Letter from the Chief Inspector of General Practice

We carried out an announced comprehensive inspection of The Paradise Road Practice 9 March 2016. A breach of legal requirements was found requirements in relation to the breaches of regulation 17 (Good governance) of the Health and Social Care Act 2008 (Regulated Activities) Regulations 2014. A follow-up focussed inspection was carried-out on 6 December 2016 where we found that the practice was in the process of addressing the breach of regulation, but that this had not been completed. The practice subsequently provided evidence that they had completed the work required to make them fully compliant with the regulations.

During the comprehensive inspection we found that the practice had failed to ensure that a complete and contemporaneous record in respect of each service user was kept. We also identified areas where improvements should be made, which included reviewing their complaints process to ensure that it is clear and accessible to all patients; taking necessary action as recommended in their Legionella risk assessment; encouraging patient feedback; advertising the availability of the language interpretation service; reviewing their appointment system to ensure that longer appointments are given to patients who need then; reviewing their systems for recording information such as staff training, complaints and safeguarding concerns; reviewing the safety arrangements of medicines kept at the practice; and ensuring that they are meeting the needs of patients who are carers. During the follow-up inspection on 6 December 2016 we found that the practice had fully addressed all of these issues with the exception of ensuring that a complete and contemporaneous record in respect of each service user was kept, where they were in the process of arranging for their paper patient records were transferred to their electronic system.

We undertook this further focussed desk-based inspection on 13 June 2017 to check that the practice had completed the work that they had started to transfer all of their paper patient records onto their electronic system. This report covers our findings in relation to this issue. You can read the report from our previous inspections by selecting the ‘all reports’ link for The Paradise Road Practice on our website at www.cqc.org.uk.

Overall the practice was rated as good following the comprehensive inspection and subsequent focussed inspection. They were rated as requires improvement for providing effective services following both inspections. Following this focussed inspection the practice is rated as good for providing an effective service.

Our key findings were as follows:

• The practice had transferred consultation summaries for all patient records onto the electronic system, and had put in place effective quality assurance arrangements to ensure that records were clearly and accurately scanned.
• The practice’s previous achievement for the Quality Outcomes Framework (QOF) was below average is several areas. There had been no additional QOF data published since the previous inspection in December 2016, as data is typically published in October; however, the practice reported that for the 2016/17 reporting year, they were not outliers for any category and had achieved 96% of the total points available.
• The practice had recruited a new chair for their Patient Participation Group (PPG), and were in the process of recruiting additional members to the group.

However, there is one area provider should make improvements.

The provider should:

• Continue the work they have started to grow and establish the PPG.

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 of The Paradise Road Practice 9 March 2016. A breach of legal requirements was found. After the comprehensive inspection, the practice submitted an action plan, outlining what they would do to meet the legal requirements in relation to the breaches of regulation 17 (Good governance) of the Health and Social Care Act 2008 (Regulated Activities) Regulations 2014.

During the comprehensive inspection we found that the practice had failed to ensure that a complete and contemporaneous record in respect of each service user was kept. We also identified areas where improvements should be made, which included reviewing their complaints process to ensure that it is clear and accessible to all patients; taking necessary action as recommended in their Legionella risk assessment; encouraging patient feedback; advertising the availability of the language interpretation service; reviewing their appointment system to ensure that longer appointments are given to patients who need then; reviewing their systems for recording information such as staff training, complaints and safeguarding concerns; reviewing the safety arrangements of medicines kept at the practice; and ensuring that they are meeting the needs of patients who are carers.

We undertook this focussed desk-based inspection on 6 December 2016 to check that the practice had followed their plan and to confirm that they now met the legal requirements. This report covers our findings in relation to those requirements. You can read the report from our last comprehensive inspection by selecting the ‘all reports’ link for The Paradise Road Practice on our website at www.cqc.org.uk.

Overall the practice was rated as good following the comprehensive inspection. They were rated as requires improvement for providing effective services. Following the focussed inspection the practice remained as requires improvement for providing an effective service.

Our key findings across all the areas we inspected

were as follows:

• The practice displayed information in the waiting area about how to make a complaint, including information about the Patient Advice and Liaison Service. We saw evidence that complaints were discussed with staff during practice meetings and that learning was shared.
• At the time of the initial inspection, we found that the practice had had a Legionella risk assessment completed by a plumber, but that they had not completed the water testing that was recommended. When we re-inspected, we saw evidence that the practice had put in place arrangements to monitor water temperatures and we viewed their records relating to this.
• The practice was actively developing its Patient Participation Group, and we saw evidence that they had advertised the group to patients and that they had written to patients to invite them to join. We were told that a Chair had been identified, and that the practice was in the process of arranging for the group to meet.
• The practice displayed information about the availability of language translation in the patient waiting area.
• The practice provided longer appointments for patients who needed them. A flag was put on the appointment system for relevant patients to alert reception staff of the need to book an extended appointment.
• The practice had processes in place to record and monitor staff training.
• In order to ensure the security of medicines, the practice had applied “tamper tape” to the emergency medicines box, and we were told that they had begun to lock the nurse’s room where medicines were kept when it was not in use.
• At the time of the previous inspection the practice had identified 28 carers, which represented less than 1% of their patient list, and the practice had recently placed cards in the waiting area for carers to complete to identify themselves. At the time of the re-inspection the practice had identified a further five carers, which brought the total to 33 (approximately 1% of the patient list). The practice offered an annual health check to carers and we saw evidence that 16 carers (48%) had attended for this during the past year.

There was one area of practice where the provider must make improvements:

• They must ensure that all patient records are transferred onto the electronic record system.

In addition, there were two areas where the practice should make improvements:

• They should review and address areas where they remain outliers for the Quality Outcomes Framework.
• They should continue to develop their PPG to ensure that they can gather input from 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 The Paradise Road Practice on 9 March 2016. Overall the practice is rated as good.

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.
• Risks to patients were assessed and most were well managed, however, in some cases there was no evidence that the practice had taken action to mitigate risks identified.

• Staff assessed patients’ needs and delivered care in line with current evidence based guidance, however, the practice was in the process of transitioning to a fully computerised patient record system, and we had concerns about their ability to provide effective care to patients whilst they were operating a dual system.
• 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 was available and easy to understand.
• Information about how to complain was available, but only directed patients to speak to the practice manager about their complaint.
• Patients said they found it easy to make an appointment with a named GP and that there was continuity of care, with urgent appointments available the same day.
• 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 was actively exploring ways to seek feedback from patients; it had effective ways to seek feedback from staff, which it acted on.
• The provider was aware of and complied with the requirements of the Duty of Candour.

We found one area where the provider must make improvements:

• They must take action to ensure that all patient information is stored in an accessible format to ensure that the planning and delivery of patient care is safe and effective.

The areas where the provider should make improvement are as follows. They should:

• Review their complaints process to ensure that it is clear and accessible to all patients.
• Consider the recommendations made as a result of the Legionella risk assessment and take necessary action.
• Seek ways to encourage patient feedback.
• Advertise the availability of the language interpretation service.
• Review their appointment system to ensure that where necessary patients are given longer appointments.
• Review their systems for recording information such as staff training, patient complaints, and safeguarding concerns to ensure early detection of areas where action needs to be taken.
• Review the security arrangements for medicines kept at the practice.
• Ensure that they are meeting the needs of patients who are identified as carers.

Professor Steve Field CBE FRCP FFPH FRCGP

Chief Inspector of General Practice