Letter from the Chief Inspector of General Practice

We carried out an announced comprehensive inspection at Rosebank Health on 29 June 2017. Overall the practice is rated as requires improvement.

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

• There was an open and transparent approach to safety and an effective system in place for reporting and recording significant events.
• All patients requesting urgent care were triaged by an advanced nurse practitioner or a doctor who would assess their needs and direct them appropriately.
• Risks to patients were assessed and well managed, with the exception of those relating to infection control and legionnaires disease.
• Patients said they were treated with compassion, dignity and respect and they were involved in their care and decisions about their treatment. However, patients expressed concern over the availability of routine appointments and the ability to book an appointment with a named GP.
• The arrangements for managing medicines, including emergency medicines and vaccines, in the practice minimised risks to patient safety, apart from the storage of blank prescription forms once distributed to a clinician’s room.
• The majority of patients said they were treated with compassion, dignity and respect.
• Not all staff had received essential training.
• The practice had a number of policies and procedures to govern activity but these did not always operate effectively. For example those relating to recruitment checks.

The areas where the provider must make improvements are:

• Ensure arrangements in respect of staff support and training are reviewed.
• Ensure systems and processes are reviewed to ensure safe care and treatment for service users.
• Ensure there are effective systems and processes to seek and act on feedback received about the services provided.
• Ensure the practice assess the risks relating to the health, safety and welfare of patients, staff and visitors to the practice and have plans that ensure adequate measures are taken to minimise those risks.

In addition the provider should:

• Continue to monitor and evaluate their system for exception reporting.
• Continue to encourage all patients who are carers to register as such to enable the practice to offer the additional support available for this group of patients.

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 Rosebank Health, also known as Rosebank Surgery on 8 January 2015. Overall the practice is rated as good.

Rosebank Health is a partnership of seven GPs. It has two purpose built surgeries one located near to the city centre of Gloucester, known as Rosebank Surgery and the other practice at St James in Quedgeley known as the Severnvale Surgery. As part of this inspection we visited both surgeries.

Specifically, we found the practice to be good for providing well-led, effective, caring and responsive services. It required improvement in order to provide safe services.

Rosebank Health was also good for providing services for older patients, patients with long term conditions and patients with poor mental health. It also provided good services for patients of working age, the recently retired and students, patients whose circumstances made them vulnerable and mothers families and young patients.

Our key findings were as follows:

• Staff understood and fulfilled their responsibilities to raise concerns, and to report incidents and near misses. Lessons were learned and communicated widely to support improvement.
• Staff referred to guidance from National Institute for Health and Care Excellence and used it routinely.
• Patients said they were treated with compassion, dignity and respect and they were involved in decisions about their care and treatment.
• The practice responded when patients said they found it difficult to make a same day appointment.
• There was a clear leadership structure and staff felt supported by management.
• There were clinics held within the practice where staff from the Benefits Agency attended to give advice. Patients were able to make appointments to have confidential advice. Also the GPs could refer patients to the clinics if they felt it appropriate.
• Learning from a significant event, several years ago led to the development of the ‘Gold Standard Patient’ initiative within the practice. If patients were having a difficult time with their health they were referred to as a Gold Standard Patient. They were sent a letter explaining how the practice would like to do everything possible to help patients make appointments, request home visits or get prescriptions more efficiently. They were asked to say they were a gold standard patient when telephoning the practice so that they received priority treatment.

We saw an area of outstanding practice:

The GPs referred some patients with poor mental health to an art service to assist with their mental well-being. We saw evidence to show this was successful as a comparison of before and after referral to the service reduced consultation rates. We were told this was popular with patients.

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

Importantly, the provider must:

• Review the way it manages medicines. We found the storage of medicines in refrigerators to be unsatisfactory.

Professor Steve Field CBE FRCP FFPH FRCGP 

Chief Inspector of General Practice

This practice is rated as Good overall.

This practice was previously inspected in June 2017 and the overall rating was requires improvement. It was rated requires improvement for the provision of safe, effective, responsive and well led services and good for providing caring services. The report for the 2017 inspection can be found by selecting the ‘all reports’ link for Rosebank Health on our website at .

This announced comprehensive inspection was undertaken on 16 August 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 in 2017. This report covers our findings in relation to those requirements and additional improvements made since our last inspection.

The key questions at this inspection are rated as:

Are services safe? – Good

Are services effective? – Good

Are services caring? – Good

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.
• 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 and was focussed to meet the needs of patients in the most appropriate way.
• Staff involved and treated patients with compassion, kindness, dignity and respect.
• The practice could demonstrate how they responded to the needs of patients. For example, they held education events for patient with complex needs and appointed a sexual health specialist nurse due to increase demand in sexual health service.
• There was a clear leadership structure and staff felt supported by management.
• Patients found the appointment system easy to use and reported that there had been a significant improvement in accessing the practice by telephone.
• There was a focus on continuous learning and improvement at all levels of the organisation.

The areas where the provider should make improvements are:

• Take action to ensure all patient facing staff had received immunisations as recommended by Public Health guidance.
• Continue to monitor and improve uptake for the cervical screening programme.
• Continue to drive improvements and respond to patient feedback.

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.