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Inspection carried out on 2 November 2017

During a routine inspection

Letter from the Chief Inspector of General Practice

This practice is rated as Good overall. (Previous inspection 8 April 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

As part of our inspection process, we also look at the quality of care for specific population groups. The population groups are rated as:

Older People – Good

People with long-term conditions – Good

Families, children and young people – Good

Working age people (including those recently retired and students – Good

People whose circumstances may make them vulnerable – Good

People experiencing poor mental health (including people with dementia) - Good

We carried out an announced comprehensive inspection at Ribbleton Medical Centre on 2 November 2017 as part of our inspection programme to inspect 10% of practices before April 2018 that were rated Good in our previous 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. There was evidence that incidents were not always shared effectively with staff and the practice was working to improve this.

  • The practice conducted safety risk assessments and staff recruitment processes were comprehensive. However, there were no occupational health checks undertaken for new staff to assess that working conditions were appropriate. Staff told us that these would be introduced in the future.

  • 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.

  • When GPs were very busy, they asked staff to work to a practice protocol to process some normal patient test results without sight of a GP. This protocol was comprehensive but there was no audit of its use to ensure that it was followed correctly.

  • Staff involved and treated patients with compassion, kindness, dignity and respect.

  • When patients reported problems in accessing the appointment system the practice worked to resolve these and had introduced a new telephone system. They had recruited an advanced nurse practitioner to improve access to clinicians from January 2018.

  • There was a proactive approach to managing the skill mix of staff needed to provide best care to patients. Staff felt respected, valued and supported.

  • Quality improvement issues were discussed in regular staff meetings. Clinical matters were discussed in weekly meetings although there were no formal minutes kept for these meetings.

  • There was a strong focus on continuous learning and improvement at all levels of the organisation.

The areas where the provider should make improvements are:

  • Continue to develop a system to allow better communication of safety incidents to all staff and to record and share clinical discussion.

  • Introduce occupational health screening for new staff to assess whether working conditions are appropriate.

  • Introduce an audit process to ensure that the practice protocol for staff filing patient test results has been followed correctly.

  • Take steps to better identify patients on the practice list who are also carers.

Professor Steve Field (CBE FRCP FFPH FRCGP) 

Chief Inspector of General Practice

Inspection carried out on 08 April 2015

During a routine inspection

Letter from the Chief Inspector of General Practice

We had previously undertaken an inspection at this practice in July 2014 as part of our pilot inspections testing our new methodology. We found one area for improvement and we issued a compliance action in relation to this at that time.

We carried out an inspection of Ribbleton Medical Centre on 8 April 2015 as part of our new comprehensive inspection programme and to determine the actions taken since the last inspection.

Overall the practice is rated as Good.

Our key findings were as follows:

  • Improvements had been implemented for the safe and effective recruitment and employment of staff.

  • Staff understood and fulfilled their responsibilities to raise concerns, and to report incidents and near misses. Information about safety was recorded, monitored, appropriately reviewed and addressed.

  • Patients’ needs were assessed and care was planned and delivered following best practice guidance. Staff had received training appropriate to their roles.

  • Patients we spoke with said the GPs and nurses were very good and caring. Out of 106 responses to the Friends and Family test between December 2014 and March 2015, 94 respondents said they were either extremely likely or likely to recommend the practice to friends and family.

  • Information about services and how to complain was available and the practice responded appropriately to these.

  • Patients said they found it easy to make an appointment with a named GP. The practice was committed to providing continuity of care. Urgent appointments were available each 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.

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

The provider should:

  • Ensure that all clinical staff receive training in the principles of the Mental Capacity Act 2005.

  • Ensure staff who perform chaperoning duties are trained to undertake this role.

  • Ensure that staff training is effectively recorded and monitored and copies of training certificates kept.

  • Ensure an accessible record of clinical staff professional registration numbers are kept, so that these can be checked more efficiently.

  • Ensure regular checks on infection control are carried out and ensure disposable curtains are changed appropriately.

  • Ensure a clear documentary record is maintained of the staff recruitment processes including when references are requested and the actions taken when these are not provided.

  • Ensure a Legionella risk assessment is carried out for the premises.

Professor Steve Field (CBE FRCP FFPH FRCGP) 

Chief Inspector of General Practice

Inspection carried out on 14 July 2014

During a routine inspection

Ribbleton Medical Centre operates from a converted detached building within the Ribbleton area of Preston. There are four practice General Practitioner (GP) partners and a salaried GP working with practice staff serving a population size of approximately 7,949 people. The practice has high levels of deprivation with Index of Multiple Deprivation (IMD) score of 1 which is the most deprived.

The practice is registered with the Care Quality Commission (CQC) to provide the regulated activities diagnostic and screening procedures, family planning, maternity and midwifery services, surgical procedures and treatment of disease, disorder or injury.

The practice has a culture of patient safety and awareness. Staff are encouraged to be proactive in learning from incidents and taking ownership when things didn’t go as planned and incidents occurred. The practice is providing an effective service for their local population. Care and treatment is considered in line with current published guidelines and best practice all of which are available to staff on the practice intranet.

Throughout our inspection we observed good compassionate care where patients are given time and support during their appointment. We observed how the whole team are responding to both the clinical and non-clinical needs of their patients. We found the practice to be a responsive practice in particular in terms of patient access and in listening to patient feedback. Each of the population groups we reviewed during the inspection received a good service from the practice.

The practice does not ensure that safe and effective staff pre employment checks are in place to ensure patient safety and welfare. Robust recruitment processes are not in place for staff working with children and or vulnerable adults. We found the practice had recruited a new staff member without undertaking previous references, employment history and professional fitness checks. We found also that  appropriate Disclosure and Barring Systems (DBS) and Criminal Records Bureau Disclosure (CRB) checks are sought prior to commencement of work at the practice.

CQC Insight

These reports bring together existing national data from a range of indicators that allow us to identify and monitor changes in the quality of care outside of our inspections. The data within the reports do not constitute a judgement on performance, but inform our inspection teams. Our judgements on quality and safety continue to come only after inspection and we will not make judgements on data alone. The evidence tables published alongside our inspection reports from April 2018 onwards replace the information contained in these files.