Risedale Surgery

We carried out an announced focused inspection of Risedale Surgery on 29 and 30 November 2022. Overall, the practice is rated as Good.

The ratings for each of the key questions are as follows:

Safe - Good

Effective - Good

Caring – Good (not inspected - rating awarded at the inspection on 21 April 2022).

Responsive – Good (not inspected - rating awarded at the inspection on 21 April 2022)

Well-led - Requires Improvement

Why we carried out this inspection

We carried out this inspection to follow up breaches of regulation from a previous inspection in April 2022, where the practice was rated as requires improvement overall, and for the safe, effective and well led key questions. The full reports for previous inspections can be found by selecting the ‘all reports’ link for Risedale Surgery on our website at www.cqc.org.uk.

At our last inspection there were breaches of Regulation 12 HSCA (RA) Regulations 2014 Safe care and treatment and Regulation 17 HSCA (RA) Regulations 2014 Good governance. At the last inspection in April 2022 we found:

• Staff were not all trained to the correct level in safeguarding.
• Disclosure and barring checks were not in place for clinicians or appropriate risk assessments for non-clinical staff.
• The range of emergency medicines was insufficient to respond to some medical emergencies, the medicines were not kept securely and there was no risk assessment in place to mitigate against the risk from missing medicines in place.
• The cold chain for storing vaccinations was not maintained appropriately.
• Medicines safety alerts were not always responded to and patients were left uninformed.
• The practice was unable to demonstrate that clinical and non-clinical staff had completed all mandatory training in the last two years.
• Patient Group Directions were not complied with appropriately.
• The practice was not able to demonstrate a formal system of oversight or supervision for non-medical prescribers.
• The system to identify, investigate and review significant events was ineffective.
• Communication systems were ineffective.
• There was no evidence of audit or other structures quality improvement processes in place.
• There were no systems to ensure records of patients who had been identified as not to be resuscitated remained appropriate.
• There was no system to ensure that policies were in date and reflected current activities in place.

There was no freedom to speak up guardian in place.

Our findings

We based our judgement of the quality of care at this service on a combination of:

• what we found when we inspected
• information from our ongoing monitoring of data about services and
• information from the provider, patients, the public and other organisations.

We found that:

• The provider had taken action to address the breaches and risks identified during the last inspection.
• Staff were appropriately trained in safeguarding.
• Medicines were now managed safely.
• The practice supported people with learning disabilities living locally and worked with the care provider to provide continuity of care.
• The practice was providing ongoing care and treatment for a number of patients who had arrived into the UK as refugees.
• Supervision and appraisal had recently been introduced but were not yet fully embedded and documented.
• Incident reporting was embedded and used to improve care and share learning.
• There were short daily meetings to share information and learning.
• Governance systems were not consistent.
• Quality work to improve patient care was not documented or shared formally.
• No formal patient engagement activity was taking place.
• Not all staff were aware of speak up guardian arrangements.

We found that one regulation was breached, the provider MUST:

Establish effective systems and processes to ensure good governance in accordance with the fundamental standards of care.

In addition, the provider should:

• Review waste storage arrangements with building partners to ensure that waste is stored securely, and liaise with the building management team to ensure cleaning meets NHS requirements and is monitored.
• Review prescription storage arrangements to keep these secure when not in use.
• Introduce a system to ensure that all MHRA alerts are reviewed appropriately.
• Inform all patients who make complaints of their escalation routes to NHS E/I and the Parliamentary and Health Services Ombudsman when sending response letters.
• Facilitate appropriate development to support non-clinical managers.

Details of our findings and the evidence supporting our ratings are set out in the evidence tables.

Dr Sean O’Kelly BSc MB ChB MSc DCH FRCA

Chief Inspector of Hospitals and Interim Chief Inspector of Primary Medical Services