This practice is rated as ‘Good’ overall. (Previous rating December 2017 – Requires improvement)

The key questions at this inspection are rated as:

Are services safe? – Requires improvement

Are services effective? – Good

Are services caring? – Good

Are services responsive? – Good

Are services well-led? - Good

We carried out an announced comprehensive inspection of Riverlyn Medical Centre on 13 November 2018. The inspection was carried out under Section 60 of the Health and Social Care Act 2008 as part of our regulatory functions to check whether the provider was meeting the legal requirements and regulations associated with the Health and Social Care Act 2008, to look at the overall quality of the service, and to provide a rating for the service under the Care Act 2014.

At this inspection we found:

• We found effective systems were in place to promote adult and child safeguarding.
• Staff immunisation records were not fully complete.
• Safety checks of equipment and the premises were taking place but were not always fully documented.
• The premises were clean and infection control practices were being followed.
• Medicines were generally safely managed but patient-specific directions were not appropriately authorised and emergency medicines and equipment checks were not always fully documented.
• The practice team reviewed significant events to learn and share best practice. If a patient was involved in an adverse incident, they would receive an explanation as part of the duty of candour.
• The practice ensured that care and treatment was delivered according to evidence-based guidelines.
• The provider’s performance in the 2017-18 Quality and Outcomes Framework (QOF) was generally in alignment with local and national averages apart from one diabetes indicator.
• Screening rates were generally in alignment with local and national averages.
• Childhood immunisation rates, especially at age of one, were below World Health Organisation targets.
• Patients provided positive feedback about the care they had received, and this was demonstrated by outcomes from external and internal surveys and patient comment cards.
• Feedback regarding access to appointments was generally positive and in alignment with local and national averages apart from telephone access.
• Complaints were managed appropriately.
• We found an open and supportive culture within the practice. Staff felt valued and told us they found the GP Partners to be accessible and approachable.
• The practice had clear vision and values in place and staff were observed to act in line with them.
• Governance arrangements were in place and had been improved following the appointment of the practice manager.

Importantly, the provider must make improvements to the following areas of practice:

• Ensure care and treatment is provided in a safe way to patients. The practice should ensure its staff immunisation records are complete and staff are vaccinated appropriately. Patient-specific directions must be appropriately authorised.

There were some areas where the provider should make improvements:

• The practice should ensure that all safety checks are fully documented.
• The infection control lead should attend some additional training to support their lead role.
• The practice should continue to work to improve their diabetes and childhood immunisation performance.

Professor Steve Field CBE FRCP FFPH FRCGP
Chief 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

This practice is rated as requires improvement.

The key questions are rated as:

Are services safe? – Inadequate

Are services effective? – Good

Are services caring? – Requires improvement

Are services responsive? – Requires improvement

Are services well-led? – Requires Improvement

As part of our inspection process, we also look at the quality of care for specific population groups. The population groups are rated as:

Older People – Requires improvement

People with long-term conditions – Requires improvement

Families, children and young people – Requires improvement

Working age people (including those retired and students – Requires improvement

People whose circumstances may make them vulnerable – Requires improvement

People experiencing poor mental health (including people with dementia) - Requires improvement

We carried out an announced comprehensive inspection at Riverlyn Medical Centre on 7 December 2017. The inspection was undertaken following the registration of the practice with the Care Quality Commission in August 2017.

At this inspection we found:

• The practice had some systems in place to manage risk so that safety incidents were less likely to happen. When incidents did happen, the practice reviewed events but learning outcomes were not always clearly recorded or documented.
• Processes for the recording of action taken in respect of safety alerts (including MHRA alerts) required strengthening.
• Prescription stationery was not managed securely in line with guidance.
• There were appropriate safeguarding arrangements in place and staff had received relevant training. There were regular meetings with attached staff.
• The practice reviewed the effectiveness and appropriateness of the care it provided. Care and treatment was delivered according to evidence- based guidelines.
• Multi-disciplinary meetings were held regularly to discuss and review patients at risk of being admitted to hospital.
• During our inspection we saw that staff involved and treated patients with compassion, kindness, dignity and respect.
• Feedback from the national GP patient survey indicated patient satisfaction with care and treatment and access to appointments was below local and national averages.
• There were regular meetings within the practice but governance arrangements needed to be strengthened to ensure clinical leaders had oversight.

The areas where the provider must make improvements as they are in breach of regulations are:

• Ensure care and treatment is provided in a safe way to patients
• Establish effective systems and processes to ensure good governance in accordance with the fundamental standards of care

The areas where the provider should make improvements are:

• Continue to review, act on and improve patient satisfaction in areas where the practice is performing below local and national averages. This includes on patients being able to access services at the practice in a timely way and in their interactions with clinical staff.

Professor Steve Field (CBE FRCP FFPH FRCGP) 

Chief Inspector of General Practice