Rosedale Surgery

This practice is rated as Good overall. (Previous rating January 2015 - Good)

The key questions at this inspection are rated as:

Are services safe? – Good.

Are services effective? – Requires improvement.

Are services caring? – Good.

Are services responsive? – Good.

Are services well-led? – Good.

We carried out an announced comprehensive inspection at Rosedale Surgery on 16 October 2018. This was part of our planned inspection programme.

At this inspection we found:

• The practice had 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. Risks were assessed and acted upon, however there was no formalised process for identifying the risks in relation to fire and premises safety.
• Effective processes were in place for the management of medicines. All prescription stationary was kept secure, although there was not an effective tracking system for prescription paper.
• The practice routinely reviewed the effectiveness and appropriateness of the care it provided. It ensured care and treatment was delivered according to evidence-based guidelines. The practice’s performance on quality indicators for mental health and long-term conditions was in line with and above the Clinical Commissioning Group (CCG) and England averages. However, the exception reporting for some of the Quality and Outcomes Framework (QOF) indicators for diabetes, asthma and Chronic Obstructive Pulmonary Disease (COPD), were higher than the CCG and England averages. They were significantly higher for some of the mental health and dementia indicators and some of these had increased significantly from the year 2016/2017 to 2017/2018. Although the practice excepted patients in line with QOF requirements, a significant number of patients were not receiving the interventions and there was no evidence of additional outreach to increase this.
• Staff worked together and with other health and social care professionals. Multi-professional meetings were held where patients with, for example, palliative care, or complex needs were discussed and reviewed. The practice encouraged other professionals to engage with the practice and invited them to six monthly informal meetings.
• The practice had 77 patients on the learning disability register and 45 had received a health check. They were aware of this and although they had not completed many learning disability health checks since April 2018, appointments had been scheduled to catch up with these.
• Staff involved and treated patients with compassion, kindness, dignity and respect.
• The practice gave patients timely support and information. There were some examples where the flexibility of the same day team clinicians had resulted in patients being given more time.
• Patients found the appointment system easy to use and reported they could access care when they needed it.
• There was a strong focus on continuous learning and improvement at all levels of the practice. Regular training tutorials were held for practice staff. All staff received an appraisal. Staff reported feeling well supported.
• Leaders were knowledgeable about issues and priorities relating to the quality and future of services. They understood the challenges and were addressing them.

The areas where the provider must make improvements as they are in breach of regulations are:

• Ensure the care and treatment of patients is appropriate, meets their needs and reflects their preferences.

The areas where the provider should make improvements are:

• Formalise the process for identifying risks in relation to fire and premises safety.
• Improve the tracking in and out of prescription paper.
• Continue to improve the uptake of health checks for patients with a learning disability.

Professor Steve Field CBE FRCP FFPH FRCGPChief Inspector of General Practice

Please refer to the detailed report and the evidence tables for further information.