Letter from the Chief Inspector of General Practice

This practice is rated as Good overall. (Previous inspection March 2016 – Good)

The key questions are rated as:

Are services safe? – Requires Improvement

Are services effective? – Good

Are services caring? – Good

Are services responsive? – Good

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 – Requires Improvement

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 Royal Crescent Surgery on 8 November 2017 as part of our inspection programme.

At this inspection we found:

• When incidents happened, the practice learned from them and improved their processes.

• The practice routinely reviewed the effectiveness and appropriateness of the care it provided. Staff ensured that care and treatment was delivered according to evidence- based guidelines.

• Although the practice had systems for the safe management of medicines, these had not been applied consistently to ensure that safety incidents were less likely to happen. For example, actions had not been taken when one of the three vaccine fridges operated outside of the required range.

• A number of patients had been excluded from reviews of their long term conditions, however, there was no clear rationale with regards to these exclusions.

• Staff involved and treated patients with compassion, kindness, dignity and respect.

• Patients found the appointment system easy to use and reported that they were able to access care when they needed it.

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

We saw one area of outstanding practice:

The practice recognised the needs of patients with dementia and had developed a template providing a summary of the consultation for patients living with dementia. This had been devised so that those patients had a record of their consultation to take home to aid their memory of the discussions held during their appointment.

The areas where the provider must make improvements as they are in breach of regulations are:

• Ensure care and treatment is provided in a safe way for patients with regards to vaccines and the monitoring of long term conditions.

The areas where the provider should make improvements are:

• Continue to improve the identification of carers so these patients receive appropriate support.

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 Royal Crescent Surgery on 23 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 well managed.
• The practice had experienced an unexpected reduction in GP cover, this had resulted in a temporary increase in locum cover, however the practice had worked together effectively and demonstrated good resilience to continue to meet the patients’ needs
• 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.
• Feedback from patients about their care and treatment was consistently and strongly positive. Patients said they were treated with compassion, dignity and respect and they were involved in decisions about their care and treatment.
• We saw a strong patient centred caring ethos throughout the practice team.
• 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 proactively 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.

Professor Steve Field (CBE FRCP FFPH FRCGP) 

Chief Inspector of General Practice

This practice is rated as Good overall. (Previous rating November 2017 – Good)

The key questions at this inspection are rated as:

Are services safe? – Good

We carried out an announced comprehensive inspection at Royal Crescent Surgery on 8 November 2017. Overall the practice was rated as good for providing effective, caring, responsive and well-led services giving an overall rating of good. However, the practice was rated as requires improvement for providing safe services and for people with long-term conditions population group. The full comprehensive report of the 8 November 2017 inspection can be found by selecting the ‘all reports’ link for Royal Crescent Surgery on our website at .

This inspection was an announced focused inspection carried out on 25 September 2018. The purpose was to confirm that the practice had carried out their plan to meet the legal requirements in relation to the breaches in regulations identified in our previous inspection on 8 November 2017. This report covers our findings in relation to those requirements and also additional improvements made since our last inspection.

We have amended the rating for this practice to reflect these changes. The practice is now rated good for the provision of safe services and for people with long term conditions. Overall the practice remains rated as good.

At this inspection we found:

• The practice had reviewed and improved systems and processes to ensure the temperature of vaccine fridges were monitored and actions were taken when there were signs that the fridges had operated outside of the normal range.
• 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.
• Systems and processes had been reviewed to ensure all patients with long term conditions were reviewed including those who had previously been excepted from reviews.
• The practice had increased the number of patients identified as carers.

The areas where the provider should make improvements are:

• Continue to monitor and improve uptake for reviews of patients with long term-conditions.
• Provide written guidance setting out the standards for the management of test results in the practice.

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

Please refer to the detailed report and the evidence tables for further information.