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Inspection Summary


Overall summary & rating

Good

Updated 6 April 2017

Letter from the Chief Inspector of General Practice

Our previous comprehensive inspection at Ringmead Medical Practice on 12 August 2016 found breaches of regulations relating to the safe and well-led delivery of services. The overall rating for the practice was requires improvement. Specifically, we found the practice to require improvement for provision of safe and well led services. It was good for providing effective, caring and responsive services. Consequently we rated all population groups as requires improvement. The full comprehensive report on the August 2016 inspection can be found by selecting the ‘all reports’ link for Ringmead Medical Practice on our website at www.cqc.org.uk.

This inspection was an announced focused inspection carried out on 8 March 2017 to confirm that the practice had carried out their plan to meet the legal requirements in relation to the breaches in regulations that we identified in our previous inspection on 12 August 2016. This report covers our findings in relation to those requirements and improvements made since our last inspection.

We found the practice had made improvements since our last inspection. At our inspection on the 8 March 2017 we found the practice was meeting the regulations that had previously been breached. We have amended the rating for this practice to reflect these changes. The practice is now rated good for the provision of safe, effective, caring, responsive and well led services. Overall the practice is now rated as good. Consequently we have rated all population groups as good.

Our key findings were as follows:

  • The practice had demonstrated significant improvements in governance arrangements.
  • Blank prescription printer forms were kept securely and tracked through the practice.
  • We found management of legionella and medicines management had been improved.
  • The practice had demonstrated improvements in patients’ outcomes for patients with dementia.
  • For example, the practice had carried out dementia face to face reviews for 50 out of 56 patients, which demonstrated improvement from 74% to 89%, compared to the previous inspection.
  • All staff had received an annual appraisal in the last 12 months. We noted the practice manager had received a formal written appraisal on 21 October 2016.
  • Staff feedback had been considered and the practice had made improvements in staffing levels, however it was too early to assess the positive impact.
  • The practice had displayed an information poster in the waiting area, written in multi-languages about the available translation service. 

  • Staff we spoke with on the day of inspection were aware of the translation service.
  • Aside from the translation poster; information posters and leaflets were not available in multi-languages. However, the practice website could be translated into various languages and the staff were all aware of this.
  • The practice had taken steps to identify carers to enable them to access the support available via the practice and external agencies. The practice register of patients who were carers had increased from 153 (0.98%) patients to 283 patients (1.8% of the practice patient population list size).

The areas where the provider should make improvements are:

  • Review how information is displayed in practice and how this could be provided in multiple languages to meet patient needs.

Professor Steve Field (CBE FRCP FFPH FRCGP) 

Chief Inspector of General Practice

Inspection areas

Safe

Good

Updated 6 April 2017

The practice had taken appropriate action and is now rated good for the provision of safe services.

  • When we inspected the practice in August 2016 we found concerns relevant to staffing levels, management of blank prescription printer forms and management of legionella. We noted the vaccine fridge in reception office at the branch practice (Great Hollands Health Centre) was not locked and the key was not accessible.
  • At the inspection on 8 March 2017, we saw the concerns had been addressed:
  • The storage of medicines was safe and secure. The practice had purchased key cabinets with combination locks to store all keys. The practice was carrying out regular medicines checks.
  • The practice had managed risks associated with legionella.
  • Blank prescription printer forms were tracked through the practice and kept securely at all times.
  • The practice had reviewed and improved staffing levels. However it was too early to assess the positive impact.

Effective

Good

Updated 23 September 2016

The practice is rated as good for providing effective services.

  • Data from the Quality and Outcomes Framework (QOF) showed patient outcomes were above average for the local Clinical Commissioning Group (CCG) and compared to the national average.
  • Staff assessed need and delivered care in line with current evidence based guidance.
  • Clinical audits demonstrated quality improvement.
  • Staff had the skills, knowledge and experience to deliver effective care and treatment.
  • There was evidence of appraisals and personal development plans for most staff. However, we noted the practice manager had not received a formal appraisal since February 2015.
  • The practice’s uptake of the national screening programme for cervical and breast cancer screening were above national average and bowel cancer screening uptake was slightly below the national average.
  • The practice’s uptake for the breast cancer screening programme was 77%, which was higher than the national average of 72%.
  • The practice was extending health promotion to Member of Parliaments (MPs) and Peers by offering annual flu vaccines at Westminster.
  • Staff worked with multidisciplinary teams to understand and meet the range and complexity of patients' needs.

Caring

Good

Updated 23 September 2016

The practice is rated as good for providing caring services.

  • Data showed that patient outcomes were mixed compared to others in locality for several aspects of care.
  • Most of the patients said they were treated with compassion, dignity and respect and they were involved in decisions about their care and treatment.
  • Information for patients about the services was available. However, we noted information about translation services was not displayed in the reception or waiting area and limited multi-language information leaflets were available.
  • We also saw that staff treated patients with kindness and respect, and maintained confidentiality.
  • Staff told us that if families had suffered bereavement, their usual GP contacted them and offered a bereavement visit within 24 hours. During consultation the practice was handing out a bereavement information leaflet accompanied by a book of poems.

Responsive

Good

Updated 23 September 2016

The practice is rated as good for providing responsive services.

  • Practice staff reviewed the needs of its local population and engaged with the NHS England Area Team and Clinical Commissioning Group to secure improvements to services where these were identified. For example, an anti-coagulation clinic (an anti-coagulant is a medicine that stops blood from clotting) was offered onsite, resulting in the 190 patients who required this service not having to travel to local hospitals.
  • The practice had reviewed appointment booking system, introduced unlimited telephone consultation with GPs for patients requesting same day urgent appointments, added four additional telephone lines and increased locum GP sessions.

  • The practice had good facilities and was well equipped to treat patients and meet their needs.
  • Information about how to complain was available and easy to understand and evidence showed the practice responded quickly to issues raised.
  • The practice worked closely with other organisations and with the local community in planning how services were provided to ensure that they met patients’ needs.

Well-led

Good

Updated 6 April 2017

The practice had taken appropriate action and is now rated good for the provision of well-led services.

  • When we inspected the practice in August 2016, we found the governance and monitoring of specific areas required improvement, such as, management of blank prescriptions, staffing levels, monitoring of vaccine fridges and medicines and management of legionella.
  • At the inspection on 8 March 2017, the practice had demonstrated significant improvements.
  • Effective monitoring systems had been implemented and all the areas of concerns from the previous inspection had been resolved.
  • There were arrangements for identifying, recording and managing risks, issues and implementing mitigating actions.
  • The practice had implemented an effective system to monitor the staffing levels and the management of blank prescriptions.
  • The practice had demonstrated improvements in patient’s outcomes.
Checks on specific services

People with long term conditions

Good

Updated 6 April 2017

The provider had resolved the concerns for safe and well-led identified at our inspection on 12 August 2016 which applied to everyone using this practice, including this population group. The population group ratings have been updated to reflect this.

Families, children and young people

Good

Updated 6 April 2017

The provider had resolved the concerns for safe and well-led identified at our inspection on 12 August 2016 which applied to everyone using this practice, including this population group. The population group ratings have been updated to reflect this.

Older people

Good

Updated 6 April 2017

The provider had resolved the concerns for safe and well-led identified at our inspection on 12 August 2016 which applied to everyone using this practice, including this population group. The population group ratings have been updated to reflect this.

Working age people (including those recently retired and students)

Good

Updated 6 April 2017

The provider had resolved the concerns for safe and well-led identified at our inspection on 12 August 2016 which applied to everyone using this practice, including this population group. The population group ratings have been updated to reflect this.

People experiencing poor mental health (including people with dementia)

Good

Updated 6 April 2017

The provider had resolved the concerns for safe and well-led identified at our inspection on 12 August 2016 which applied to everyone using this practice, including this population group. The population group ratings have been updated to reflect this.

  • The practice had carried out dementia face to face reviews for 50 out of 56 patients, which demonstrated improvement from 74% to 89%, compared to the previous inspection.

People whose circumstances may make them vulnerable

Good

Updated 6 April 2017

The provider had resolved the concerns for safe and well-led identified at our inspection on 12 August 2016 which applied to everyone using this practice, including this population group. The population group ratings have been updated to reflect this.