Archived: Radnor House Surgery and Ascot Medical Centre

Letter from the Chief Inspector of General Practice

We carried out an announced comprehensive inspection at Radnor House Surgery and Ascot Medical Centre on 10 November 2016. This comprehensive inspection was carried out to check that the practice was meeting the regulations and to consider whether sufficient improvements had been made since the previous inspection in March 2016.

Our previous inspection in March 2016 found breaches of regulations relating to the safe, effective, caring, and responsive delivery of services. There were also concerns and regulatory breaches relating to the management and leadership of the practice, specifically in the well led domain. The overall rating of the practice in March 2016 was inadequate and the practice was placed into special measures for six months.

During the inspection in November 2016, we found evidence that improvements had been made. Our improved rating of good for the provision of well led services reflects the positive development of leadership and management systems to deliver significant progress in improving services across the board for all patient groups. Our rating of requires improvement for the provision of safe and effective services reflects that some positive changes have been made, however improvements are still required.

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

• Risks to patients were assessed and well managed. However, they had not ensured that blank prescription stationery was tracked within the practice. The practice implemented a change in process and sent an action plan following the inspection.
• There was an open and transparent approach to safety and an effective system in place for reporting and recording significant events.
• The practice had responded to their vulnerable population group and had worked effectively to ensure that their needs were fully met. All staff within the practice showed that they recognised the signs when further support may be needed.
• 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.
• 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 and easy to understand. Improvements were made to the quality of care as a result of complaints and concerns.
• Patients said they did not find it easy to make an appointment; the practice had recognised and put measures in place to respond to this.
• The practice had good facilities and was well equipped to treat patients and meet their needs.
• There was a clear leadership structure and staff felt supported by management. The practice proactively sought feedback from staff and patients, which it acted on.
• The provider was aware of and complied with the requirements of the duty of candour.
• The practice had recently integrated their Saturday flu clinics with a one-stop shop service to encourage patients to have regular health reviews.

The areas where the provider must make improvements are:

• Ensure blank prescription stationery distribution is monitored within the practice in accordance with current guidelines.

The areas where the provider should make improvements are:

• Ensure there is a system in place to action and mitigate the risks to patients if a vaccine cold chain breach occurs.
• Ensure patient outcomes are reviewed to ensure that patients with long term conditions receive appropriate care and treatment.

This service was placed in special measures in March 2016. Improvements have been made such that ratings of good for the delivery of responsive, caring and well led services and a rating of requires improvement for safe services have now been achieved. This has led to an improved rating of good. I am taking this service out of special measures. This recognises the significant improvements made to the quality of care provided by this service.

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 Radnor House Surgery and Ascot Medical Centre on 2 March 2016. The practice is rated as Inadequate for Safe, Responsive and Well Led and Requires Improvement for Effective and Caring. Overall the practice is rated as Inadequate.

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

• Staff were not clear about reporting incidents, near misses and concerns and there was no evidence of learning and communication with staff.

• Staff reported feeling that they were not communicated with and felt vulnerable as they were often unsupported by the leaders of the practice.

• Patients were at risk of harm because systems and processes were not in place to keep them safe. For example, appropriate recruitment checks on staff had not been undertaken prior to their employment and there were gaps in training required to keep patients safe.

• The practice had a number of policies and procedures to govern activity, but many were overdue a review.
• Data showed patient outcomes were low compared to the locality and nationally.
• Patients told us they found it difficult to make an appointment at a time to suit them, although urgent appointments were usually available on the day they were requested.
• The practice had no clear leadership structure, insufficient leadership capacity and limited formal governance arrangements across both practice sites.
• The majority of patients said they were treated with compassion, dignity and respect. However, not all felt cared for, supported and listened to.

There were, however some areas of good practice;

• Eight clinical audits had been carried out and were used to drive improvements in patient outcomes.
• The practice had sought feedback from patients and had an active patient participation group.

The areas where the provider must make improvements are:

• Introduce robust processes for reporting, recording, acting on and monitoring significant events, incidents and near misses.

• Ensure recruitment arrangements include all necessary employment checks for all staff.

• Put systems in place to ensure all staff are kept up to date with mandatory training in line with national guidance and guidelines.

• Implement and improve formal governance arrangements including systems for assessing and monitoring risks and the quality of the service provision.

• Provide staff with appropriate policies and guidance to carry out their roles in a safe and effective manner which reflect the requirements of the practice.

• Clarify the leadership structure and ensure there is leadership capacity to deliver all improvements.

• Ensure systems to monitor quality outcomes are monitored to demonstrate improvements in patient outcomes have been achieved.

• Communicate more effectively with staff, offering them appropriate management support.

• Ensure safeguarding training and updates are implemented for all staff at the appropriate level.

The areas where the provider should make improvement are:

• Improve processes for making appointments.
• Review how carers are identified and recorded on the patient record system to ensure information, advice and support is made available to all.
• Ensure actions identified in infection control audit are documented once completed.
• Consider how emergency medicines are stored, particularly in relation to the accessibility of emergency medicines for all staff.

I am placing this practice in special measures. Practices placed in special measures will be inspected again within six months. If insufficient improvements have been made so a rating of inadequate remains for any population group, key question or overall, we will take action in line with our enforcement procedures to begin the process of preventing the provider from operating the service. This will lead to cancelling their registration or to varying the terms of their registration within six months if they do not improve.

The practice will be kept under review and if needed could be escalated to urgent enforcement action. Where necessary, another inspection will be conducted within a further six months, and if there is not enough improvement we will move to close the service.

Special measures will give people who use the practice the reassurance that the care they get should improve

Professor Steve Field (CBE FRCP FFPH FRCGP) 

Chief Inspector of General Practice