Letter from the Chief Inspector of General Practice

On 6 September 2016 we carried out an announced comprehensive inspection at St George’s and Riverside Medical Group. The overall rating for the practice was requires improvement, having being judged as requires improvement for Safe, Effective and Well Led. The full comprehensive report on the September 2016 inspection can be found by selecting the ‘all reports’ link for St George’s and Riverside Medical Group on our website at www.cqc.org.uk.

After the comprehensive inspection the practice wrote to us to say what they would do to meet the following legal requirements set out in the Health and Social Care Act (HSCA) 2008:

• Regulation 17 Health & Social Care Act 2008 (Regulated Activities) Regulations 2014 Good governance.

This announced comprehensive inspection was carried out on the 27 April 2017 in order to review the action by the practice to be compliant with the regulations. Overall the practice is now rated as good.

• Staff understood and fulfilled their responsibilities to raise concerns, and report incidents and near misses; improvements had been made to the significant event reporting process.

• Risks to patients were assessed and well managed.

• Outcomes for patients who use services had improved and there was a programme of clinical audit in place.

• Patients’ needs were assessed and care was planned and delivered following best practice guidance.

• Staff were consistent and proactive in supporting patients to live healthier lives through a targeted approach to health promotion. Information was provided to patients to help them understand the care and treatment available.

• Patients said they were treated with compassion, dignity and respect and they were involved in their care and decisions about their treatment.

• The practice had a system in place for handling complaints and concerns and responded quickly to any complaints.

• The practice had good facilities and was well equipped to treat patients and meet their needs.

• There was a leadership structure in place and staff felt supported by management. The practice sought feedback from staff and patients, which they acted on.

• The practice was aware of and complied with the requirements of the Duty of Candour regulation.

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

In addition the provider should:

• Liaise with the landlord of the premises to repair or replace the damaged seats in the reception area.

• Follow the Public Health Guidelines in relation to the record keeping of the stock control of vaccines.

• Update the locum induction pack with more comprehensive information, for example, safeguarding arrangements for the practice and locality.

• Complete the process for appointing a registered manager for the merged practice in line with CQC guidance.

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 St Georges & Riverside Medical Group on 6 September 2016. Overall, the practice is rated as requires improvement.

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

• The provider, Intrahealth Limited, took over the two separate practices of St Georges Medical Centre and Trinity Riverside Practice in early 2015 and since the merger the practices became known as St Georges & Riverside Medical Group. Since that time, the provider had experienced a number of difficulties, including retaining and recruiting GPs to work at the practice.
• Staff understood and fulfilled their responsibilities to raise concerns and report incidents and near misses. However, the systems in place at the practice were not effective and this resulted in incidents and near misses not always been effectively managed, recorded or used to support learning.
• Risks to patients were not always assessed and well managed. For example, the practice used a high number of locum GPs and the number of established clinical staff was below the number they had agreed with NHS England to provide.
• 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 was available and easy to understand.
• Urgent appointments were available on the day they were requested. However, some patients told us that they had to wait two weeks or more for routine appointments and appointments with a named GP.
• The practice had good facilities and was well equipped to treat patients and meet their needs.
• There was a clear leadership structure and staff felt supported by management.
• The practice proactively 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 regulation.

The areas where the provider must make improvements are:

• Review the systems and processes in place to assess, monitor and improve the quality and safety of the service provided. Specifically, to ensure lessons are learned from significant events to prevent events reoccurring.

The areas where the provider should make improvements are:

• Review staffing levels within the clinical teams so that sufficient staff are employed to provide safe, effective and consistent care.
• Complete the process for appointing a registered manager for the merged practice in line with CQC guidance.
• Review their arrangements for clinical audit at the practice. Clinical audit should be clearly linked to patient outcomes, monitored for effectiveness and comprise of two cycles to monitor improvements to patient outcomes.
• Update the patient group directives (PGD’s) in place at the practice to include the signature of each practitioner and authorisation by a practice signatory.

Professor Steve Field CBE FRCP FFPH FRCGP

Chief Inspector of General Practice