Letter from the Chief Inspector of General Practice

We carried out an announced comprehensive inspection at The Red House on 26 October 2016. The overall rating for the practice was good. However, we identified a breach of legal requirements. Improvements were needed to systems, processes and procedures to ensure the practice provided safe services. Consequently the practice was rated as requires improvement for providing safe services. The full comprehensive report from the 26 October 2016 inspection can be found by selecting the ‘all reports’ link for The Red House on our website at www.cqc.org.uk.

After the comprehensive inspection, the practice wrote to us and submitted an action plan outlining the actions they would take to meet legal requirements in relation to;

• Regulation 18 Health & Social Care Act 2008 (Regulated Activities) Regulations 2014

- Staffing.

The area identified as requiring improvement during our inspection in October 2016 was as follows:

• Ensure that staff who act as chaperones are appropriately trained.

In addition, we told the provider they should:

• Implement a system to monitor the temperature of vaccines transported between the three surgeries to ensure they stay within the required levels.
• Ensure that comprehensive fire safety records and logs are maintained at all three surgeries.
• Ensure that water temperature checks are completed.
• Ensure that all appropriate medical equipment is checked and calibrated within the required timescales.

• Ensure that all staff employed are supported by receiving appropriate supervision and appraisal and are completing the essential training relevant to their roles, including infection prevention and control training.
• Continue to identify and support carers in its patient population.
• Ensure that, where practicable and appropriate, all reasonable adjustments are made for patients with a disability in line with the Equality Act (2010).

We carried out an announced focused inspection on 19 July 2017 to confirm that the practice had carried out their plan to meet the legal requirements in relation to the breach of regulation that we identified in our previous inspection on 26 October 2016. This report covers our findings in relation to those requirements and also additional improvements made since our last inspection.

Our key finding on this focused inspection was that the practice had made improvements since our previous inspection and were now meeting the regulation that had previously been breached.

The practice is now rated as good for providing safe services.

On this inspection we found:

• All staff who acted as chaperones were trained for the role.

Additionally where we previously told the practice they should make improvements our key findings were as follows:

• All staff had completed infection control training.
• A system was in place and adhered to for monitoring the temperature of vaccines when they were transported between the surgeries and ensure they stayed within the required levels.
• Fire safety logs and records were appropriately maintained.
• All clinical equipment was checked to ensure it was working properly.
• Water temperature checks were completed and recorded.
• A programme was in place to ensure all staff received an appraisal on an annual basis and this was on schedule. We found that of the nine non-clinical staff previously overdue their annual appraisals and who were still employed by the practice, all had received or been offered a fully documented appraisal between December 2016 and March 2017.

• Through a proactive approach from staff the practice had increased the amount of carers identified in its patient population. As of July 2017 the practice had identified 335 patients on the practice list as carers. This was approximately 1.7% of the practice’s patient list and was an increase of around 50% from our inspection in October 2016. The practice held a carers’ event in January 2017 and another event was planned for September 2017. The practice’s Patient Participation Group (the PPG is a community of patients who work with the practice to discuss and develop the services provided) was actively engaged with this.

• We saw that following our comprehensive inspection in October 2016 the practice had installed a support rail in the accessible toilet facility at Park Street Surgery. A baby change mat was purchased for the surgery and a notice was displayed in the toilet to promote this facility. We saw that hearing loops were provided in the reception areas at Gateways Surgery and Park Street Surgery (one was available at The Red House Surgery during our October 2016 inspection). The staff we spoke with said they were confident in using the equipment if the need arose and written guidance was available to them.

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 Red House on 26 October 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 managed.

• 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. However, some staff who acted as chaperones had not received the appropriate training.
• The patients we spoke with or who left comments for us were positive about the standard of care they received and about staff behaviours. They said staff were helpful, friendly, sympathetic and attentive. They told us that their privacy and dignity was respected 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. Improvements were made to the quality of care as a result of complaints and concerns.
• Patients said they found it easy to make an appointment with a named GP and 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 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.

We saw one area of outstanding practice:

• A weight management service was provided at The Red House Surgery twice each week. As part of this the practice offered advice to patients on diet and exercise programmes with follow ups over a 13 week period. At the time of our inspection, 506 patients had participated in the programme with 48% achieving a weight loss of between 5kg and 10kg.

The areas where the provider must make improvements are:

• Ensure that staff who act as chaperones are appropriately trained.

The areas where the provider should make improvements are:

• Implement a system to monitor the temperature of vaccines transported between the three surgeries to ensure they stay within the required levels.
• Ensure that comprehensive fire safety records and logs are maintained at all three surgeries.
• Ensure that water temperature checks are completed.
• Ensure that all appropriate medical equipment is checked and calibrated within the required timescales.
• Ensure that all staff employed are supported by receiving appropriate supervision and appraisal and are completing the essential training relevant to their roles, including infection prevention and control training.

• Continue to identify and support carers in its patient population.
• Ensure that, where practicable and appropriate, all reasonable adjustments are made for patients with a disability in line with the Equality Act (2010).

Professor Steve Field (CBE FRCP FFPH FRCGP) 

Chief Inspector of General Practice