Letter from the Chief Inspector of General Practice

Rosedale Surgery has a practice population of approximately 11700 patients. We carried out a comprehensive inspection at Rosedale Surgery on 8 October 2014.

We have rated each section of our findings for each key area. We found that the practice provided a safe, effective, caring, responsive and well led service for the population it served. The overall rating was good and this was because the practice staff were extremely well organised which, led to a very efficient service. Each senior member had dedicated roles. Improvements had been identified and made that had a positive impact on patient care. For example, longer appointment times were provided for patients with long term conditions such as diabetes and vulnerable patients who had learning disabilities.   

Our key findings were as follows:

• We found evidence that the practice staff worked together to make ongoing improvements for the benefit of patients.
• Each day there was an assigned duty doctor to respond to any unexpected peaks in patient requests to be seen. The feedback we received from patients informed us they could get appointments when they needed to.
• The practice was able to demonstrate a good track record for safety. Effective systems were in place for reporting safety incidents. Untoward incidents were investigated and where possible improvements made to prevent similar occurrences.
• We found that patients were treated with respect and their privacy was maintained. Patients informed us they were satisfied with the care they received. One comment card we received stated; ‘Excellent service at all times.’

We saw an areas of outstanding practice:

• The practice was exceptionally well organised and this resulted in an efficient service that was well led for the benefit of patients.

Professor Steve Field (CBE FRCP FFPH FRCGP) 

Chief Inspector of General Practice

This practice is rated as Good overall. (Previous rating January 2015 - Good)

The key questions at this inspection are rated as:

Are services safe? – Good.

Are services effective? – Requires improvement.

Are services caring? – Good.

Are services responsive? – Good.

Are services well-led? – Good.

We carried out an announced comprehensive inspection at Rosedale Surgery on 16 October 2018. This was part of our planned inspection programme.

At this inspection we found:

• The practice had 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. Risks were assessed and acted upon, however there was no formalised process for identifying the risks in relation to fire and premises safety.
• Effective processes were in place for the management of medicines. All prescription stationary was kept secure, although there was not an effective tracking system for prescription paper.
• The practice routinely reviewed the effectiveness and appropriateness of the care it provided. It ensured care and treatment was delivered according to evidence-based guidelines. The practice’s performance on quality indicators for mental health and long-term conditions was in line with and above the Clinical Commissioning Group (CCG) and England averages. However, the exception reporting for some of the Quality and Outcomes Framework (QOF) indicators for diabetes, asthma and Chronic Obstructive Pulmonary Disease (COPD), were higher than the CCG and England averages. They were significantly higher for some of the mental health and dementia indicators and some of these had increased significantly from the year 2016/2017 to 2017/2018. Although the practice excepted patients in line with QOF requirements, a significant number of patients were not receiving the interventions and there was no evidence of additional outreach to increase this.
• Staff worked together and with other health and social care professionals. Multi-professional meetings were held where patients with, for example, palliative care, or complex needs were discussed and reviewed. The practice encouraged other professionals to engage with the practice and invited them to six monthly informal meetings.
• The practice had 77 patients on the learning disability register and 45 had received a health check. They were aware of this and although they had not completed many learning disability health checks since April 2018, appointments had been scheduled to catch up with these.
• Staff involved and treated patients with compassion, kindness, dignity and respect.
• The practice gave patients timely support and information. There were some examples where the flexibility of the same day team clinicians had resulted in patients being given more time.
• Patients found the appointment system easy to use and reported they could access care when they needed it.
• There was a strong focus on continuous learning and improvement at all levels of the practice. Regular training tutorials were held for practice staff. All staff received an appraisal. Staff reported feeling well supported.
• Leaders were knowledgeable about issues and priorities relating to the quality and future of services. They understood the challenges and were addressing them.

The areas where the provider

must

make improvements as they are in breach of regulations are:

• Ensure the care and treatment of patients is appropriate, meets their needs and reflects their preferences.

The areas where the provider should make improvements are:

• Formalise the process for identifying risks in relation to fire and premises safety.
• Improve the tracking in and out of prescription paper.
• Continue to improve the uptake of health checks for patients with a learning disability.

Professor Steve Field CBE FRCP FFPH FRCGPChief Inspector of General Practice

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