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Inspection carried out on 30 August 2017

During a routine inspection

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 carried out on 14 November 2016

During a routine inspection

Letter from the Chief Inspector of General Practice

We carried out an announced comprehensive inspection at Ripon Spa Surgery on 14 November 2016. Overall the practice is rated as requires improvement.

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

  • The practice reported, recorded and reviewed significant events. The practice carried out a thorough analysis of each significant event and evidenced changes as a result. However, there was no evidence in the records to show that if changes had been made following an event that these had been revisited over time to ensure the changes were effective and embedded within the practice.
  • Systems, processes and practices were not always reliable or appropriate to keep people safe. We found concerns relating to a number of areas, mainly the management of infection control, medicines management, recruitment, and ensuring staff had the required training and supervision for them to carry out their role.
  • There was evidence of clinical audit. However the practice did not have a programme of clinical audit in place. There was limited evidence of non-clinical audit.
  • 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.
  • The practice reviewed the needs of its local population and engaged with the NHS England Area Team and Clinical Commissioning Group (CCG) to secure improvements to services where these were identified.
  • Patients said they found it easy to make an appointment with a named GP and there was continuity of care, with urgent appointments available the same day.

  • The practice did not have an effective system in place for implementing and reviewing policies and procedures.

  • There was limited evidence to show the governance arrangements operated effectively and that risks and issues were always identified or dealt with appropriately or in a timely way.
  • Staff told us they were supported by the management and felt there was an open culture at the practice.

The areas where the provider must make improvements are:

  • Ensure robust processes are in place for all aspects of medicines management.
  • Take action to ensure arrangements are in place for managing infection prevention and control.
  • Implement a system for monitoring the completion of all required training. Take action to address gaps in the mandatory training completed by staff.
  • Ensure that nursing staff receive ongoing or periodic supervision in their role.
  • Implement robust governance arrangements to enable the provider to assess, monitor and mitigate the risks relating to the health, safety and welfare of service users and others who may be at risk.

The areas where the provider should make improvement are:

  • Take action to ensure policies and procedures are regularly reviewed and updated.
  • Develop a programme of clinical and non-clinical audit.
  • Review the arrangements currently in place for revisiting changes introduced by the practice over time to ensure they are effective and embedded within the practice.

  • Review the effectiveness of the governance arrangements in place for the recruitment of staff to ensure staff are recruited in a safe and timely way.

  • Review the effectiveness of the arrangements for summarising patient records.
  • Review the systems in place for reviewing the recording of patient consent.

Professor Steve Field (CBE FRCP FFPH FRCGP) 

Chief Inspector of General Practice