We carried out an announced comprehensive inspection at Two Rivers Medical Centre on 15 August 2017. The practice was rated as requires improvement for providing safe services and good for providing effective, caring, responsive and well led services. Overall the practice was rated as good. The full comprehensive reports on the 15 August 2017 inspection can be found by selecting the ‘all reports’ link for Two Rivers Medical Centre on our website at www.cqc.org.uk.

We carried out an announced focused inspection at Two Rivers Medical Centre on 19 February 2018. This was to check they had followed their action plan and to confirm they now met legal requirements in relation to the breaches identified in our previous inspection on 15 August 2017. This report covers our findings in relation to those requirements and also additional improvements made since our last inspection.

Overall the practice is now rated as good, and good for providing safe services.

Our key findings from this inspection were as follows:

• The practice had effective systems in place to ensure that Disclosure and Barring Service (DBS) checks were completed for all staff who worked unsupervised with patients.
• Significant events were investigated, reviewed and all learning had been identified and outcomes were monitored to completion.
• Emergency medicines were stored appropriately and room temperatures were recorded to ensure these medicines were stored within the recommended range.
• Portable electrical appliance testing had been undertaken in September 2017.
• The practice had five nurse practitioners, all of whom had qualified as Independent Prescribers and could therefore prescribe medicines for specific clinical conditions. They received support from GPs for this extended role; however there was no formal review of their work.
• The practice had a carers’ champion and a dedicated carers’ information board in the reception area. Work had been undertaken to ensure that patients identified as carers had been coded appropriately. The practice had identified 549 patients as carers, which was just over 2% of the practice list.

The areas where the provider should make improvements are:

• Consider the need to formally review the work undertaken by the nurse practitioners to obtain assurance of the quality of their work.

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 Two Rivers Medical Centre on 15 August 2017. Overall the practice is rated as good.

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

• There was an effective system in place for reporting and recording significant events. The investigation of significant events was not always documented fully to ensure that all learning had been identified. Learning was shared and action was taken to improve safety in the practice.

• The practice had systems, processes and practices in place to keep patients safe and safeguarded from abuse. However not all staff, which included four nurses who had unsupervised contact with patients, had a Disclosure and Barring Service check.

• Patient safety alerts were logged, shared and initial searches were completed and the changes effected.

• Medicines were generally managed well at the practice. Patients on high risk medicines were identified, monitored and reviewed. However the temperature of the room where some medicines were stored was not being monitored.

• Comprehensive infection prevention and control processes were in place, including training and a detailed programme of audits.
• 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.
• The practice had two carer champions who had undertaken work to inform carers about the services available. The practice identified 155 patients as carers, (0.6% of the practice list).
• 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. In depth investigations were undertaken in response to complaints and learning and improvements were made to the quality of care as a result of complaints and concerns.
• The practice had employed a range of health care professionals which included two paramedics, a pharmacist and five nurse practitioners, who were independent prescribers to meet the range of patients’ needs. The paramedics and nurse practitioners received supervision and support from GPs, although this was only formalised for the paramedics.
• The practice had very good facilities and was well equipped to treat patients and meet their needs.
• The practice sought feedback from staff and patients, which it acted on. Some patients and representatives we spoke with and received comments from, reported difficulty in getting a routine GP appointment, or a home visit by a GP. The practice continuously monitored access and gave examples of how they had responded to meet patient demand.
• The practice management team and the staff had worked hard during the process of merging two GP practices into Two Rivers Medical Centre team, which had included the building of and relocation to the new building. There was a clear leadership structure, which was continuing to develop. There was an open and friendly management style, and staff felt supported by management.

The areas where the provider must make improvement are:

• Ensure care and treatment is provided in a safe way to patients.

The areas where the provider should make improvement are:

• Review the documentation of all significant events to ensure that all learning had been identified.

• Consider the need to formally review the work undertaken by the nurse practitioners to obtain assurance of the quality of their work.

• Monitor room temperatures where medicines are stored to ensure they are within the recommended range.

• Undertake checks of the portable electrical appliances used at the practice.

• Continue to identify carers and ensure they are coded appropriately.

Professor Steve Field (CBE FRCP FFPH FRCGP) 

Chief Inspector of General Practice