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Review carried out on 1 November 2019

During an annual regulatory review

We reviewed the information available to us about The Ridgeway Surgery on 1 November 2019. We did not find evidence of significant changes to the quality of service being provided since the last inspection. As a result, we decided not to inspect the surgery at this time. We will continue to monitor this information about this service throughout the year and may inspect the surgery when we see evidence of potential changes.

Inspection carried out on 1 May 2018

During a routine inspection

This practice is rated as Good overall. (Previous inspection 02/2015 – Good)

The key questions are rated as:

Are services safe? – Good

Are services effective? – Good

Are services caring? – Good

Are services responsive? – Outstanding

Are services well-led? - Good

We carried out an announced comprehensive inspection at The Ridgeway Surgery on 1 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.
  • The most recent published QOF results showed the practice performed above local and national averages.
  • The GP partners and management team were forward thinking. There was a strong commitment towards development and integrated care and the practice was involved in innovative projects both internally and within the locality.
  • Staff involved and treated patients with compassion, kindness, dignity and respect.
  • Patients could access care at the main practice, branch surgery and a walk-in centre which was run by the practice. Some clinical staff worked across all three services which offered continuity of care for patients
  • Feedback from patients and comment cards showed patients found the appointment system easy to use and reported that they were able to access care when they needed it.
  • Data from the GP patient survey showed some patients reported difficulties getting through to the practice by phone and delays in the punctuality of appointments. The practice had reviewed patient feedback and implemented new strategies to improve these areas.
  • There was a strong focus on continuous learning and improvement at all levels of the organisation. The practice supported members of staff to upskill and progress within their careers.
  • There were systems to manage most risks within the practice. However, we found the process for monitoring emergency medicines at the branch surgery was not robust and some clinicians were not adhering to the practice’s infection control policy.

We saw areas of outstanding practice:

  • The practice employed two enhanced practice nurses who visited patients in their own home for a review. Triggers for a review included: admission to hospital on more than one occasion; increased frailty; new development of co-morbidities; becoming housebound; dementia; patients in the last phase of life; and carers. The practice had evidence to demonstrate the positive impact these nurses had on patient care. For example, case studies demonstrating positive outcomes for patients and a reduction in A&E attendances for patients over 75 years. The practice shared the concept of enhanced practice nurses with their locality group and four local practices agreed to appoint nurses for similar roles.
  • The practice undertook a pharmacy project to improve communication with local pharmacies, improve patient care, and explore the educational needs of pharmacists and clinicians. The project developed into quarterly meetings with integrated multi-professional education for GPs and pharmacists and joint educational sessions with patients. Patients rated the educational session highly and the practice had seen an increase in the usage of repeat dispensing via the electronic prescription service. The practice shared learning from the project with the wider GP community and were presented with an award from Health Education England for Excellence in Education and Training in recognition of their work with local pharmacists.
  • The practice worked with representatives of a local learning disability charity to improve health outcomes and access for patients with learning disabilities. Staff were given training and a representative was elected to the patient group committee. Improvements made as a result included: updating the learning disability annual review template; creating easy-read leaflets and satisfaction surveys with pictures; and appointing a member of staff as learning disability champion. Learning from the scheme was shared at a local practice managers meeting.

The areas where the provider should make improvements are:

  • Review the systems in place for recording all significant events and monitoring emergency medicines.
  • Review staff members’ knowledge of infection prevention and control guidance relating to the disposal of urine samples.

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

Inspection carried out on 5 February 2015

During a routine inspection

Letter from the Chief Inspector of General Practice

We carried out an announced comprehensive inspection at The Ridgeway Surgery on 5 February 2015. The practice also provides services at a branch surgery at 275 Alexandra Avenue, Harrow. Patients registered with the practice may attend either surgery. On this occasion we inspected the main surgery and overall we rated the service at this location as Good.

Specifically, we found the practice to be good for providing safe, effective, caring, responsive and well- led services. It was good for providing services for older people, people with long term conditions, families, children and young people, working age people, people whose circumstances may make them vulnerable and people experiencing poor mental health.

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

  • Staff understood and fulfilled their responsibilities to raise concerns, and to report incidents and near misses. There were processes in place to safeguard vulnerable adults and children.
  • Patients’ needs were assessed and care was delivered following best practice guidance. Staff had received training appropriate to their roles and any further training needs had been identified and planned through personal development plans.
  • Patients described staff as helpful, kind, efficient, gentle and caring and said they were involved in decisions about their care and treatment.
  • Information about services and how to complain was available and easy to understand.
  • Patients were generally satisfied with the appointment system and found it easy to make an appointment.
  • Staff felt the practice management team was supportive and they had opportunity and funding to attend training courses for professional development.
  • The practice had a pro-active and enthusiastic Patient Participation Group (PPG) that was representative of the practice population.

We saw some areas of outstanding practice:

  • The pro-active involvement and commitment of the Patient Participation Group (PPG), the patient engagement activities organised by the group and the quarterly patient newsletter produced.
  • Health information provided on the practice website for patients fasting during Ramadan.

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

The provider should:

  • Maintain a risk log that records how identified risks have been assessed and progressed.
  • Ensure that clinical waste bins stored outside the practice premises are kept securely at all times.

Professor Steve Field (CBE FRCP FFPH FRCGP) 

Chief Inspector of General Practice