Letter from the Chief Inspector of General Practice

We previously carried out an announced comprehensive inspection at Rainhill Village Surgery on 27 September 2016. The overall rating for the practice was good but required improvement in providing safe services. The full comprehensive report on the 27 September 2016 inspection can be found by selecting the ‘all reports’ link for Rainhill Village Surgery on our website at www.cqc.org.uk.

This inspection was an announced focused inspection carried out on 17 February 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 27 September 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 addressed the issues identified during the previous inspection.
• There was system in place to check whether medical equipment on the premises was in date and therefore safe to use.

In addition, the practice had made the following improvements:

• Staff had received additional guidance on chaperoning.
• There was new system for securely storing blank prescription forms.
• There was now a data sharing agreement for patient information to be shared with other GPs when treating patients from other practices.
• Complaints information both in the practice leaflet and on the website had been updated to reflect patients could complain to either NHS England or the practice.
• The practice had arranged end of year meetings to analyse incidents and complaints for trends.

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 Rainhill Village Surgery on 27 September 2016. Overall the practice is rated as good. The practice is rated as requiring improvement for providing safe services and good for providing effective, caring, responsive and well led services.

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

• The practice had been established for many years and is a traditional family practice situated in a converted Victorian house. The practice had a ramp for disabled access but no doorbell or intercom to gain access through the surgery door. There were translation and signers for the deaf services, but no hearing loop. The practice has a set of steep steps to access the second floor treatment room, which would be difficult for some patients to use and the emergency services to utilise if needed.

• Information reviewed from the GP national patient survey and patient comment cards indicated patients were happy with the service provided and that they could easily get an appointment.

• The practice was in the process of a changeover of practice manager and senior partner and had recently installed a new computer system.

• There were systems in place to mitigate safety risks. However, there were gaps in some safety processes. For example, there was out of date medical equipment and printer blank prescription forms were insecurely stored.

• Information about services and how to complain was available. However, this information needed updating and more work could be done in terms of analysing complaints.
• The practice was aware of and had systems in place to ensure compliance with the requirements of the duty of candour. (The duty of candour is a set of specific legal requirements that providers of services must follow when things go wrong with care and treatment).
• Patients’ needs were assessed and care was planned and delivered in line with current legislation.
• Patients said they were treated with compassion, dignity and respect and they were involved in their care and decisions about their treatment.

• The practice sought patient views about improvements that could be made to the service; including having a patient participation group (PPG) and acted, where possible, on feedback.

• There was an open and transparent culture and staff worked well together as a team. Staff received training and appraisals to support them carry out their roles.

There was an element of outstanding practice:

• The practice took part in a trial to reduce antibiotic prescribing for respiratory illness whereby patients were encouraged to have alternative remedies were possible. Results showed a 10% decrease in antibiotic prescribing over a year.

The areas where the provider must make improvements are:

• Have a system in place to monitor the medical equipment used to ensure that it is in date and dispose of any that has expired.

The areas where the provider should make improvements are:

• Revisit chaperone training for both GPs and staff to ensure all involved are following the correct procedures.
• Review processes in place to make sure complying with all current Health and Safety regulation. For example, check all blank prescriptions are securely stored and that all materials are clearly labelled and have appropriate safety data information available or displayed.
• Update their complaints information both in the practice leaflet and on the website to reflect patients can complain to either NHS England or the practice.
• Implement a system to review trends in incidents and complaints and review any complaint to see if it should be escalated to a significant event.
• Have a doorbell or intercom system so that those patients who have difficulty opening the inner door to the practice can be assisted.
• Retain documented recruitment information, such as references, for all staff.
• Correspond with any referring GP when patients are treated from other practices to outline the treatment received and any outcome or follow up care required.

Professor Steve Field (CBE FRCP FFPH FRCGP) 

Chief Inspector of General Practice