The Care Quality Commission
  • Doctor
  • GP practice

GP Practice at Riverside

Overall: Good read more about inspection ratings

Riverside Centre for Health, Park Street, Liverpool, Merseyside, L8 6QP (0151) 295 9210

Provided and run by:
Dr Don Jude Chaminda Mahadanaarachchi

Important: The provider of this service changed - see old profile

All Inspections

Not applicable

During an inspection looking at part of the service

We carried out an announced review at GP Practice at Riverside on 28 and 29 June 2021. This review focused on the regulatory breaches previously found.

This remote assessment did not result in the provider being awarded a rating as a site visit was not undertaken.

The full report for the previous inspection can be found by selecting the ‘all reports’ link for GP Practice at Riverside on our website at www.cqc.org.uk

Why we carried out this review.

This review was a focused follow-up review of information without undertaking a site visit, to follow up on two breaches of regulation. These were identified at the previous review we carried out between 9 and 12 November 2020. At that time, we identified improvements were needed to the governance of the service and to ensure medicines were managed safely. We issued warning notices for breaches of:

  • Regulation 12(1) HSCA (RA) Regulations 2014 Safe care and treatment
  • Regulation 17(1) HSCA (RA) Regulations 2014 Good governance

We looked at the following key questions:-

  • Safe
  • Effective
  • Responsive
  • Well-led

How we carried out the review

Throughout the pandemic CQC has continued to regulate and respond to risk. However, taking into account the circumstances arising as a result of the pandemic, and in order to reduce risk, we have conducted our reviews differently.

This review was carried out in a way which enabled us to not spend any time on site. This was with consent from the provider and in line with all data protection and information governance requirements.

This included:

  • Conducting staff interviews using video conferencing
  • Completing clinical searches on the practice’s patient records system and discussing findings with the provider
  • Reviewing patient records to identify issues and clarify actions taken by the provider
  • Requesting evidence from the provider

Our findings

We based our judgement of the quality of care at this service on a combination of:

  • what we found when we inspected
  • information from our ongoing monitoring of data about services and
  • information from the provider, patients, the public and other organisations.

We found that a number of improvements had been made since the last remote assessment, including:

  • The provider had undertaken a recruitment drive and new systems and induction programmes were developed to support new and temporary staff.
  • The processes for monitoring patients’ health in relation to the use of medicines including high risk medicines, had significantly improved.
  • There had been improvements to policies and procedures to ensure there was clear guidance for staff.
  • The arrangements for identifying, recording and managing risks, issues and mitigating actions had improved. This included the management of significant events and complaints monitoring.
  • The practice had systems and processes to keep clinicians up to date with current evidence-based practice.
  • The practice had an improved programme of quality improvement and used information about care and treatment to make improvements.
  • We found that improvements had been made to the governance systems to ensure better oversight, monitoring and review.
  • There was improved clinical leadership from a lead GP and nurse and regular monthly clinical meetings with practice staff.
  • Staff reported that they felt able to raise concerns without fear of retribution.
  • Staff reported that there had been improvements to communication and their involvement in the operation of the service.

We found areas where improvements needed to be made:-

  • Since the last inspection the provider had developed a training plan. However, there were gaps identified in the required mandatory training for a number of clinical staff.
  • A systematic approach to determine the number of staff and range of skills required in order to meet the needs of patients and keep them safe was not in place.
  • There was insufficient support or monitoring of clinical staff. Appraisals and formal supervision had not taken place.
  • Some staff told us there was not always enough clinical staff for the volume of work and there was a lack of continuity of staff. Staff told us there was not enough practice nurses and not enough long-term GPs.
  • The provider used a high number of locum staff to maintain clinical staffing levels without effective oversight.

We found a breach of regulation. The provider must:

  • Ensure sufficient numbers of suitably qualified, competent, skilled and experienced persons are deployed to meet the fundamental standards of care and treatment.
  • Ensure persons employed in the provision of the regulated activity receive the appropriate support, training, professional development, supervision and appraisal necessary to enable them to carry out their duties.

(Please see the specific details on action required at the end of this report).

The areas where the provider should make improvements:

  • Review and improve significant event reporting and analysis forms to fully document learning and action taken.
  • Review and improve processes to seek feedback from patients about access to the services provided.
  • Review and improve the procedures for offering patients a service at another location operated by the provider.
  • Review and improve the policy for staff development and retention.
  • Review and improve the record keeping of checks to ensure the receptionists are allocating patients to the correct area of the triage system.
  • A programme for audits should be put in place which reflects local, national and service priorities.
  • The provider should ensure that a written agreement or contract is in place for GP locums working at the practice. Formal procedures and monitoring processes should be put into place for locum GPs to ensure safe treatment and care is carried out.

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

Dr Rosie Benneyworth BM BS BMedSci MRCGP

Chief Inspector of Primary Medical Services and Integrated Care

09 - 12 November 2020

During an inspection looking at part of the service

This report was created as part of a pilot which looked at new and innovative ways of fulfilling CQC’s regulatory obligations and responding to risk in light of the Covid-19 pandemic and reducing the burden placed on practices by minimising the time inspection teams spend on site.

This was conducted with the consent of the provider. Unless the report says otherwise, we obtained the information in it without visiting the Provider. The assessment did not include on-site inspection and therefore the practice has not been rated or ratings from our previous inspection have not been reviewed.

Background:

We undertook a remote regulatory assessment between 9 and 12 November 2020 following information of concern being brought to our attention. The concerns related to staffing levels, care and treatment of patients, the management of the service and staff welfare. The practice had previously not been inspected under this provider’s registration.

The service is registered with CQC under the Health and Social Care Act 2008 to provide the regulated activities of: Diagnostic and screening procedures, Maternity and midwifery services, Surgical procedures and Treatment of disease, disorder or injury.

The registered provider is the responsible individual and is the ‘registered person’. Registered persons have legal responsibility for meeting the requirements in the Health and Social Care Act 2008 and associated Regulations about how the service is run.

During the assessment we reviewed GP Practice at Riverside’s clinical record system which included the practice’s task management system and a sample of electronic patient records.

We based our judgement of the quality of care at this service on a combination of:

  • what we found when we carried out the assessment.
  • information from our ongoing monitoring of data about services and
  • information from the provider, staff, patients, the public and other organisations.

We found that:

  • Staff felt patients had their needs met and that overall care was prioritised depending on need. However, the workload was high, sometimes excessive and sometimes there were insufficient staff to meet patient demand.
  • The provider did not have a system in place to effectively assess and manage staffing needs to ensure patient safety.
  • There were gaps in systems to assess, monitor and manage risks to patients, for example, the management of patients’ medicine reviews.
  • The monitoring of patients’ medication, including high risk medication, was not robust. Medication reviews and monitoring was not done in a timely manner, lacked oversight and was not always managed safely.
  • There were no assurance processes that patients test results were processed and acted upon in a timely manner.
  • The systems to report, analyse, learn and make improvements when things went wrong were not robust. The significant event procedures needed improvement.
  • Good governance systems and processes required improvements. The governance framework was not clearly defined or identified. There was insufficient review, analysis and a lack of action planning and review.
  • There was a senior management team and structure in place, they had a vision and supporting strategies in place.
  • The organisation and the practice were supported by a culture strategy and staff reported that they felt able to raise concerns without fear of retribution. Staff generally felt well supported by colleagues and managers and they felt the culture of the practice was one of openness and honesty.
  • There were a number of communication methods in place, however improvements were needed. Structured, formally recorded meetings that looked specifically at operational or clinical issues were not taking place at practice level.
  • Some of the policies and procedures that we looked at required review and improvements as they lacked significant detail such as the checks to be undertaken during the staff recruitment process.
  • The system in place for monitoring and auditing the practice required improvement. The audit plan did not demonstrate that it was based on local, national or service priorities.
  • Improvements were needed to the support provided to clinical staff. There were informal arrangements to review the consultations, referrals and prescribing of clinicians and no formal induction for locum staff. Locum staff were not always included in the appraisal process, audits or involved in the significant event process.

The areas where the provider must make improvements:

  • Ensure care and treatment is provided in a safe way to patients.
  • Establish effective systems and processes to ensure good governance in accordance with the fundamental standards of care.

(Please see the specific details on action required at the end of this report).

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

Dr Rosie Benneyworth BM BS BMedSci MRCGP

Chief Inspector of Primary Medical Services and Integrated Care

06 February 2018

During an inspection looking at part of the service

Letter from the Chief Inspector of General Practice

We carried out an announced comprehensive inspection at GP Practice at Riverside on 3 May 2017. The overall rating for the practice was good but the practice was rated as requires improvement for ensuring safe services. The full comprehensive report on the May 2017 inspection can be found by selecting the ‘all reports’ link for GP Practice at Riverside on our website at www.cqc.org.uk.

This inspection was an announced focused inspection carried out on 6 February 2018 to confirm that the practice had carried out their plan to meet the legal requirements in relation to the breaches in regulations that we identified in our previous inspection on 3 May 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.

Our key findings were as follows:

  • The registered provider had reviewed the overall governance structure of the practice including staff roles and communications. New team and operational meetings were taking place. Key senior team members had developed leadership roles to support governance arrangements.

  • Clearer systems were in place 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. Risk assessments, monitoring and audit systems were improved to mitigate safety risks, in particular with regard to safety alerts and guidance, staffing, emergency medication and prescriptions and safety of the premises and equipment.

  • Practice specific policies and standard operating procedures were available to all staff.

  • There were clear methods of communication across the staff team. Records showed that regular meetings were carried out as part of the quality improvement process to improve the service and patient care.

  • New systems and monitoring responsibilities had been put into place to ensure that records relating to the practice, including policies, staff recruitment and training documentation were completed. A staff training matrix was used by the practice to monitor staff training.

  • A complaints policy and procedure was in place and information was available to help patients understand the complaints procedure and how they could expect their complaint to be dealt with.

  • An improved system for cascading NICE guidelines and patient safety alerts had been put in place.

  • New procedures were in place to monitor the emergency medicines, doctors’ bags and emergency equipment.

In addition the provider should:

  • Review how information collected by the practice could improve the support available for carers.

Professor Steve Field (CBE FRCP FFPH FRCGP) 

Chief Inspector of General Practice

03 May 2017

During a routine inspection

Letter from the Chief Inspector of General Practice

We carried out an announced comprehensive inspection at GP Practice at Riverside on 3 May 2017. 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 a system in place for reporting and recording significant events. Staff learning from significant events was shared across the practice, however the record keeping of such events required improvement.
  • The practice had systems to minimise risks to patient safety but improvements were required for the monitoring of risks related to the premises.
  • The practice maintained appropriate standards of cleanliness and hygiene and we observed the premises to be clean and tidy.
  • There were arrangements for managing medicines, including emergency medicines and vaccines in the practice. However, we found that safe systems for the destruction of unused prescription forms was not in place. Staff were aware of current evidence based guidance. Staff had been trained to provide them with the skills and knowledge to deliver effective care and treatment.
  • Audits of clinical practice were undertaken and discussed.
  • The practice demonstrated how they ensured role-specific training and updating for relevant staff.
  • Results from the national GP patient survey showed patients were treated with compassion, dignity and respect and were involved in their care and decisions about their treatment.
  • The practice reviewed the needs of the local population and worked in collaboration with the NHS England Area Team, Clinical Commissioning Group (CCG), other GP practices, and partner agencies to secure improvements to services where these were identified and to improve outcomes for patients.
  • Information about services and how to complain was available but improvements were needed to the records made of these.
  • Patients we spoke with said they found it easy to make an appointment with a named GP and there was continuity of care, with urgent appointments available the same day.
  • The provider was aware of the requirements of the duty of candour. Examples we reviewed showed the practice complied with these requirements.

However, there were areas where the provider must make improvements. The provider must:

Review the overall governance structure of the practice including staff roles and communications and in particular:-

  • Ensure all records relating to the practice, including policies, staff recruitment and training documentation, actions taken as a result of incidents or complaints, monitoring records and action plans, are appropriately maintained.

  • Ensure appropriate risk assessments, monitoring and audit systems are in place to mitigate safety risks in particular with regard to safety alerts and guidance, staffing, emergency medication and prescriptions and safety of the premises and equipment.

There were areas also where the provider should make improvement. The provider should:

  • Implement a system to ensure that NICE guidelines are followed up by clinical staff.

  • Develop a staff training matrix to ensure accurate records are kept for the full training undertaken by staff.

  • Review how information collected by the practice could improve the support available for carers.

  • Review the numbers of staff trained and able to undertake chaperoning duties.

  • Consider the inclusion of reception staff to regular practice meetings so that communications can improve.

  • Monitor the contents of GPs bags and medicines.

  • Undertake a risk assessment to ensure that the movement of staff across each of the providers GP practices does not compromise the health, safety and welfare of patients and staff.

  • Review the management and leadership structure of the practice. This should include a risk assessment and needs analysis as the basis for deciding sufficient management and leadership roles are in place at all times.

  • Ensure that minutes of meetings with reception staff are recorded.

Professor Steve Field (CBE FRCP FFPH FRCGP) 

Chief Inspector of General Practice