Ringmead Medical Group

On this page

• Overview
• Learning culture
• Safe systems, pathways and transitions
• Safeguarding
• Involving people to manage risks
• Safe environments
• Safe and effective staffing
• Infection prevention and control
• Medicines optimisation

During the assessment we reviewed evidence remotely, spoke with staff, completed remote clinical searches of the practice’s clinical system and undertook observations while on site. We also reviewed feedback provided to CQC by people that had used the service. At our last assessment we rated this key question requires improvement. At this assessment we found improvements had been made and this key question is now rated good. We found the following:

The provider had improved its systems and processes in relation to safe care and treatment, although we found instances where these had not operated effectively. The provider is no longer in breach of regulation 12 related to safe care and treatment because none of these issues directly impacted on patients.

Our assessment found:

The provider now had embedded processes for raising incidents and these ensured learning was identified and shared with staff in the practice.

Process improvements had taken place since our last inspection to reduce the likelihood of backlogs of clinical correspondence. The system was monitored and at the time of our assessment there was no backlog and the system had operated as intended to ensure tasks had been managed in a timely manner.

Safeguarding processes to protect vulnerable patients had improved. Staff were now appropriately trained and systems to ensure Disclosure and Barring Service (DBS) checks were completed embedded and operating consistently. A DBS check is used to search a person’s criminal record to assess their suitability to work with vulnerable adults and children.

Action had been taken to improve systems and processes for ensuring premises occupied by the provider were maintained and safe for people that used the service. However, these were not fully effective

The provider now ensured that recruitment processes were in accordance with the requirements of relevant legislation. Systems and processes to give the provider assurance about the training compliance of staff had improved. Both these systems were effective and embedded but had not operated completely consistently.

Processes to manage Infection Prevention and Control (IPC) risks had improved. Staff were trained, audits took place regularly and the premises were visibly clean. The provider now held accurate records of vaccinations of staff. However, quality assurance had not identified a lack of information regarding completion of cleaning by the external contractor.

The provider’s systems and processes related to medicines management had improved. The provider now monitored patients with long-term conditions or prescribed medicines requiring monitoring inline with national guidance.

Staff operating under Patient Group Directions (PGDs) and Patient Specific Directions (PSDs) were now authorised correctly. A PGD is an authorisation which allows healthcare professionals to administer or supply specific medicines to a predefined group of patients without a doctor’s prescription. They are commonly used for immunisations. A PSD is a signed authorisation by qualified prescriber for a specific medicine to be supplied or administered to a specific patient after assessment.

Systems and processes to respond to medicines safety alerts from the Medicine and Healthcare products Regulatory Agency (MHRA) were embedded and operating effectively.

Systems and processes to monitor the stock of emergency medicines and equipment within the practice had improved and were now embedded.

Overall, we were assured that patients received safe care and treatment.

This service scored 72 (out of 100) for this area. Find out what we look at when we assess this area and How we calculate these scores.

The practice had taken action to improve their process for managing significant event activity (SEA) and this was now embedded. Incidents were raised and investigated and where necessary, changes to processes were made to reduce the likelihood of recurrence or make improvements. To support this, the practice completed an annual audit which included theme analysis to identify patterns or trends.

Leadership had oversight of SEA investigations and these were discussed during practice meetings to ensure effective management of the incident and that learning resulting from the incident was identified and shared throughout the practice.

Staff we spoke with were confident about how to raise an incident and reported SEAs were routinely discussed at meetings. Staff could also access recent and historic incidents to assist their learning and awareness.

We sampled 2 SEA reports and found both identified changes which could be made to improve processes and the SEA had not been closed until all actions were completed and learning had been shared in the practice.

At our January 2024 assessment we found a backlog of clinical tasks. This, most recent, assessment included remote searches of the practice’s clinical system by a Care Quality Commission (CQC) GP Specialist Advisor (SPA). We found the process to manage tasks was operating effectively because there were no backlog and tasks being managed had been received that day.

We received a limited amount of negative feedback from people that had used the service in the last 12 months that related to referrals. The themes involved dissatisfaction that a clinician had sought further advice prior to referral and that a referral had failed due to a lack of information. We were told a patient had wanted an immediate referral to secondary care but the clinician wanted further advice before referring and, another patient felt the referral could have included more information to make the referral more effective.

However, staff we spoke with explained how they made referrals to other services and how these were monitored by care coordinators. Audit was used to monitor referrals and to help the practice follow up patients’ care. Staff explained they liaised with other services for advice while patients waited for care, for example, the tissue viability service. We also heard examples of how staff gave patients ‘safety netting’ advice about worsening or deteriorating symptoms.

Overall, we were assured that care was planned and organised with patients’ involvement and other system partners.

The practice had improved its safeguarding processes since the last assessment. We sampled the training of 5 members of staff and found all had completed safeguarding training to the recommended level in national guidance for their role.

We also found disclosure and barring service (DBS) checks had been completed for the staff sampled and a system was in place providing management oversight of staffs’ DBS status. The DBS checks were appropriate to the staffs’ roles. This helped to safeguard vulnerable patients from the risk of abuse, including the potential for abuse by staff employed by the practice.

The practice continued to have a lead and a deputy for safeguarding. Staff we spoke with knew who the leads were and were confident about signs and symptoms of abuse they would be alert to when supporting with patients. They were also clear about what they would do if they needed to raise or share concerns about a vulnerable patient.

The practice held regular meetings to discuss vulnerable patients and system partners were invited to ensure information was shared and to ensure patients in the community were safeguarded and supported.

Our GP SpA completed remote clinical searches of the practice’s clinical system which included reviewing patients’ medical records, care planning and medicine reviews. The GP SpA found that when patients were prescribed medicines, they were informed about the risks associated with taking them and the need for monitoring to ensure prescribing was safe.

We also reviewed national data which indicated some patients felt they were not as involved in decisions about their care and treatment as they would like when comparing the practice to others. We also reviewed feedback provided to the CQC from people that had used the service in the last 12 months. None of this feedback raised concerns about not being involved in decisions. However, one patient felt they had not been well supported to understand and manage a newly diagnosed long-term condition.

We were provided unverified data by the provider which showed a high uptake of flu vaccinations by patients had been achieved. To support other providers to improve their own uptake the practice had contributed to a promotional document prepared by a pharmaceutical company which shared their approach to planning vaccination programmes to protect patients from the risk of catching flu.

Although there were indications in national data and feedback that patients felt they could be more involved in their care and treatment, overall, we were assured the practice shared information and safety netted patients about the risks of conditions, medicines and worsening or deteriorating symptoms.

The provider had improved their systems and processes for maintaining their premises and managing health and safety risks to ensure environments were safe for people using the service. There were now clear roles and responsibilities and leadership had systems which provided oversight; however, these could be further improved.

We found a programme of routine monitoring, maintenance and risk assessment existed. For example, we found routine monitoring of risks such as hot and cold water temperatures, flushing of little used water outlets and emergency lighting were embedded processes.

External contractors were used to complete risk assessments. Where remedial action to lower, control or remove a risk was indicated, a process existed to monitor and ensure action was taken in a timely manner. We reviewed the systems to manage risks associated with fire, legionella and electrical safety found these were effective and operating as the practice intended.

We also found a cupboard used to store harmful substances used within the practice was not labelled to help identify this risk to staff. Shortly after our inspection we were advised that risk management systems had been reviewed and strengthened.

Overall, we were assured the practice had improved systems and processes to keep their premises safe and that where risks were identified, action was taken promptly to mitigate or reduce the risk. However, there were opportunities to further develop these systems to make them more effective at identifying and mitigating risks.

The provider recruitment systems and processes now meant staff were recruited in accordance with relevant legislation.

While on site we sampled the recruitment records for 5 members of staff, both clinical and non-clinical, and found 4 of the records contained all the required information. One record did not have evidence of the staff member’s full employment history but the practice assured us this it was held and had been seen and it was provided on the day of the site visit.

We also sampled the training compliance for 5 members of staff while on site and found all were up to date with the mandatory training required by the practice. One staff member’s file had 1 record of training missing; however, the practice assured us this was held and the evidence was reviewed on the day of the site visit.

Staff throughout the practice had access to support and supervision as required. We found there were buddy arrangements and staff had dedicated time in clinical sessions to discuss patients as well as ongoing arrangements for clinical supervision and development.

Although not all systems had operated as the provider intended, overall we were assured the practice now had embedded processes that ensured staff were recruited safely and had the necessary skills, knowledge and training to carry out their roles.

The provider had made improvements to the processes to manage the risk of infection within the practice. The infection prevention and control (IPC) lead was a GP partner assisted by the practice Operations Manager. All staff had received IPC training appropriate to their roles, including 'IPC champion' training for staff in lead roles.

We found evidence the practice had a programme of IPC audits which included annual, quarterly and monthly audits. Where risks were identified processes existed to give the IPC lead and management oversight and action was taken to mitigate, lower or remove the risk. The system ensured actions were not closed until completely resolved.

We saw evidence that the practice audited stock to ensure no consumable items were out of date and our own sampling found all were in date and there was sufficient stock available to staff within the practice.

The provider followed national guidance regarding the immunisation status of staff. The provider now had systems and processes which ensured the immunisation status staff working in the practice was held and management maintained oversight of compliance against the provider policy. We were shown the process for monitoring this and sampled the records of 5 staff. All staff sampled had complete records.

The premises were visibly clean and we saw evidence that the quality of cleaning was monitored and audited on a regular basis. However, at the Owlsmoor site, we found the monthly cleaning schedules had only been partially completed prior to September 2025 and not completed after this date. This oversight had not been identified by the provider's own governance arrangements. After the site visit the provider confirmed that all cleaning had been completed but documentation had been taken off site. We were provided copies of fully completed cleaning schedules after our visit.

Overall, we were assured the provider now had improved systems and processes to manage the risk of infection. When governance oversight concerns were identified, the provider took immediate action to strengthen governance arrangements. However, the provider's own governance had not identified that incomplete information was held.

Action had been taken since our last inspection to improve patient monitoring arrangements. Our GP SpA carried out remote searches of the practice's clinical system. These included searches for patients prescribed medicine which require ongoing monitoring and with long-term conditions. We highlighted 5 patients that needed further review by the practice and immediate action was taken in response to ensure the practice had accurate information such as blood pressure readings and weight of the patient. Overall, we found the practice's processes regarding prescribing and monitoring of patients had improved since the last assessment and now followed national guidance and best practice.

We reviewed the practice's processes to manage and store prescription stationary. We found there was a process to ensure stationary was logged when received, stored securely and when stationary was issued there was an audit trail allowing the practice to track stationary.

We found the provider now had an embedded process for monitoring the stock of emergency medicines and equipment. We inspected this process at the 3 sites we visited and found all items recorded on the inventory were in the emergency equipment, weekly checks of stock and equipment were being completed and all stock was in date.

Action had been taken since our last inspection such that staff operating under PGDs had now been authorised correctly. Systems had improved such that PSDs were now in place prior to the administration of medicine of vaccine. The practice had a lead for immunisations who was supported by a deputy and a member of administrative staff to ensure PGD authorisations and PSDs were completed correctly.

Our remote clinical searches found the practice had improved their systems and processes to receive and act on medicines safety alerts issued by the MHRA. Our GP SpA reviewed 5 patient records and found all the patients had been informed of the risks associated with the medicine they were prescribed.

A process was in place to monitor and manage medicines which required refrigeration. We inspected the process for a random sample of fridges and found this operated as the provider intended for the medical fridges.

Feedback to CQC from people that had used the service indicated their experience when requesting repeat prescriptions from the service had not been positive. Staff and leaders were aware there had been difficulties and they had engaged with stakeholders to improve patients' experience. For example, we were told staff now worked closely with local Community Pharmacies and had introduced systems to ensure prescribing queries are managed efficiently and safely.

Overall, we were assured by the results of remote clinical searches that processes existed to ensure patients were monitored and when medicines were prescribed this was done safely.