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Reports


Inspection carried out on 25 April 2019

During a routine inspection

We carried out this announced comprehensive inspection of The Rowans Surgery on 25 April 2019. We had previously carried out an announced comprehensive inspection on 27 February 2018. At that time the service was rated as requires improvement. It was rated as requires improvement for the safe, effective, responsive and well led domains and good for caring. All population groups were rated as requires improvement.

The areas where we said that the provider must make improvement were:

  • Establish effective systems and processes to ensure good governance in accordance with the fundamental standards of care with regards to: monitoring single use equipment, emergency medical equipment, cleaning of clinical equipment, vaccine refrigerator temperatures, uncollected prescriptions and cascading information effectively to staff.
  • Ensure sufficient numbers of suitably qualified, competent, skilled and experienced persons are deployed to meet the fundamental standards or care and treatment with regards to timely access to appointments.

The areas where we said the provider should make improvements were:

  • Review and improve uptake for immunisations and screening programmes.
  • Improve patient satisfaction with care and treatment and access to the service.
  • Make information about how to make a complaint or raise concerns readily available to patients and the public.
  • Review practice policies and procedures so the duty of candour is clearly reflected.
  • Improve systems for engaging with patients, obtaining patient feedback and acting on concerns.

At the inspection on 25 April 2019 we found that these areas had been addressed by the practice which is now rated as good in all areas.

We have rated this practice as good overall and good for all population groups.

We found that:

  • The practice provided care in a way that kept patients safe and protected them from avoidable harm.
  • Patients received effective care and treatment that met their needs.
  • Staff dealt with patients with kindness and respect and involved them in decisions about their care.
  • The practice organised and delivered services to meet patients’ needs. Patients could access care and treatment in a timely way.
  • The way the practice was led and managed promoted the delivery of high-quality, person-centre care.

Whilst we found no breaches of regulations, the provider should:

  • Continue to develop systems to improve the management of patients with long term conditions, particularly hypertension.
  • Continue to review and act on patient satisfaction surveys.

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

Inspection carried out on 27 February 2018

During a routine inspection

This practice is rated as requires improvement overall.

The key questions are rated as:

Are services safe? – requires improvement

Are services effective? – good

Are services caring? – requires improvement

Are services responsive? – requires improvement

Are services well-led? - requires improvement

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 – requires improvement

People with long-term conditions – requires improvement

Families, children and young people – requires improvement

Working age people (including those retired and students – requires improvement

People whose circumstances may make them vulnerable – requires improvement

People experiencing poor mental health (including people with dementia) - requires improvement

We undertook an announced comprehensive inspection of The Rowans Surgery on 27 February 2018 under Section 60 of the Health and Social Care Act 2008 as part of our regulatory functions. The practice had not received a previous inspection due to two changes in the provider organisation within the last two years. This inspection was carried out in line with our next phase inspection programme.

At this inspection we found:

  • The practice had some well-managed systems in place to keep people safe and reduce risk so that safety incidents were less like to happen.

  • There was a clear process for acting on safety and medicines alerts.

  • The practice had improved the management of controlled drugs and high risk medicines so they were safe.

  • Governance systems for monitoring some equipment, vaccine refrigerator temperatures and uncollected prescriptions were not operating effectively.

  • The practice had improved the monitoring of patients, particularly those with long-term conditions and mental health conditions.

  • A number of audits and processes to monitor quality were in place.

  • The practice held daily clinical meetings. This provided opportunities for clinical staff to share best practice, discuss clinical risks and provide peer support.

  • Staff told us that they treated patients with compassion, kindness, dignity and respect and involved patients in decisions about their care. However some patients reported that satisfaction with care and compassion shown was low.

  • Although the practice had tried to improve appointment availability, patients found they were not able to get appointments when they needed them and they were not able to easily see their preferred GP.

  • Complaints were investigated and responded to openly and thoroughly and information about how to make a complaint was easily accessible for patients.

  • There was a positive and open culture and staff felt supported by the practice leaders; however systems for cascading information to staff were not always working effectively.

  • The provider had faced significant challenges when they took over the service on 1 October 2017 but leaders demonstrated they had the skills and capability to deliver high quality care.

  • The practice had worked with the Patient Participation Group and analysed NHS Friends and Family Test data to gather patient views.

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

  • Establish effective systems and processes to ensure good governance in accordance with the fundamental standards of care with regards to: monitoring single use equipment, emergency medical equipment, cleaning of clinical equipment, vaccine refrigerator temperatures, uncollected prescriptions and cascading information effectively to staff.

  • Ensure sufficient numbers of suitably qualified, competent, skilled and experienced persons are deployed to meet the fundamental standards of care and treatment with regards to: timely access to appointments.

The areas where the provider should make improvements are:

  • Improve the incident reporting process to ensure all incidents are correctly recognised and reported.

  • Action the recommendation for a fixed electrical wiring assessment of the premises.

  • Improve the systmes to ensure patients with a learning disability receive a structured review of their needs.

  • Improve multi-disciplinary meeting minutes so that they contain adequate records of discussions.

  • Review quality improvement processes in relation to audits of antimicrobial prescribing.

  • Improve patient satisfaction with care and treatment received and ensure patients are involved in decisions about their care.

  • Improve systems in place for prioritising patients for urgent appointments

Professor Steve Field CBE FRCP FFPH FRCGP

Chief Inspector of General Practice