Archived: Ravensbury Park Medical Centre

Letter from the Chief Inspector of General Practice

We carried out an announced comprehensive inspection at Ravensbury Park Medical Centre on 11 January 2017. The overall rating for the practice was inadequate (inadequate ratings for all key questions apart from caring, which was rated as requires improvement) and the practice was placed in special measures for a period of six months. The previous reports can be found by selecting the ‘all reports’ link for Ravensbury Park Medical Centre on our website at www.cqc.org.uk.

This inspection was undertaken following the period of special measures and was an announced comprehensive inspection on 26 September 2017. Overall the practice remains rated as inadequate.

Our key findings were as follows:

• The system for managing significant events did not ensure that lessons were learned.
• There were not effective arrangements to safeguard children and vulnerable adults from abuse.
• Arrangements for managing medicines, including emergency medicines and vaccines, in the practice did not keep patients safe.
• Arrangements for emergencies and major incidents still did not ensure that the practice would be able to respond effectively.
• Data showed rates of childhood immunisation and patient outcomes for some long-term conditions were below the national average.
• The practice had failed to act on evidence of deteriorating satisfaction with telephone access.
• There was little evidence of quality improvement activity that resulted in improved patient care.
• There were no governance meetings. Clinical meetings had no evidence of follow up on actions that been agreed.
• There was no evidence of continuous learning and improvement driven from within the practice.

Importantly, the provider must:

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

In addition the provider should:

• Review the systems for information governance, to maintain patient confidentiality.
• Develop arrangements to ensure female patients can be treated by a clinician of the same sex.
• Review the impact on patient care of the ‘one issue per appointment policy’.
• Review how patients with caring responsibilities are identified and recorded on the clinical system to ensure information, advice and support is made available to them.
• Improve the complaints system to ensure that all complaints are recorded, including verbal complaints, and that this information is formally reviewed to assess for trends.

This service was placed in special measures in March 2017. As a result, the practice received a package of support from the Royal College of General Practitioners, NHS England and the Clinical Commissioning Group.

Insufficient improvements have been made such that there remain ratings of inadequate for safety, effectiveness, responsiveness and being well led. Therefore the service will remain in special measures. 

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 Ravensbury Park Medical Centre on 11 January 2017. Overall the practice is rated as inadequate.

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

• There was not an effective system in place for reporting, recording and learning from significant events.

• There was not an effective system for acting upon patient safety alerts, and no evidence that patient safety alerts had been acted upon.

• The systems and processes to keep patients safe and safeguarded from abuse, were not effective or well-embedded.

• There were weaknesses in the practice arrangements to prevent and control the spread of infections

• Arrangements for managing medicines, including emergency medicines and vaccines, in the practice were not sufficient to keep patients safe

• Arrangements were in place for planning and monitoring the number of staff and mix of staff needed, but at times there were not sufficient staff to meet patients’ needs.

• Appropriate recruitment checks had not been undertaken, including checks of records through the Disclosure and Barring Service for all clinical staff and those carrying out chaperoning duties.

• Risks to patients were not adequately assessed or managed.

• The practice did not have all of the medicines required to manage emergencies, and there was no plan in place for major incidents such as power failure or building damage.

• Data from the Quality and Outcomes Framework (QOF) showed patient outcomes were at below the national average, particularly for diabetes and hypertension (high blood pressure).

• There was minimal quality improvement activity, and little evidence that this activity had led to improvement in patient care. There were not adequate systems in place to monitor the practice performance and adherence to guidance, and to ensure improvement.

• Data from the national GP patient survey showed patients rated the practice higher than others for several aspects of care from GPs, but below average for aspects of care from nurses. Patient satisfaction with how they could access care and treatment was below the national average.

• The practice did not have an effective system in place for handling complaints.

• The practice had a number of policies and procedures to govern activity, but these were not regularly updated and they were not well embedded. .

• There was no effective system in place to ensure that staff received the training required for their roles.

• The practice held regular whole team meetings, but no regular governance or clinical meetings.

The areas where the provider must make improvement are:

• Ensure all risks to patients are assessed and acted upon in relation to patient safety alerts, medicines management, infection control and fire risk management.

• Ensure patients are safeguarded from abuse.

• Ensure that all relevant recruitment checks are completed, including Disclosure and Barring Service checks or risk assessments of those with relevant roles, and ensure staff receive the training required for their roles.

• Ensure that there are sufficient staff to meet patients’ needs.

• Ensure that there are adequate arrangements to respond to emergencies and major incidents.

• Implement an effective system for handling complaints.

• Develop and implement appropriate practice-specific policies which are clear and accessible to all staff.

• Monitor the practice performance and adherence to guidance and take action on evidence of poor or deteriorating performance.

The areas where the provider should:

• Review how patients with caring responsibilities are identified and recorded on the clinical system to ensure information, advice and support is made available to them.

• Review and act upon the results of the national GP patient survey.

• Implement an effective system to record and follow up on actions discussed in meetings.

I am placing this service in special measures. Services placed in special measures will be inspected again within six months. If insufficient improvements have been made such that there remains a rating of inadequate 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.

Professor Steve Field CBE FRCP FFPH FRCGP

Chief Inspector of General Practice