essential training.
• Continue to review and improve telephone access to the practice.

Professor Steve Field CBE FRCP FFPH FRCGPChief Inspector of General Practice

Please refer to the detailed report and the evidence tables for further information.

Letter from the Chief Inspector of General Practice

We inspected this service on 6 November 2014 as part of our new comprehensive inspection programme.

The overall rating for this practice is outstanding. We found the practice to be outstanding in the caring and responsive domains and good in the safe, effective and well led domains. We found the practice provided outstanding care to older people, people with long term conditions and people whose circumstances may make them vulnerable. They provided good care to families, children and young people, working age people and people experiencing poor mental health.

Our key findings were as follows:

• Patients were kept safe because there were arrangements in place for staff to report and learn from key safety risks. The practice had a system in place for reporting, recording and monitoring significant events over time.
• There were systems in place to keep patients safe from the risk and spread of infection. Systems were in place to monitor and make required improvements to the practice.
• Patients were very satisfied with how they were treated and this was with compassion, dignity and respect. GPs were good at listening to patients and gave them enough time.
• Not all patients found it easy to get through on the telephone to book an appointment however, most patients reported they got an appointment when needed.

We saw several areas of outstanding practice including:

• The practice used a nationally recognised patient safety framework to enable them to identify and put plans of care in place for patients with the highest health risks.
• The practice employed a community and care co-ordinator to provide services to support vulnerable people. This included a support group for carers of people with dementia and a twice monthly bereavement support group.
• The practice ran a support group for patients with chronic fatigue and Myalgic Encephalopathy (ME) to ensure patients were supported in decisions about available care and treatment.
• The practice had proactively engaged with teenagers to involve them in health care services.
• The practice had helped to established Compassionate Communities, a voluntary service that the community and care co-ordinator worked alongside to provide support for patients whose circumstances may make them vulnerable.
• The practice provided GP support to a 12 bedded rehabilitation unit in one of the nursing homes for patients whose vulnerability meant they needed additional support following discharge from hospital. The aim of this was to reduce hospital re-admission rates.

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

The provider should:

• Ensure that all patient group directions for the safe delivery of childhood immunisations are in date.
• Introduce a system for monitoring GP prescription pads, in line with national guidelines.

Professor Steve Field (CBE FRCP FFPH FRCGP)

Chief Inspector of General Practice

This inspection was a desk-based review carried out on 26 February 2019.

We previously carried out an announced comprehensive inspection at Radbrook Green Surgery on 20 November 2018. Overall the practice was rated as good with requires improvement for providing safe services. No breaches in regulations were identified, however we made some good practice recommendations. The full comprehensive report on the November 2018 inspection can be found by selecting the ‘all reports’ link for Radbrook Green on our website at .

We carried out this desk-based review on 26 February 2019 to confirm that the practice had obtained the required staff checks and actioned the recommendations made. This report covers our findings in relation to those requirements and additional improvements made since our last inspection.

Overall the practice remains rated as good and Safe is now rated good.

We found that:

• The provider had reviewed and strengthened their recruitment procedures. All but one of the outstanding recruitment checks had been obtained for the staff we previously reviewed. The provider was in the process of obtaining all of the required checks for a new member of staff, who was due to commence working at the practice shortly.
• Significant improvements had been made in relation to staff training. The provider had developed an action plan and were reviewing staff completion rates on a monthly basis. Training records showed the majority of staff had since completed essential training, to include safeguarding.
• The practice had reviewed and improved telephone access to the practice. No verbal or written complaints had been received from patients since improvements to the telephone system had been implemented on 24 January 2018. A telephone survey had been developed and distributed to capture patient feedback, however no responses had been received to date. The practice planned to run a telephone survey for two weeks every quarter to gain patient feedback.

Details of our findings and the evidence supporting our ratings are set out in the evidence tables.

Professor Steve Field CBE FRCP FFPH FRCGP
Chief Inspector of General Practice