Archived: RHR Medical Centre

We carried out an announced focussed inspection of RHR Medical Centre on the 8th January 2020. This inspection was undertaken to follow up on breaches of regulations which had been identified at our previous inspection in October 2019 in relation to governance, therefore the practice was not rated at this inspection.

The warning notice that we issued in October 2019 required the practice to achieve compliance with the regulations by the 10th December 2019.

The practice is currently rated as Requires Improvement which remains unchanged until we undertake a full comprehensive inspection of the practice.

Previous reports for this provider can be accessed on our website at www.cqc.org.uk.

At this inspection we found that the requirements of the warning notice had been fully met.

Our key findings across the areas that we inspected for this focussed inspection were as follows:

• There was a system to ensure that patients requiring appointments were assessed and directed to an appropriate service if they were not able to be seen within the practice.
• We saw evidence of accurate, complete and comprehensive records on patient’s clinical records. There were complete audit trails to follow for patient care received at the practice. The practice had implemented policies and training to ensure staff documented all contact with patients.
• There was a policy in place to ensure that patients with urgent medical conditions were signposted appropriately. We saw evidence of this being followed by staff.
• Follow up appointments were scheduled and attended if required.
• There were systems and audits in place for the oversight of prescribing within the practice.

Details of our findings are set out in the evidence table.

Dr Rosie Benneyworth BM BS BMedSci MRCGP

Chief Inspector of Primary Medical Services and Integrated Care

We carried out an announced focussed inspection of RHR Medical Centre on the 29th October 2019. This inspection was undertaken to follow up on breaches of regulations which had been identified at our previous inspection in June 2019 in relation to safe care and treatment.

This practice is currently rated as Requires Improvement.

We issued the practice with a warning notice requiring them to achieve compliance with the regulations by the 29th September 2019.

At this inspection we did not find that all of the requirements of the warning notice had been fully met.

Our key findings across the areas that we inspected for this focused inspection were as follows:

• We saw evidence that patients were being seen by the appropriate clinician for their health concern however this was not always being done in a timely manner to ensure that urgent presentations were seen in line with the practice policy.
• There were not always adequate systems to ensure patients’ health concerns were followed up when expected.
• There was not always comprehensive detail recorded in patient records of discussions, examinations and safety netting advice given to patients.
• We did not always see that patients were being prescribed medicines appropriately and appropriate rationale was not always documented. There was also evidence of patients being prescribed inappropriate amounts of medicines such as courses of antibiotics or being issued four months supply of repeat medicines on one prescription.

Due to the practice not meeting the requirements of the warning notice, the practice have been issued a further warning notice in relation to Regulation 17 of the Health and Social Care Act 2008 (Regulated Activities) Regulations 2014 in relation to governance at the practice.

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

Dr Rosie Benneyworth BM BS BMedSci MRCGP

Chief Inspector of Primary Medical Services and Integrated Care

We carried out an unannounced focussed inspection at RHR Medical Practice on 18 June 2019 in response to concerns that were found at another practice which was part of the Beechdale Medical Group.

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 have rated this practice as Requires Improvement overall and for all population groups.

We have rated the practice as requires improvement for providing safe services.

We found that:

• There were gaps in systems to assess, monitor and manage risks to patient safety.
• When things went wrong, reviews and investigations were not always sufficiently thorough. Improvements were not always identified.
• There were gaps in recruitment and training records of staff.

We have rated the practice as requires improvement for providing effective services.

We found that:

• Care and treatment was not always delivered in line with national guidance.
• There was no clinical oversight of clinicians and management were not aware of competencies of clinical staff.
• There was limited evidence of quality improvement.

We have rated the practice as requires improvement for providing well-led services.

We found that:

• The practice was transitioning through a change in management, and systems had not been embedded.
• The practice did not always act on appropriate and accurate information.
• We saw little evidence of systems and processes for learning, continuous improvement and innovation.

The areas where the provider must make improvements are:

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

The areas where the provider should make improvements are:

• Ensure that staff recruitment files, training requirements and vaccination status are up to date including any checks on locum GPs.
• Ensure fire alarm checks are being carried out at the practice.
• Improve methods of quality improvement at the practice including learning from events and completing audits.

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