The Care Quality Commission
  • Doctor
  • GP practice

Royal Manor Health Care

Overall: Good read more about inspection ratings

Park Estate Road, Easton, Portland, Dorset, DT5 2BJ (01305) 820422

Provided and run by:
Portland Group Practice

All Inspections

3 August 2023

During a routine inspection

We carried out an announced comprehensive inspection at Royal Manor Health Care on 3 August 2023. Overall, the practice is rated as good.

Safe - good

Effective - good

Caring - good

Responsive - good

Well-led – good

Following our previous inspection in May 2022, the practice was rated requires improvement overall and for all key questions. At this inspection, we found that those areas previously regarded as requires improvement were now improved. The practice is therefore now rated good.

The full reports for previous inspections can be found by selecting the ‘all reports’ link for Royal Manor Health Care on our website at www.cqc.org.uk

Why we carried out this inspection

We carried out this inspection to follow up breaches of regulation from a previous inspection in line with our inspection priorities.

How we carried out the inspection

This inspection was carried out in a way which enabled us to spend a minimum amount of time on site.

This included:

  • Conducting staff interviews using video conferencing.
  • Completing clinical searches on the practice’s patient records system (this was with consent from the provider and in line with all data protection and information governance requirements).
  • Reviewing patient records to identify issues and clarify actions taken by the provider.
  • Requesting evidence from the provider.
  • A short site visits.

Our findings

We based our judgement of the quality of care at this service on a combination of:

  • what we found when we inspected .
  • information from our ongoing monitoring of data about services and
  • information from the provider, patients, the public and other organisations.

We found that:

  • The practice provided care in a way that kept patients safe and protected them from avoidable harm.
  • Patients received effective care and treatment that met their needs.
  • Staff dealt with patients with kindness and respect and involved them in decisions about their care.
  • Patients could access care and treatment in a timely way.
  • The way the practice was led and managed promoted the delivery of high-quality, person-centre care.

Whilst we found no breaches of regulations, the provider should:

  • Implement a system for maintaining staff vaccination in line with current guidance.
  • Improve systems and processes for care navigators in order to have appropriate understanding, confidence and consistent approach when dealing with unwell patients.

Details of our findings and the evidence supporting our ratings are set out in the evidence tables.

Dr Sean O’Kelly BSc MB ChB MSc DCH FRCA

Chief Inspector of Health Care

11 May 2022

During a routine inspection

We carried out an announced inspection at Royal Manor Health Care on 11 May 2022. Overall, the practice is rated as Requires Improvement.

Set out the ratings for each key question

Safe - Requires Improvement

Effective - Requires Improvement

Caring – Requires Improvement

Responsive - Requires Improvement

Well-led - Requires Improvement

Following our previous inspection in May 2018, the practice was rated Good overall and for all key questions.

The full reports for previous inspections can be found by selecting the ‘all reports’ link for Royal Manor Health Care on our website at www.cqc.org.uk

Why we carried out this inspection

This inspection was carried out as part of our regulatory programme and all key questions were inspected.

How we carried out the inspection

Throughout the pandemic CQC has continued to regulate and respond to risk. However, taking into account the circumstances arising as a result of the pandemic, and in order to reduce risk, we have conducted our inspections differently.

This inspection was carried out in a way which enabled us to spend a minimum amount of time on site. This was with consent from the provider and in line with all data protection and information governance requirements.

This included:

  • Conducting staff interviews using video conferencing
  • Completing clinical searches on the practice’s patient records system and discussing findings with the provider
  • Reviewing patient records to identify issues and clarify actions taken by the provider
  • Requesting evidence from the provider
  • A short site visit

Our findings

We based our judgement of the quality of care at this service on a combination of:

  • what we found when we inspected
  • information from our ongoing monitoring of data about services and
  • information from the provider, patients, the public and other organisations.

We have rated this practice as Requires Improvement overall

We found that:

  • The provider had not consistently ensured medicines were prescribed safely on an ongoing basis.
  • Significant events were discussed in practice meetings, but we found there were limited details in meeting minutes on discussions held and learning points shared from significant events. There was limited information to demonstrate what actions were taken or the processes used to ensure these were fully put into place.
  • Royal Manor healthcare had systems and processes in place for monitoring patients with long term conditions, but these were not always effective. Staff had appropriate skills and experience to manage these patients, but there were shortfalls in making sure that all relevant information was available, and care and treatment provide was consistently safe and effective.
  • Staff dealt with patients with kindness and respect, improvements were needed to ensure patients were involved in decisions about their care.
  • The practice adjusted how it delivered services to meet the needs of patients during the COVID-19 pandemic. Patients could access care and treatment in a timely way.
  • Governance systems and processes did not enable the provider to have a full oversight of how the practice was running. The provider was not able to demonstrate fully how they were assured that risks to patients were minimised as far as possible.
  • Information from significant events and complaints was not used effectively to drive improvement within the practice.
  • The provider did not fully involve staff in the running of the practice and future plans for service provision.

We found breaches of regulations. The provider must:

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

The provider should:

  • Continue to work with the landlord to ensure the premises at the main location are safe to use.
  • Continue to promote uptake of cervical screening.

Details of our findings and the evidence supporting our ratings are set out in the evidence tables.

Dr Rosie Benneyworth BM BS BMedSci MRCGP

Chief Inspector of Primary Medical Services and Integrated Care

16/05/2018

During a routine inspection

This practice is rated as Good overall. (Previous inspection June 2015 – Good)

The key questions are rated as:

Are services safe? – Good

Are services effective? – Good

Are services caring? – Good

Are services responsive? – Good

Are services well-led? - Good

We carried out an announced comprehensive inspection at Royal Manor Health Care on 16 May 2018 as part of our inspection programme.

At this inspection we found:

  • The practice had clear systems to manage risk so that safety incidents were less likely to happen. When incidents did happen, the practice learned from them and improved their processes.
  • The practice routinely reviewed the effectiveness and appropriateness of the care it provided. It ensured that care and treatment was delivered according to evidence- based guidelines.
  • Staff involved and treated patients with compassion, kindness, dignity and respect.
  • The practice had responded to the low survey results by reviewing and implementing new systems for accessing appointments including a ‘walk in and wait’ clinic.
  • The carers’ lead facilitated a carers’ group every week at the local village hall. The group invited people from external agencies to discuss areas of interest. The carers’ lead was provided with two hours of protected time each week to complete work to support patients who were also carers.
  • There was a strong focus on continuous learning and improvement at all levels of the organisation.
  • The practice had implemented a ‘walk in and wait’ clinic every morning in December 2017. The nurse practitioner led Service had improved access by increasing the amount of same day appointments being available. This had increased the number of GP routine appointments.

At our last inspection in June 2015 we recommended that the practice should make improvements relating to staff training, the dissemination of The National Institute for Health and Care Excellence (NICE) guidelines to all staff and ensuring patients with learning disabilities had a care plan in place. At this inspection we found the practice had taken steps to implement positive changes that addressed our recommendations and improved quality of services for patients.

We saw one area of outstanding practice:

  • The practice offered caring support by providing a ‘tea and chat’ social gathering at the practice, facilitated by health care assistants and receptionists each month. The group was formed to reduce social isolation of older patients and bereaved patients.

Professor Steve Field CBE FRCP FFPH FRCGP
Chief Inspector of General Practice

24 June 2015

During a routine inspection

Letter from the Chief Inspector of General Practice

We carried out an announced comprehensive inspection at Royal Manor Health Care on 24 June 2015. Overall the practice is rated as good.

Specifically we rated the practice as good for providing safe, effective, caring, responsive and well-led services. The practice was rated as good for providing services to the population groups of older people, people with long-term conditions, families, children and young people, working age people (including those recently retired and students), people whose circumstances may make them vulnerable and people experiencing poor mental health (including people with dementia).

The practice is the only registered location for the provider Portland Group Practice and the provider has a branch surgery at Gatehouse Surgery, Castle Road, Portland, Dorset, DT5 1 AU.

Our key findings were as follows:

  • Staff understood and fulfilled their responsibilities to raise concerns and report incidents. Action was taken in response to incidents and events and learning as a result of incidents and events was shared with staff.
  • Risks to patients were assessed and managed and all staff had received training in how to conduct a risk assessment.
  • Patients were treated with compassion, dignity and respect and supported to make decisions about their care.
  • The practice responded to feedback from patients and from the Patient Participation Group.
  • The practice had a clear leadership structure and staff were supported by management.
  • The practice proactively sought feedback from staff and patients, which it acted on.
  • The practice used the Quality and Outcomes Framework to measure its performance and QOF data for 2013/2014 indicated that the practice had achieved 95.6% of the total points available.
  • We saw one area of outstanding practice: The practice provided a ‘tea and chat’ service for patients who were isolated. The sessions were used to provide health advice to patients on matters such as sun safety.

However, there were also areas of practice where the provider needs to make improvements.

The provider should:

  • Provide training to all staff on information governance.
  • Ensure that all GPs are trained to Level three in Safeguarding Children
  • Update the emergency medicines checklist to ensure that the contents annotated reflect those that are currently available.
  • Introduce a single system to ensure that NICE guidelines are disseminated to all staff.
  • Ensure that all patients with a learning disability have a care plan in place.
  • Look at ways to improve access to appointments.

Professor Steve Field CBE FRCP FFPH FRCGP

Chief Inspector of General Practice