Letter from the Chief Inspector of General Practice

We carried out an announced comprehensive inspection of this practice on 21 December 2015. Breaches of legal requirements were found. After the comprehensive inspection, the practice wrote to us to say what they would do to meet legal requirements in relation to the regulatory breaches of the Health and Social Care Act 2008 (Regulated Activities) 2014 Regulation 12 Safe care and treatment, Regulation 17 Good governance and Regulation 19 Fit and proper persons employed.

We undertook this focused inspection on 29 June 2016 to check that they had followed their plan and to confirm that they now met the legal requirements. This report only 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 Rossington Practice on our website at www.cqc.org.uk.

Overall the practice is rated as Good.

Specifically,following the focused inspection we found the practice to be good for providing safe, effective and well-led services.

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

• All staff who acted as chaperones were trained for the role and had received a Disclosure and Barring Service (DBS) check completed following our last inspection in December 2015.
• We were shown the protocol for the safe storage and use of prescription pads implemented in January 2016. We observed blank prescription forms and pads were securely stored and there were systems in place to monitor their use and the protocol was being followed.
• We were shown a copy of the Health and Safety policy which was implemented in January 2016. We were told by the practice manager that updated health and safety training was arranged for staff to complete in July 2016.

• The practice had purchased a new defibrillator in January 2016 which was available on the premises and ready for use.
• The practice had a reviewed its business continuity arrangements for major incidents such as power failure or building damage.
• The practice had reviewed the information collected for the Quality and Outcomes Framework (QOF) and performance against national screening programmes to monitor and improve outcomes for patients. Improvements were demonstrated.

• Staff had also reviewed outcomes for patients and there was evidence of quality improvement including clinical audit.
• The practice had reviewed the overarching governance framework which supported the delivery of the strategy and good quality care. This outlined the structures and procedures in place. We observed recruitment records were now organised and kept in a secure place.

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 Rossington Practice on 21 December 2015. Overall the practice is rated as requires improvement.

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

• Staff understood and fulfilled their responsibilities to raise concerns, and to report incidents and near misses. However, outcomes of incident investigations were not reviewed to identify themes and trends.
• Some risks to patients were assessed and managed, with the exception of those relating to pre-employment and emergency equipment checks.
• Data showed patient outcomes were low compared to the locality and nationally. Some audits had been carried out and we saw some evidence audits were driving improvement in performance to improve patient outcomes.  The practice did not have a programme of continuous clinical audit.
• The majority of patients said they were treated with compassion, dignity and respect.
• Information about services was available but not kept up to date on the practice website.
• Urgent appointments were usually available on the day they were requested.
• The practice had a number of policies and procedures to govern activity, but some were overdue a review.
• The practice had proactively sought feedback from patients and was actively trying to recruit more members to the patient participation group.

The areas where the provider must make improvements are:

• Ensure recruitment arrangements include all necessary employment checks for all staff.
• Ensure emergency equipment is available and where applicable in date ready for use.
• Review and update procedures and guidance promoting consistency in practice.
• Ensure prescriptions are tracked through the practice following NHS Protect guidance.

In addition the provider should:

• Review the risk assessment for administration staff not requiring disclosure and barring service checks.
• Consider a continuous quality improvement programme to include clinical audit, medication optimisation and other performance activity to improve outcomes for patients.
• Review the use of care plans for patients to promote consistency in care.
• Maintain an up to date record of staff training activity.

Professor Steve Field CBE FRCP FFPH FRCGP 

Chief Inspector of General Practice

We carried out a follow-up inspection to assess whether The Rossington Practice had implemented actions in response to non-compliance found at its inspection in November 2013. This was in relation to infection, prevention and control and the assessment and monitoring of the quality of services patients received.

We found action had been taken to ensure standards in these areas were being met. The practice had put systems in place to assess the risk of and to prevent and control the spread of health care associated infection. Changes had also been made to ensure that learning from incidents and investigations took place and appropriate changes were implemented. Staff told us meetings had been introduced where patient safety was discussed with all practice staff. We saw the systems for responding and learning from complaints had improved. The practice complaints procedure had been updated to reflect national guidance. The practice took account of patient complaints and comments to improve the quality of the service.

During the inspection we spoke with ten patients. They told us they understood the care and treatment choices available to them. They said they received sufficient information to make decisions about their care and treatment. One patient said, "I get good information and feel involved in my treatment. The GP gives me time to ask any questions." Another patient told us, "The female GP is lovely and explains all the tests and treatment."

We received mixed comments from patients about the standard of care they had received. Most of the patients we spoke with were satisfied with their care and treatment. One patient told us, "Perfect treatment, I have no complaints." Another patient said, "I get good care, can't fault it, happy with everything." A few patients told us sometimes they felt some doctors didn't have time for them and where dismissive about their health concerns.

We found patients were not protected from the risk of infection because appropriate guidance had not been followed. The systems in place were not effective to assess the risk of and prevent, detect and control the spread of infection.

Patients were cared for by staff who were supported to deliver care and treatment safely and to an appropriate standard. Staff had received sufficient training to ensure they continued to meet the professional standards which were a condition of their ability to practice.

The provider did not have an effective system to regularly assess and monitor the quality of service that patients received. The systems in place were not sufficient to identify, assess and manage the risks to the health, safety and welfare of patients who used the service and others.