Letter from the Chief Inspector of General Practice

We carried out an announced comprehensive inspection at Royal Manor Health Care on 24 June 2015. Overall the practice is rated as good.

Specifically we rated the practice as good for providing safe, effective, caring, responsive and well-led services. The practice was rated as good for providing services to the population groups of older people, people with long-term conditions, families, children and young people, working age people (including those recently retired and students), people whose circumstances may make them vulnerable and people experiencing poor mental health (including people with dementia).

The practice is the only registered location for the provider Portland Group Practice and the provider has a branch surgery at Gatehouse Surgery, Castle Road, Portland, Dorset, DT5 1 AU.

Our key findings were as follows:

• Staff understood and fulfilled their responsibilities to raise concerns and report incidents. Action was taken in response to incidents and events and learning as a result of incidents and events was shared with staff.
• Risks to patients were assessed and managed and all staff had received training in how to conduct a risk assessment.
• Patients were treated with compassion, dignity and respect and supported to make decisions about their care.
• The practice responded to feedback from patients and from the Patient Participation Group.
• The practice had a clear leadership structure and staff were supported by management.
• The practice proactively sought feedback from staff and patients, which it acted on.
• The practice used the Quality and Outcomes Framework to measure its performance and QOF data for 2013/2014 indicated that the practice had achieved 95.6% of the total points available.

• We saw one area of outstanding practice: The practice provided a ‘tea and chat’ service for patients who were isolated. The sessions were used to provide health advice to patients on matters such as sun safety.

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

The provider should:

• Provide training to all staff on information governance.
• Ensure that all GPs are trained to Level three in Safeguarding Children
• Update the emergency medicines checklist to ensure that the contents annotated reflect those that are currently available.

• Introduce a single system to ensure that NICE guidelines are disseminated to all staff.
• Ensure that all patients with a learning disability have a care plan in place.
• Look at ways to improve access to appointments.

Professor Steve Field CBE FRCP FFPH FRCGP

Chief Inspector of General Practice

This practice is rated as Good overall. (Previous inspection June 2015 – Good)

The key questions are rated as:

Are services safe? – Good

Are services effective? – Good

Are services caring? – Good

Are services responsive? – Good

Are services well-led? - Good

We carried out an announced comprehensive inspection at Royal Manor Health Care on 16 May 2018 as part of our inspection programme.

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.
• Staff involved and treated patients with compassion, kindness, dignity and respect.
• The practice had responded to the low survey results by reviewing and implementing new systems for accessing appointments including a ‘walk in and wait’ clinic.
• The carers’ lead facilitated a carers’ group every week at the local village hall. The group invited people from external agencies to discuss areas of interest. The carers’ lead was provided with two hours of protected time each week to complete work to support patients who were also carers.
• There was a strong focus on continuous learning and improvement at all levels of the organisation.
• The practice had implemented a ‘walk in and wait’ clinic every morning in December 2017. The nurse practitioner led Service had improved access by increasing the amount of same day appointments being available. This had increased the number of GP routine appointments.

At our last inspection in June 2015 we recommended that the practice should make improvements relating to staff training, the dissemination of The National Institute for Health and Care Excellence (NICE) guidelines to all staff and ensuring patients with learning disabilities had a care plan in place. At this inspection we found the practice had taken steps to implement positive changes that addressed our recommendations and improved quality of services for patients.

We saw one area of outstanding practice:

• The practice offered caring support by providing a ‘tea and chat’ social gathering at the practice, facilitated by health care assistants and receptionists each month. The group was formed to reduce social isolation of older patients and bereaved patients.

Professor Steve Field CBE FRCP FFPH FRCGP
Chief Inspector of General Practice