This inspection was an announced focused inspection carried out on 14 January 2019. This was to confirm that the practice had improved in the areas identified at an earlier inspection. We previously carried out an announced comprehensive inspection at The Ridge Medical Practice on 28 November and 5 December 2017. The overall rating for the practice was good, with a rating of requires improvement for providing responsive services. We told the provider they should:

• Continue to review, act on and improve patient satisfaction in accessing services at the provider and in their interactions with clinical staff. Patient satisfaction in these areas was below local and national averages and highlighted as an issue of concern in patient feedback during the inspection.

• Review how strategic policy and decision making is shared by the senior leadership team across the wider staff team and patient population. Some staff we spoke with spoke with described a lack of effective communication across the organisation. Patient insights into why non-GP clinicians were offered in place of a doctor was not widely understood in some of the feedback we received during our inspection.

The full comprehensive report for that inspection (published on 29 January 2018) can be found by selecting the ‘all reports’ link for The Ridge Medical Practice on our website at .

Our judgement of the quality of care at this service is based on a combination of what we found when we inspected, information from the provider, patients, public, other organisations and our ongoing monitoring of data about services.

Our findings from the most recent inspection confirm that:

This practice remains rated as good overall and is also now rated as good for providing responsive services.

At this inspection we found:

• The practice had undertaken their own comprehensive patient satisfaction survey and consulted widely across their practice population. Results from this survey showed improvement against the most recent GP national patient survey against like for like questions and was twice the sample of the national survey.
• Focus group consultations had been held with hard to reach sections of the patient population to be assured that all voices were being actively heard.
• Additional resources had been invested into the telephone system that had improved the effectiveness of the appointment system. We saw that patient satisfaction had improved as a result.
• The practice had engaged with two other practices to understand how they had achieved high levels of patient satisfaction and applied the learning to their ongoing business and communication strategy across the staff team and patient population.
• The practice had trained staff in the care navigation model of care to direct patients to the most appropriate clinician or service.
• Patients who did not speak English were able to see an East European interpreter available at the main site every weekday morning or speak to a range of staff fluent in a range of commonly spoken South Asian languages.

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

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 Ridge Medical Practice on 19 July 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.

• Staff assessed patients’ needs and delivered care in line with current evidence based guidance. Staff had been trained to provide them with 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. The GPs and Business Manager had met with patients to discuss their concerns and improvements were made to the quality of care as a result of complaints and concerns. There were two lead GPs identified who led on all clinical complaints and provided advice and support to other clinicians in the practice in relation to complaints.

• Risks to patients were assessed and well managed and the practice was able to evidence references for all staff with copies of job descriptions. The practice had a robust electronic storage and retrieval system in place for staff records. All staff had appropriate Disclosure and Barring Service check (DBS) which had been undertaken on all staff. DBS checks identify whether a person has a criminal record or is on an official list of people barred from working in roles where they may have contact with children or adults who may be vulnerable.

• 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. Staff told us that they would feel confident to raise any concerns with the GP partners and that there was an open and supportive culture within the practice.

• The provider was aware of and complied with the requirements of the duty of candour.

We saw areas of outstanding practice

• The Ridge actively looked to make sure that they identify and prioritise care for any who may be vulnerable. The practice has pioneered a new template with the CCG in the last year around equitable access needs and they have already met the new standard well in advance of the CCG deadline.

• In the role as mental health commissioning lead for the CCG a Ridge GP led the team that designed and established the award winning First Response Service. All patients on the SMI (Severe Mental Illness) register are given an annual check-up focusing on the five care processes defined nationally.

• The practice had a Slovakian speaking wellbeing worker one day per week and a Slovakian interpreter based in the reception area at the practice every morning, which was designed to help people understand the services that the GP surgery would offer.

• The practice health champions group hosted a number of community focussed social groups such as the” Knit and Natter” group. The practice and the partners used these groups to deliver health education messages and improve access to health care for their patients. For example, the practice focussed on teaching people how to book and arrange appointments and what services were available.

• The practice health champions managed stalls and provision of second hand clothes. There were stalls in reception that encouraged all to participate in supporting this good cause.

Professor Steve Field (CBE FRCP FFPH FRCGP) 

Chief Inspector of General Practice

Letter from the Chief Inspector of General Practice

This practice is rated as Good overall, but Requires Improvement for providing responsive services.

The practice had been previously inspected on 19 July 2016 when it was rated as Good overall.

The key questions are rated as:

Are services safe? – Good

Are services effective? – Good

Are services caring? – Good

Are services responsive? – Requires Improvement

Are services well-led? - Good

As part of our inspection process, we also look at the quality of care for specific population groups. The population groups are rated as:

Older People – Good

People with long-term conditions – Good

Families, children and young people – Good

Working age people (including those recently retired and students – Good

People whose circumstances may make them vulnerable – Good

People experiencing poor mental health (including people with dementia) - Good

We carried out an announced comprehensive inspection at The Ridge Medical Practice on the 28th November and 5th December 2017. The inspection was carried out 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.

• There was extensive evidence of clinical audit and implementation of learning across the clinical team

• The provider was an Advanced Training Hub; this meant that a wide variety of clinicians including trainee GPs, paramedics, pharmacists and medical undergraduates attended placements at the provider.

• The provider employed a number of clinical staff who had received enhanced training in the care of the children, the elderly, patients with mental illness and those with epilepsy.

• Prescribing levels of antibiotics had been reduced in line with local and national targets.

• The majority of patients told us that staff across the whole team were kind and caring and that they were treated with compassion, dignity and respect.

• Results from the national GP patient survey showed that the provider was performing lower than the national average in terms of access and in some consultations with clinical staff.

• Patients who were receiving end of life care were identified by the provider and care was effectively coordinated with their choices being actively met.

• Patients frequently found it difficult to access routine appointments. However, they told us that they were usually able to access urgent care when they needed it.

• There was a strong focus on continuous learning, clinical education and improvement at all levels of the organisation.

• Volunteer Practice Champions from across the patient group actively supported various health promotion and well-being initiatives.

The areas where the provider should make improvements are:

• Continue to review, act on and improve patient satisfaction in accessing services at the provider and in their interactions with clinical staff. Patient satisfaction in these areas was below local and national averages and highlighted as an issue of concern in patient feedback during the inspection.

• Review how strategic policy and decision making is shared by the senior leadership team across the wider staff team and patient population. Some staff with spoke with described a lack of effective communication across the organisation. Patient insights into why non-GP clinicians were offered in place of a doctor was not widely understood in some of the feedback we received during our inspection.

Professor Steve Field CBE FRCP FFPH FRCGP

Chief Inspector of General Practice