You are here

Inspection Summary


Overall summary & rating

Good

Updated 6 October 2017

Letter from the Chief Inspector of General Practice

We carried out an announced comprehensive inspection at Ripon Spa Surgery on 14 November 2016. The findings at that inspection led to an overall rating for the practice of requires improvement. We also issued three requirement notices for breaches in regulations relating to the Health and Social Care Act 2008. The full comprehensive report for that inspection can be found by selecting the ‘all reports’ link for Ripon Spa Surgery on our website at www.cqc.org.uk.

This inspection was an announced comprehensive inspection on 30 August 2017. Overall the practice is now rated as good.

Our key findings were as follows:

  • Systems and processes had been improved and were now embedded within the practice. These included comprehensive processes in place regarding infection prevention and control, medicines management, recruitment, training and appropriate supervision of staff.
  • There was evidence of actions, shared learning and reviews of any changes undertaken in relation to reported incidents or near misses.
  • We saw that a programme of clinical and non-clinical audit was in place. There was evidence to demonstrate quality improvement as a result of the audits that had been undertaken.
  • There was an effective process in place for obtaining patient consent for specific procedures. Consent was clearly documented in a patient’s record.
  • There was a system in place and an identified person to support the summarising of patient records.
  • There was a system in place to ensure all policies and procedures were in date, reviewed as appropriate and that staff knew where to access them.
  • A range of clinical and non-clinical meetings took place within the practice. We saw formal minutes arising from those meetings.
  • We saw evidence that staff were up to date with their appraisals and mandatory training; which included safeguarding, mental capacity of patients, infection prevention and control, fire safety and basic life support.
  • There was evidence that governance arrangements within the practice were effective. Risks and issues were identified and dealt with accordingly.
  • The practice delivered enhanced services and participated in programmes to meet the needs of their patient population.
  • There was evidence of strong teamwork and a commitment to deliver a quality service to patients. Staff were clearly valued by the partners in the practice.
  • Patients’ comments we received were extremely positive and demonstrated they held the practice and staff that worked there in high regard.

We saw an area of outstanding practice:

  • There was evidence of a caring practice, where staff had ‘gone the extra mile’ for patients. For example, providing food, transport and presents for patients who were in poverty or homeless. Dispensing staff had taken prescriptions to patients if they had difficulty getting to the practice due to ill health. The GPs provided their personal mobile numbers to patients with palliative care needs, and/or their families. This allowed for them to contact their own GP at the weekend, during bank holidays or out of normal practice hours. Opportunistic home visits were undertaken on patients who staff may have had some concerns about.

There was an area where the provider should make improvements:

  • Ensure that the backlog of the summarising of patient records is completed in a timely way.

Professor Steve Field CBE FRCP FFPH FRCGP

Chief Inspector of General Practice

Inspection areas

Safe

Good

Updated 6 October 2017

The practice is rated good for providing safe services.

  • Systems and processes had been improved and were now embedded within the practice. These included comprehensive processes in place regarding infection prevention and control, medicines management, recruitment, training and appropriate supervision of staff.
  • From the sample of documented examples we reviewed, we found there was an effective system for reporting and recording significant events. Lessons learned were shared to make sure action was taken to improve safety in the practice. When things went wrong patients were informed as soon as practicable, received reasonable support, truthful information and a written apology. There was evidence of actions, shared learning and reviews of any changes undertaken in relation to reported incidents or near misses
  • Infection prevention and control measures had been reviewed and improved processes implemented. There were identified leads and audits undertaken.
  • There were systems in place for checking that equipment was tested, calibrated and fit for purpose.
  • There were clearly defined and embedded, systems, processes and practices to keep patients and staff safe and safeguarded from abuse. There was a nominated lead for safeguarding and staff demonstrated they understood their responsibilities in relation to safeguarding.
  • There were processes in place, including standard operating procedures in the dispensary, for the safe management of medicines.

Effective

Good

Updated 6 October 2017

The practice is rated good for providing effectives services.

  • Data from the Quality and Outcomes Framework showed the practice performed consistently higher than local and national averages.
  • The practice worked with other health and social care professionals to ensure that patients with complex needs, including those with life-limiting conditions or reaching end of life, were supported to receive co-ordinated care. 
  • There was evidence of multidisciplinary meetings to support collaboration between health and social care professionals regarding patient care packages.
  • There was a system in place to monitor staff training. We saw evidence that staff were up to date with their appraisals and mandatory training; which included safeguarding, mental capacity of patients, infection prevention and control, fire safety and basic life support.
  • We saw a programme of clinical and non-clinical audit was in place. There was evidence to demonstrate quality improvement as a result of the audits.
  • There was an effective process in place for obtaining patient consent for specific procedures. Consent was clearly documented in a patient’s record.
  • There was a system in place and an identified person to support the summarising of patient records.

Caring

Good

Updated 6 October 2017

The practice is rated as good for providing caring services.

  • The practice had a strong patient-centred culture and we observed that staff treated patients with kindness, dignity, respect and compassion. Patients’ comments aligned with these observations.
  • The practice held a carers’ register and provided health checks and influenza vaccinations for those patients.
  • Data from the most recently published national GP patient survey showed patients rated the practice generally higher than local and national averages in response to questions relating to how well cared for they felt.
  • We saw evidence of a caring and professional practice, where staff had ‘gone the extra mile’ for patients. For example, providing food, transport, presents and delivery of prescribed medication to patients in the community who were unable to attend the practice.
  • The GPs provided their personal mobile numbers to patients with palliative care needs, and/or their families. This allowed for them to contact their own GP at the weekend or out of normal practice hours.
  • Opportunistic home visits were undertaken on patients who staff may have had some concerns about.
  • Staff undertook bereavement visits and supported those patients who were isolated.

Responsive

Good

Updated 6 October 2017

The practice is rated as good for providing responsive services.

  • The practice had a good understanding of their patient population and provided services to meet the needs of patients.
  • The practice took account of the needs and preferences of patients with life-limiting conditions, including patients with a condition other than cancer and patients living with dementia.
  • Extended hours until 7.30pm were available on Tuesdays and Thursdays.
  • A triage system was in place to support increases in patient demand of appointments
  • Results from the most recent national GP patient survey showed that patients’ satisfaction with how they could access care and treatment was generally higher than local and national averages.
  • The practice provided medical cover for a 12 bedded ward at Ripon Community Hospital. GPs did ward rounds three times per week, provided daytime on-call cover and also worked within the out-of-hours service.
  • The practice had facilities suitable to the needs of their patients. One of the GP partners was conversant in a range of languages and was fluent in Polish. This was of particular benefit to patients from the Polish community who were registered with the practice.
  • Information about how to complain was available and evidence from the ones we reviewed showed the practice responded quickly to issues raised. Learning from complaints was shared with staff and other stakeholders.

Well-led

Good

Updated 6 October 2017

The practice is rated as good for providing well-led services.

  • There was evidence that governance arrangements within the practice were effective. Risks and issues were identified and dealt with accordingly.
  • The practice encouraged a culture of openness and honesty. There were systems for being aware of notifiable safety incidents and sharing the information with staff and ensuring appropriate action was taken. They were aware of the requirements of the duty of candour.
  • There was evidence of strong teamwork and a commitment to deliver a quality service to patients. Staff were clearly valued by the partners in the practice.
  • There was a system in place for implementing and reviewing practice policies and procedures.
  • There was evidence of regular clinical and non-clinical meetings, which were comprehensively minuted.
  • Patients’ comments we received were extremely positive and demonstrated they held the practice and staff in high regard.
  • The patient participation group was well established and had good channels of communication with the practice.
Checks on specific services

People with long term conditions

Good

Updated 6 October 2017

The practice is rated as good for the care of people with long term conditions.

  • Nursing staff had lead roles in long term disease management and received training to support them in delivering appropriate care and treatment to those patients.
  • All these patients had a named GP and a structured annual review, at a minimum, to check their health and treatment needs were being met.
  • Patients who were on high risk medicines were reviewed in line with medicines management guidance.
  • Patients who were at risk of hospital admission were identified as a priority.
  • Performance for long term condition related indicators was higher than the CCG and national averages.
  • Monthly meetings were held to discuss the care and treatment of those patients who had diabetes. 

Families, children and young people

Good

Updated 6 October 2017

The practice is rated as good for the care of families, children and young people.

  • There were systems in place to identify and follow-up children living in disadvantaged circumstances and who were at risk. For example, children and young people who had a high number of accident and emergency (A&E) attendances.
  • The uptake rate for childhood immunisations was higher than local and national averages.
  • On the day of inspection, patients told us that children and young people were treated in an age-appropriate way and were recognised as individuals.
  • Appointments were available outside of school hours and the premises were suitable for children and babies.
  • The practice worked with midwives, health visitors and school nurses to support this population group. For example, in the provision of ante-natal, post-natal and child health surveillance clinics.
  • The practice had emergency processes for acutely ill children and young people and for acute pregnancy complications.
  • The uptake rate for cervical screening was higher than local and national averages

Older people

Good

Updated 6 October 2017

The practice is rated as good for the care of older people.

  • Staff were able to recognise the signs of abuse in older patients and knew how to escalate any concerns.
  • The practice offered proactive, personalised care to meet the needs of the older patients in its population. Although the avoiding unplanned admissions enhanced service had ceased to be funded, the practice continued to treat frail patients as a priority. They carried out care planning and reviews as appropriate.
  • The practice liaised with other health and social care professionals and, with the patient’s consent, shared care records to support an appropriate package of care.
  • The practice identified at an early stage older patients who may need palliative care as they were approaching the end of life. Patients were involved in planning and making decisions about their care.
  • The practice was responsive to the needs of older patients, and offered home visits and urgent appointments for those with enhanced needs.
  • Weekly ‘ward rounds’ were undertaken at a local care home, where some patients resided. Regular reviews of patients’ care and treatment were carried out.
  • The practice had good links with the local Age UK group and signposted patients as appropriate.

Working age people (including those recently retired and students)

Good

Updated 6 October 2017

The practice is rated as good for the care of working age people (including those recently retired and students).

  • The needs of these populations had been identified and the practice had adjusted the services it offered to ensure these were accessible, flexible and offered continuity of care. For example, extended opening hours and a triage system.
  • The practice was proactive in offering online services, which included the ability to book an appointment online or request a prescription.
  • The practice promoted a full range of health promotion and screening that reflected the needs for this age group.
  • NHS health checks were offered to patients aged between 40 and 74 years, who had not seen a GP in the last three years.

People experiencing poor mental health (including people with dementia)

Good

Updated 6 October 2017

The practice is rated as good for the care of people experiencing poor mental health (including people with dementia).

  • Performance for mental health related indicators was higher than CCG and national averages. For example, 100% of patients who were currently being prescribed lithium (medication used to treat the manic episodes of bipolar disorder) had undergone appropriate blood tests in the preceding four months, compared to the CCG average of 95% and the national average of 90%.
  • Those patients who were living with dementia or had a complex mental health disorder, had an annual review of their care.
  • Patients at risk of dementia were identified and offered an assessment.
  • Staff could demonstrate a good understanding of assessing mental capacity and had received appropriate training.
  • The practice regularly worked with multidisciplinary teams, such as community mental health services, in the case management of patients experiencing poor mental health.
  • There was information available both in the practice and on the website on how patients could access other avenues of support, such as local voluntary organisations or support groups.

People whose circumstances may make them vulnerable

Good

Updated 6 October 2017

The practice is rated as good for the care of people whose circumstances may make them vulnerable.

  • There was a system in place to identify patients who may be in need of extra support. For example, patients requiring end of life care, patients with a learning disability or carers.
  • The practice offered longer appointments for patients who had a complex health need.
  • The practice regularly worked with other health care professionals in the case management of vulnerable patients.
  • Where a patient had been assessed as needing Deprivation of Liberty Safeguards (DoLS), these were identified in the patient’s clinical record. GPs had undergone specific DoLS training.
  • Staff knew how to recognise signs of abuse in children, young people and adults whose circumstances may make them vulnerable. They were aware of their responsibilities regarding information sharing, documentation of safeguarding concerns and how to contact relevant agencies in normal working hours and out of hours.
  • We were provided with many examples, where staff had provided homeless patients with food and small amounts of money to support them. We were also informed of an occasion where staff had taken it upon themselves to provide food, nappies and Christmas presents for the small children of a patient living in poverty.
  • There was information about how to access various support groups and voluntary organisations.