You are here

Archived: Ravenscroft Medical Centre Good

The provider of this service changed - see new profile

Inspection Summary


Overall summary & rating

Good

Updated 12 October 2017

Letter from the Chief Inspector of General Practice

We carried out an announced comprehensive inspection at Ravenscroft Medical Centre on 14 and 19 July 2016. During the inspection we identified that governance arrangements did not always operate effectively in that there was limited evidence of sharing learning from significant events and also risks and performance were not always effectively managed (The full comprehensive report on the July 2016 inspection can be found by selecting the ‘all reports’ link for Ravenscroft Medical Centre on our website at www.cqc.org.uk).The overall rating for the practice was requires improvement.

An announced comprehensive inspection was undertaken on 10 August 2017. Overall the practice is now rated as good.

Our key findings of our inspection of Ravenscroft Medical Centre were as follows:

  • Action had been taken to ensure that significant event reviews and investigations were sufficiently thorough. For example, meetings regularly took place to share learning from significant events and to take steps to maintain or improve patient safety.
  • Action had been taken to ensure that governance arrangements operated effectively. For example, staff routinely met to identify, monitor and take mitigating actions against risks.

  • Action had been taken to improve arrangements for the safe storage of vaccines. For example, the practice had revised its systems for recording fridge temperature readings.
  • Staff were aware of current evidence based guidance.
  • Staff had the skills and knowledge to deliver effective care and treatment.

  • Data from the national GP patient survey showed that patients rated the practice higher than others on the extent to which they were treated with dignity and respect; and the extent to which they were involved in decisions about their care and treatment.

  • Information about services and how to complain was available. Improvements were made to the quality of care as a result of complaints and concerns.

  • Patients we spoke with 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 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 the requirements of the duty of candour.
  • Practice management arrangements promoted an open approach to safety which facilitated the delivery of safe and high quality care.

The areas where the provider should make improvement are:

  • Continue to monitor and take action as necessary to improve cervical screening and child immunisation uptake rates.

  • Ensure that water temperature monitoring takes place to control the risk from Legionella (a term for a particular bacterium which can contaminate water systems in buildings).

Professor Steve Field CBE FRCP FFPH FRCGP 

Chief Inspector of General Practice

Inspection areas

Safe

Good

Updated 12 October 2017

The practice is rated as good for providing safe services.

  • When we inspected in July 2016, we identified concerns regarding the effective monitoring of vaccine fridge temperatures and the robustness of significant events analyses. We asked the provider to take action and at this inspection noted that the provider had improved arrangements for the safe storage of vaccines. We also noted that there was now an effective system for reporting, recording and sharing learning from significant events.
  • The practice had clearly defined and embedded systems, processes and practices to minimise risks to patient safety.

  • When things went wrong patients were informed as soon as practicable, received reasonable support, truthful information, and a written apology. They were told about any actions to improve processes to prevent the same thing happening again.
  • Staff demonstrated that they understood their responsibilities and all had received training on safeguarding children and vulnerable adults relevant to their role.

  • The practice had adequate arrangements to respond to emergencies and major incidents.

Effective

Good

Updated 12 October 2017

The practice is rated as good for providing effective services.

  • Data from the Quality and Outcomes Framework showed patient outcomes were at or above average compared to the national average.

  • Staff were aware of current evidence based guidance.

  • Clinical audits demonstrated quality improvement.

  • Staff had the skills and knowledge to deliver effective care and treatment.

  • There was evidence of appraisals and personal development plans for staff.

  • Staff worked with other health care professionals to understand and meet the range and complexity of patients’ needs.

  • End of life care was coordinated with other services involved.

Caring

Good

Updated 12 October 2017

The practice is rated as good for providing caring services.

  • Data from the national GP patient survey showed that patients rated the practice higher than others on the extent to which they were treated with dignity and respect; and the extent to which they were involved in decisions about their care and treatment.

  • Information for patients about the services available was accessible.

  • We saw staff treated patients with kindness and respect, and maintained patient and information confidentiality.

Responsive

Good

Updated 12 October 2017

The practice is rated as good for providing responsive services.

  • The practice understood its population profile and had used this understanding to meet the needs of its population (for example regarding early morning and late evening extended opening for patients of working age).

  • 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.

  • Patients fed back that it was easy to make an appointment with a named GP and there was continuity of care, with urgent appointments available the same day.

  • The practice had good facilities and was well equipped to treat patients and meet their needs.

  • Information about how to complain was available and evidence from examples reviewed showed the practice responded quickly to issues raised. Learning from complaints was shared with staff and other stakeholders.

Well-led

Good

Updated 12 October 2017

The practice is rated as good for being well-led.

  • When we inspected in 2016, governance arrangements did not always operate effectively. For example, there were limited systems in place to performance.

  • At this inspection, the provider had taken comprehensive action to ensure that gperformance and we noted that a range of risk assessments had taken place (including fire safety and practice also now regularly met to monitor performance on cervical screening uptake.

  • The practice had a clear vision and strategy to deliver high quality care and promote good outcomes for patients. Staff were clear about the vision and their responsibilities in relation to it.

  • There was a clear leadership structure and staff felt supported by management. The practice had policies and procedures to govern activity.

  • Staff had received inductions, annual performance reviews and attended staff meetings and training opportunities.

  • The provider was aware of and complied with the requirements of the duty of candour.
  • The practice proactively sought feedback from staff and patients and we saw examples where feedback had been acted on. The practice engaged with the patient participation group.

  • There was a focus on continuous learning and improvement at all levels.

  • GPs who were skilled in specialist areas used their expertise to offer additional services to patients.

  • The practice encouraged a culture of openness and honesty. The practice had systems for being aware of notifiable safety incidents and sharing the information with staff and ensuring appropriate action was taken.

Checks on specific services

People with long term conditions

Good

Updated 12 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 patients at risk of hospital admission were identified as a priority.

  • 79% of patients with diabetes had a blood sugar level which was within the required range compared with the respective 77% and 78% CCG and national averages.

  • There were emergency processes for patients with long-term conditions who experienced a sudden deterioration in health.

  • All these patients had a named GP and there was a system to recall patients for a structured annual review to check their health and medicines needs were being met. For those patients with the most complex needs, the named GP worked with relevant health and care professionals to deliver a multidisciplinary package of care.

Families, children and young people

Good

Updated 12 October 2017

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

  • There were systems 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.

  • Immunisation rates were relatively low for all standard childhood immunisations. Staff advised us that many patients were from the orthodox Jewish community whom, for religious reasons, declined to participate in child immunisation programmes. Staff further advised us that the practice continued to actively work to improve immunisations uptake by letter, phone call and through opportunistic engagement.

  • 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 and post-natal clinics.

  • The practice had emergency processes for acutely ill children and young people and for acute pregnancy complications.

Older people

Good

Updated 12 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.

  • The practice was responsive to the needs of older patients, and offered home visits and urgent appointments for those with enhanced needs.

Working age people (including those recently retired and students)

Good

Updated 12 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.

  • The practice was proactive in offering online services as well as a full range of health promotion and screening that reflects the needs for this age group.

People experiencing poor mental health (including people with dementia)

Good

Updated 12 October 2017

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

  • The practice carried out advance care planning for patients living with dementia.

  • 86% of patients diagnosed with dementia had had their care reviewed in a face to face meeting in the last 12 months, which was comparable to the national average.

  • The practice had a system for monitoring repeat prescribing for patients receiving medicines for mental health needs.

  • Patients at risk of dementia were identified and offered an assessment.

  • The practice had information available for patients experiencing poor mental health about how they could access various support groups and voluntary organisations.

  • The practice had a system to follow up patients who had attended accident and emergency where they may have been experiencing poor mental health.

  • The practice regularly worked with multi-disciplinary teams in the case management of patients experiencing poor mental health. For example, a Mental Health Link Worker (whose weekly attendance at the practice was funded by a local Mental Health Trust) spoke positively about how their role supported the practice’s GPs and nurses to understand issues around mental health and locally available resources.

People whose circumstances may make them vulnerable

Good

Updated 12 October 2017

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

  • The practice held a register of patients living in vulnerable circumstances including those with a learning disability.

  • End of life care was delivered in a coordinated way which took into account the needs of those whose circumstances may make them vulnerable.

  • The practice offered longer appointments for patients with a learning disability.

  • The practice regularly worked with other health care professionals in the case management of vulnerable patients.

  • The practice had information available for vulnerable patients about how to access various support groups and voluntary organisations.

  • Staff interviewed 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.

  • The practice had identified that many newly registered patients were using foodbanks. Consequently, it had recently started working with a local third sector organisation with the aim of starting a local foodbank for patients and the wider community.