Letter from the Chief Inspector of General Practice

Our previous comprehensive inspection at Ringmead Medical Practice on 12 August 2016 found breaches of regulations relating to the safe and well-led delivery of services. The overall rating for the practice was requires improvement. Specifically, we found the practice to require improvement for provision of safe and well led services. It was good for providing effective, caring and responsive services. Consequently we rated all population groups as requires improvement. The full comprehensive report on the August 2016 inspection can be found by selecting the ‘all reports’ link for Ringmead Medical Practice on our website at www.cqc.org.uk.

This inspection was an announced focused inspection carried out on 8 March 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 12 August 2016. This report covers our findings in relation to those requirements and improvements made since our last inspection.

We found the practice had made improvements since our last inspection. At our inspection on the 8 March 2017 we found the practice was meeting the regulations that had previously been breached. We have amended the rating for this practice to reflect these changes. The practice is now rated good for the provision of safe, effective, caring, responsive and well led services. Overall the practice is now rated as good. Consequently we have rated all population groups as good.

Our key findings were as follows:

• The practice had demonstrated significant improvements in governance arrangements.
• Blank prescription printer forms were kept securely and tracked through the practice.
• We found management of legionella and medicines management had been improved.
• The practice had demonstrated improvements in patients’ outcomes for patients with dementia.
• For example, the practice had carried out dementia face to face reviews for 50 out of 56 patients, which demonstrated improvement from 74% to 89%, compared to the previous inspection.
• All staff had received an annual appraisal in the last 12 months. We noted the practice manager had received a formal written appraisal on 21 October 2016.
• Staff feedback had been considered and the practice had made improvements in staffing levels, however it was too early to assess the positive impact.
• The practice had displayed an information poster in the waiting area, written in multi-languages about the available translation service. 

• Staff we spoke with on the day of inspection were aware of the translation service.
• Aside from the translation poster; information posters and leaflets were not available in multi-languages. However, the practice website could be translated into various languages and the staff were all aware of this.
• The practice had taken steps to identify carers to enable them to access the support available via the practice and external agencies. The practice register of patients who were carers had increased from 153 (0.98%) patients to 283 patients (1.8% of the practice patient population list size).

The areas where the provider should make improvements are:

• Review how information is displayed in practice and how this could be provided in multiple languages to meet patient needs.

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 Ringmead Medical Practice on 12 August 2016. Overall the practice is rated as requires improvement.

Specifically, we found the practice to require improvement for provision of safe and well led services. It was good for providing effective, responsive and caring services. The concerns which led to these ratings apply to all population groups using the practice.

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

• Staff understood and fulfilled their responsibilities to raise concerns, and to report incidents and near misses.
• There were inconsistent arrangements in how risks were assessed and managed. For example during the inspection we found risks relating to management of legionella, medicines management and management of blank prescription forms for use in printers which had not been monitored.
• We found that completed clinical audit cycles were driving positive outcomes for patients.
• Staff assessed patients’ needs and delivered care in line with current evidence based guidance. Staff had the skills, knowledge and experience to deliver effective care and treatment.
• Patients said they were treated with compassion, dignity and respect and they were involved in their care and decisions about their treatment.
• Information about services and how to complain were available and easy to understand.
• The practice had reviewed appointment booking system, introduced unlimited telephone consultation with GPs for patients requesting same day urgent appointments, added four additional telephone lines and increased locum GP sessions. 
• The practice had good facilities and was well equipped to treat patients and meet their needs.
• There was an anti-coagulation clinic (an anti-coagulant is a medicine that stops blood from clotting) offered onsite, resulting in 190 patients who required this service not having to travel to local hospitals.
• There was a clear leadership structure and staff felt supported by management. The practice sought feedback from staff and patients, which it acted on.
• The provider was aware of and complied with the requirements of the Duty of Candour.

The areas where the provider must make improvements are:

• Further review, assess and monitor the governance arrangements in place to ensure the delivery of safe and effective services. For example, management of legionella, medicines management and the management of blank prescription forms for use in printers.

The areas where the provider should make improvements are:

• Consider staff feedback, and review and improve the staffing levels to ensure the smooth running of the practice and keep patients safe.
• Review the process of identifying carers to enable them to access the support available via the practice and external agencies.
• Review and improve the systems in place to effectively monitor and improve patient outcomes for patients with dementia.
• Ensure all staff has received regular annual appraisals.
• Ensure information about a translation service is displayed in the reception area informing patients this service is available. Ensure information posters and leaflets are available in multi-languages.

Professor Steve Field (CBE FRCP FFPH FRCGP) 

Chief Inspector of General Practice

During the inspection we spoke with seven patients five members of staff, the assistant manager and a partner GP. The practice was recruiting a new practice manager at the time of this inspection.

Patients were satisfied with the care and treatment they received and one told us "Staff are absolutely brilliant." They voiced some concerns regarding access to appointments and their ability to contact the surgery. The management had identified these concerns and were implementing plans to improve patients' access to services.

Patients told us they were involved in decisions about their care and treatment. One patient said “Most doctors are very good at explaining things, but some are not as good as others.”

The practice provided staff with awareness and policies on safeguarding. The service had an appropriate process for recruiting staff. Background checks and induction were undertaken before staff were allowed to work alone.

There were systems to monitor the quality of the service. Information on the performance of the service, including feedback from patients and staff, was considered by the service and acted on where possible.