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River Brook Medical Centre Good

Inspection Summary


Overall summary & rating

Good

Updated 9 October 2017

Letter from the Chief Inspector of General Practice

We previously carried out an announced comprehensive inspection at River Brook Medical Centre on 12 December 2016. As a result of our inspection the practice was rated as good overall but required improvement for providing safe services. The full comprehensive report on the December 2016 inspection can be found by selecting the ‘all reports’ link for River Brook Medical Centre on our website at www.cqc.org.uk.

This inspection was a desk-based focused inspection carried out on 21 August 2017. This was to confirm that the practice had carried out their plan to meet the legal requirements in relation to the breach in regulations we identified in our previous inspection on 12 December 2016. This report covers our findings in relation to those requirements and also additional improvements made since our last inspection.

Overall the practice is rated as good.

Our key findings were as follows:

  • The practice had introduced appropriate recruitment procedures to ensure that persons employed met the required conditions. They had sought advice from a human resource service to assist them in ensuring all the necessary checks had been included. For example, references, photographic identification, and evidence of previous employment.

  • The practice had addressed coding issues in their clinical system and could demonstrate that health checks were being offered and carried out for patients with learning disabilities. This process also incorporated calling carers and patients aged over 75 for annual health checks. The practice submitted evidence to show that, for example, 71% of learning disability health checks had been completed up to August 2017. They searched their registers monthly to identify eligible patients and invited them to the practice for health checks.
  • The practice provided evidence to confirm that that oxygen masks for children had been purchased for use in the event of a child emergency.
  • The practice’s safeguarding policy had been reviewed and updated to include all types of potential abuse.

  • The practice had carried out a comprehensive infection control audit in November 2016 and introduced the use of documentation which allowed for review and follow up in the future. All staff had received infection control training.

  • The practice manager had introduced a formal programme of appraisals which involved identification of review dates for the following year at the end of each appraisal. The annual appraisal programme included a review of training needs.

Professor Steve Field CBE FRCP FFPH FRCGP

Chief Inspector of General Practice

Inspection areas

Safe

Good

Updated 9 October 2017

During our comprehensive inspection on 12 December 2016, we identified a breach of legal requirements. The practice needed to take action to ensure that appropriate recruitment procedures were in place which confirmed that persons employed met the required conditions. During our desk based focused inspection on 21 August 2017 we found that the practice had taken action to improve this area.

The practice manager had sought advice from a human resource service and reviewed their recruitment procedures to include a process to confirm that new employees met the necessary requirements. They had recruited a new member of staff since our previous inspection and submitted documentary evidence to demonstrate they had followed the procedure and recorded all information required.

The practice had carried out an infection control audit, using a comprehensive audit tool, which demonstrated that infection control training had been provided to all staff and that they had identified and addressed any infection control risks.

The practice’s safeguarding policy had been reviewed and updated in December 2016 to include all categories and definitions of abuse, for example modern slavery.

The practice is now rated as good for providing safe services.

Effective

Good

Updated 21 February 2017

The practice is rated as good for providing effective services.

  • Data from the Quality and Outcomes Framework (QOF) showed patient outcomes were at or above average compared to the national average. The most recently published results showed the practice had achieved 98% of the total number of points available.
  • The clinical staff were able to describe a structured approach to how National Institute for Health and Care Excellence (NICE) best practice guidelines and standards were disseminated, audited and actioned.
  • Clinical audits had been completed and repeated audit cycles demonstrated that the practice monitored the findings to drive improvements in patient outcomes.
  • An overarching training matrix and policy had been put in place to monitor that all staff were up to date with their training needs. However, there were some gaps where training needs had not been identified and not all staff had received regular appraisals.
  • Childhood immunisation rates for the vaccinations given were similar to the national averages.
  • Staff worked with health care professionals to understand and meet the range and complexity of patients’ needs.
  • The practice had a system for sharing information with the out of hours service for patients nearing the end of their life or if they had a ‘do not attempt cardiopulmonary resuscitation’ (DNACPR) plan in place.

Caring

Good

Updated 21 February 2017

The practice is rated as good for providing caring services.

  • Data from the national GP patient survey, published in July 2016, showed patients rated the practice higher than others for most aspects of care.
  • 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 available was easy to understand and accessible.
  • We saw staff treated patients with kindness and respect, and maintained patient and information confidentiality.
  • The practice had identified 77 patients as carers (1.2% of the practice list) and offered them flu immunisations and annual health checks. However, there was no patient call/recall system in place to promote the uptake of these services.
  • The practice provided support to families who had suffered bereavement and had an effective system in place to notify staff and other health care professional to minimise the risk of inappropriate correspondence.

Responsive

Good

Updated 21 February 2017

The practice is rated as good for providing responsive services.

  • The practice offered extended hours and services were available to patients seven days a week.
  • 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, the practice had carried out a re-audit of A&E attendances and shared their findings with the local Clinical Commissioning Group (CCG) to inform the development of future services.
  • Patients said they found it easy to make an appointment with a named GP and there was continuity of care, with urgent appointments available the same day. This was supported by the results of the national patient survey published in July 2016.
  • Patient feedback was positive about the appointment system. Data from the national patient survey, published in July 2016, showed that 83% of respondents described their experience of making an appointment as good.
  • The practice had good facilities and was well equipped to treat patients and meet their needs.

Well-led

Good

Updated 21 February 2017

The practice is rated as good for being well-led.

  • The practice had a vision to provide high quality primary care to their practice population seven days a week and to increase the services available in the community and through information technology. Staff were clear about the vision and their responsibilities in relation to it.
  • The practice had a supporting business plan to ensure the future direction and challenges to the practice were assessed, monitored and evaluated.
  • There was a clear leadership structure and staff felt supported by the management. The practice had a number of policies and procedures to govern activity and held regular team meetings, social events and team development sessions.
  • The practice had some systems and processes in place to support an overarching governance framework that improved the quality and safety of their service. However, we identified several areas which required review.
  • The provider was aware of and complied with the requirements of the duty of candour. The partners encouraged a culture of openness and honesty. The practice had systems in place for notifiable safety incidents and ensured this information was shared with staff to ensure appropriate action was taken.
  • The practice proactively sought feedback from staff and patients, which it acted on.

Checks on specific services

People with long term conditions

Good

Updated 9 October 2017

Following our comprehensive inspection on 12 December 2016 we rated the practice as good for the population group of people with long-term conditions. We did not review any evidence during our desk based focused inspection to alter this rating.

Families, children and young people

Good

Updated 9 October 2017

Following our comprehensive inspection on 12 December 2016 we rated the practice as good for the population group of families, children and young people. We did not review any evidence during our desk based focused inspection to alter this rating.

Older people

Good

Updated 9 October 2017

Following our comprehensive inspection on 12 December 2016 we rated the practice as good for the population group of older people. We did not review any evidence during our desk based focused inspection to alter this rating.

Working age people (including those recently retired and students)

Good

Updated 9 October 2017

Following our comprehensive inspection on 12 December 2016 we rated the practice as good for the population group of working age people (including those recently retired and students). We did not review any evidence during our desk based focused inspection to alter this rating.

People experiencing poor mental health (including people with dementia)

Good

Updated 9 October 2017

Following our comprehensive inspection on 12 December 2016 we rated the practice as good for the population group of people experiencing poor mental health. We did not review any evidence during our desk based focused inspection to alter this rating.

People whose circumstances may make them vulnerable

Good

Updated 9 October 2017

Following our comprehensive inspection on 12 December 2016 we rated the practice as good for the population group of people whose circumstances may make them vulnerable. We did not review any evidence during our desk based focused inspection to alter this rating.