Archived: Rosebank Surgery

Letter from the Chief Inspector of General Practice

Rosebank Surgery operates from three sites. The first, Scale Hall, is in the north of the city. The second is in Galgate, three miles south of the city. The final is the main surgery, Rosebank, opposite the Royal Lancaster Infirmary. We visited Rosebank-Lancaster and Rosebank-Galgate sites as part of our inspection on 01 October 2014. 

We inspected this practice as part of our new focused, comprehensive, inspection programme. This practice had not been inspected before. We looked at how well the practice provided services for specific groups of patients. These included; older patients, patients with long-term conditions, families, children and young people, working age patients (including those recently retired and students), patients living in vulnerable circumstances and patients experiencing poor mental health (including people with dementia).

During our visit we spoke with staff including GPs, receptionists, administration staff, nurses, the dispensing pharmacy staff and with five patients who used the service. Patients spoken with and the 30 completed Care Quality Commission comment cards from the three sites were all extremely complimentary about the care and treatment being provided. Patients reported that all staff treated them with dignity and respect. They found the doctors and nurses delivered a very personalised service and had an excellent understanding of their needs.

We found that the leadership team was very visible. There were good governance and risk management measures in place. We found that the practice met the regulations and provided services that were caring, responsive, safe, well led and effective.

The overall rating for this practice was good.

Our key findings were as follows:

• The practice provided an effective service for all age groups. GPs, apart from having the overall competence to assess each person attending the service, had particular interest areas. For example one GP is the Cardiology Lead for the local Clinical Commissioning Group (CCG) and helps run the Community Heart Failure Service. Care and treatment was being delivered in line with current published best practice.

• The practice had systems in place that reflected best practice in end of life care and demonstrated an ethos of caring and striving to achieve a dignified death for patients. This was actively supported by practice staff and local community initiatives.
• We found that clinicians critically reviewed their practices and this had led to not only changes in their own working practice but also that of other organisations.
• Patients confirmed they were able to contact the practice and speak with a health practitioner and found the service provided was both timely and accessible. The practice operated an all-day triage system for appointment requests. Patients spoke positively about the system.  All the patients we spoke with confirmed they would be offered a same day appointment if there was an urgent need.

We saw several areas of outstanding practice including:

• One of the GP partners was appointed as the National Clinical Lead in palliative care by the Royal College of General Practitioners. The GP led a three year national programme working to improve end of life care in primary settings. The practice had systems in place that reflected best practice in this regard and demonstrated an ethos of caring and striving to achieve dignified death for patients. We were told and audits demonstrated that in appropriate cases patients were ‘offered’ conversations around end of life planning such as advance care plans, preferred care priorities and resuscitation but such discussions were never ‘imposed.'

• One GP partner is the Cardiology Lead for the local Clinical Commissioning Group and helps run the Community Heart Failure Service with remote support for their cardiac patients. This enabled patients to remain in the comfort of their own home whilst receiving appropriate monitoring of their condition.
• Staff were consistent in supporting patients to live healthier lives through a targeted and proactive approach to health promotion and the prevention of ill-health. There was for example a nurse led five year development plan in place with clear strategic vision. This included a nurse led initiative reviewing all patients at potential risk of the development of diabetes. The nurses invited patients to attend the practice in October 2014 as a group, for an education and health promotion event to improve the health of their registered population, of all ages.
• The practice had a clear vision and overall strategy regarding the practice and its development. We saw evidence that showed the practice worked with the CCG to share information, monitor performance and implement new methods of working to meet the needs of local people. There was evidence of a good learning culture and appropriate information sharing of significant events.
• The practice’s rural community dispensary and practice also provided the addition of a pharmacy in response to meeting the needs of their local community.

However, there were also areas of practice where the provider should make improvements. 

The provider should:

• Record the recruitment checks they had completed on staffs professional registration details as is appropriate.The practice was unable to provide evidence of some of the recruitment checks they had completed. The recruitment records did not always include all the information as specified in Schedule 3 of the Health and Social Care Act (2008) for the purposes of carrying on a regulated activity.
• Improve the arrangements for the reauthorisation of prescriptions for patients on medicines requiring regular blood tests.

Professor Steve Field (CBE FRCP FFPH FRCGP) 

Chief Inspector of General Practice