Letter from the Chief Inspector of General Practice

We carried out an announced comprehensive inspection at The Redcliffe Surgery on 9 July 2015. Overall the practice is rated as Good.

Please note that when referring to information throughout this report, for example any reference to the Quality and Outcomes Framework data, this relates to the most recent information available to the CQC at that time

Our key findings were as follows:

• Patients were protected from risk of harm because systems and processes were in place to keep them safe.
• Staff were clear about reporting incidents, near misses and concerns and there was evidence of communication of lessons learned with staff.
• The practice worked in collaboration with other health and social care professionals to support patients’ needs and provided a multidisciplinary approach to their care and treatment.
• The practice promoted good health and prevention and provided patients with suitable advice and guidance.
• The practice had several ways of identifying patients who needed additional support, and was pro-active in offering this.
• The practice provided a caring service. Patients indicated that staff were caring and treated them with dignity and respect. Patients were involved in decisions about their care.
• The practice provided appropriate support for end of life care and patients and their carers received good emotional support.
• The practice learned from patient experiences, concerns and complaints to improve the quality of care.
• The practice had a clear, patient-centred vision and staff were clear about the vision and their responsibilities in relation to this.
• There was an open culture and staff felt supported in their roles.

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

• Ensure regular checks carried out on the contents of the medical emergency box are recorded.
• Review the practice’s consent protocol to ensure mental capacity is appropriately taken into account, linked to the practice's mental capacity act protocol.
• Consider putting in place a practice record of GP revalidation to enable a central overview to be maintained of validation when completed or due.

Professor Steve Field (CBE FRCP FFPH FRCGP) 

Chief Inspector of General Practice

We carried out this inspection as we had received information regarding the potential incorrect storage of medicines. We found medicines including vaccines were kept safely. All medicines were clearly labelled and dated. We saw that where there had been an incident where the fridge had shown irregular temperatures on occasions, the practice had taken appropriate action.

However, whilst the practice was able to obtain computerised fridge temperature readings, we found there were gaps in the manual records of fridge temperature checks. The records also contained readings that were illegible and we were not able to identify who had taken the reading.

We carried out an announced comprehensive inspection at The Redcliffe Surgery on 8 January 2019 as part of our inspection programme.

We based our judgement of the quality of care at this service is on a combination of:

• what we found when we inspected
• information from our ongoing monitoring of data about services and
• information from the provider, patients, the public and other organisations.

We have rated this practice as good overall.

We rated the practice as outstanding for providing well-led services because:

• The culture of the practice and the way it was led and managed drove the delivery and improvement of high-quality, person-centred care.

We rated the practice as outstanding for the mental health population group because:

• Services were tailored to meet the needs of mental health patients. They were delivered in a flexible way that ensured choice and continuity of care.
• There were innovative approaches to providing integrated person-centred care

We also rated the practice as good for providing safe, effective, caring and responsive services and for all other population groups because:

• The practice provided care in a way that kept patients safe and protected them from avoidable harm.
• Patients received effective care and treatment that met their needs.
• Staff we spoke with were positive about working at the practice and the leadership and management team.
• Staff dealt with patients with kindness and respect and involved them in decisions about their care.
• The practice organised and delivered services to meet patients’ needs. Patients could access care and treatment in a timely way.
• The practice promoted good health and prevention and provided patients with suitable advice and guidance.
• The Patient Participation Group (PPG) was very involved in the practice. They met six times a year to ensure they maintained regular communication. For example, sharing information on changes and improvements and gathering regular patient feedback which contributed to shaping ongoing future developments and business planning.

We saw several areas of outstanding practice including:

• They offered a personalised holistic approach to care for patients with serious and longer term, common mental health needs, and dementia. This was done in partnership with the Community Living Well Service (CLW), offering a pro-active and preventative approach. They also made regular use of The Short Warwick-Edinburgh Mental Well-being Scale (SWEMHWB) to measure impact of care plans encouraging GPs to have wider conversations about wellbeing. The practice (Ipsos Mori GP Patient Survey 2018) showed high satisfaction ratings for treatment of those with mental health needs 95% (CCG average 86% and National Average 87%);

• The leadership drove continuous improvement and staff were accountable for delivering change. They held annual away days for all staff where they updated the business plan and strategy, including key priorities for the year. All staff would then be part of working groups to implement changes. They had protected time for learning sessions on a monthly basis to bring together the practice staff and to feedback proposals from each working group to reach agreements.

• There was a clear proactive approach to seeking out new ways of providing care and treatment. The practice recently introduced two new roles into the practice, case managers and the practice pharmacist which has freed up two hours a day of doctor time to enable them to do other medical tasks.

• The practice had developed a patient partnership charter in conjunction with the PPG that stated the practice vision and what the patients could expect from the practice and in turn what the practice expected from patients.

• Safe innovation was encouraged, for example we saw the Health and Social care assistant had arranged a coffee morning for older adults to reduce social isolation, and to introduce locally available events such as yoga which was attended by 13 patients.

The areas where the provider should make improvements are:

• Continue to implement processes to improve the take up of childhood immunisations

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Details of our findings and the evidence supporting our ratings are set out in the evidence tables.

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