This practice is rated as Good overall. (Previous rating February 2018 – Requires Improvement)

The key questions at this inspection are rated as:

Are services safe? – Good

Are services effective? – Good

Are services caring? – Good

Are services responsive? – Good

Are services well-led? - Good

We carried out an announced comprehensive inspection at DR C P Myers and D N R Ravi on 31 October 2018 to follow up on breaches of regulations identified at the inspection in February 2018.

At this inspection we found:

• The practice had responded positively and acted on the findings at the last inspection. They had reviewed and improved policies and procedures relating to health and safety, medicines management, infection prevention and control and recruitment.
• The practice had improved 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.
• The practice routinely reviewed the effectiveness and appropriateness of the care it provided. It ensured that care and treatment was delivered according to evidence- based guidelines.
• Staff involved and treated patients with compassion, kindness, dignity and respect.
• Patients found the appointment system easy to use and reported that they were able to access care when they needed it.
• There was a strong focus on continuous learning and improvement at all levels of the organisation.

Professor Steve Field CBE FRCP FFPH FRCGP

Chief Inspector of General Practice

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

This practice is rated as Requires Improvement overall. (Previous inspection 24/6.2015 – Good)

The key questions are rated as:

Are services safe? – Requires improvement

Are services effective? – Good

Are services caring? – Good

Are services responsive? – Good

Are services well-led? - Requires improvement

As part of our inspection process, we also look at the quality of care for specific population groups. The population groups are rated as:

Older People – Requires improvement

People with long-term conditions – Requires improvement

Families, children and young people – Requires improvement

Working age people (including those recently retired and students – Requires improvement

People whose circumstances may make them vulnerable – Requires improvement

People experiencing poor mental health (including people living with dementia) - Requires improvement

We carried out an announced comprehensive inspection at Dr C P Myers & Dr N R Ravi on 22 February 2018 as part of our inspection programme.

At this inspection we found:

• The practice had systems to manage risk so that safety incidents were less likely to happen although we found some aspects of risk assessment required improvement.
• When incidents did happen, the practice learned from them and improved their processes although this process was not always effective.
• The practice routinely reviewed the effectiveness and appropriateness of the care it provided. It ensured that care and treatment was delivered according to evidence- based guidelines.
• Staff involved and treated patients with compassion, kindness, dignity and respect.
• Patients told us they received excellent care and treatment. Data showed the practice scored above local and national averages in a national survey for patient satisfaction.
• Patients found the appointment system easy to use and reported that they were able to access care when they needed it.
• There was a focus on continuous learning and improvement at all levels of the organisation.

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

• Ensure care and treatment is provided in a safe way to patients (for details of the breach please see the requirement notice at the end of this report).
• Ensure recruitment procedures are established and operated effectively (for details of the breach please see the requirement notice at the end of this report).

The areas where the provider should make improvements are:

• The new procedures and records developed by the provider to ensure secure storage and tracking of prescriptions through the practice should be implemented.
• The supply of emergency medicines provided in the practice should be risk assessed.

Professor Steve Field CBE FRCP FFPH FRCGP 

Chief Inspector of General Practice

Letter from the Chief Inspector of General Practice

We carried out an announced comprehensive inspection at Dr Myers and Dr Ravi on 24 June 2015. Overall the practice is rated as good.

Specifically, we found the practice to be good for providing safe, effective, caring, and responsive and well led services. It was also good for providing services for all the population groups.

Our key findings across all the areas we inspected were as follows:

• Patients said they found it easy to make an appointment with a preferred GP, there was continuity of care and open access appointments were available daily.
• Patients’ needs were assessed and care was planned and delivered following best practice guidance. Staff had received training appropriate to their roles and any further training needs had been identified and planned.
• Patients said they were treated with compassion, dignity and respect and were involved in decisions about their care and treatment.
• Information about services and how to complain was available and easy to understand. Complaints were addressed in a timely manner and the practice endeavoured to resolve complaints to a satisfactory conclusion.
• The practice had good facilities and was well equipped to treat patients and meet their needs.
• Staff understood and fulfilled their responsibilities to raise concerns and to report incidents and near misses. Information about safety was recorded, monitored, appropriately reviewed and addressed.
• There was a clear leadership structure and staff felt supported by management. The practice proactively sought feedback from staff and patients.
• Risks to patients were assessed and well managed.
• The practice had a number of policies and procedures in place and held regular governance meetings.

We saw some areas of outstanding practice:

• Home visits were made by the GPs to recently bereaved families.
• Post natal home visits were made by the GPs to new Mums and their babies.
• GP led acupuncture services were available at the practice.
• ‘Drop in’ open access appointments were available daily.
• Late night opening was available until 9pm one day per week.

However, there were areas of practice where the provider needs to make improvements;

Importantly the provider should

• Take steps to monitor equipment to ensure it is in date and suitable for use.
• Maintain clear records on prescription stationery stock, in line with guidance from NHS Protect.
• Maintain effective infection, prevention and control monitoring.

Professor Steve Field (CBE FRCP FFPH FRCGP) 

Chief Inspector of General Practice

People’s privacy, dignity and independence were respected. People’s views and experiences were taken into account in the way the service was provided and delivered in relation to their care. One patient told us: “I ask lots of questions about my treatment. I always get an answer in a way that I understand it.” Another patient told us: “I am fully involved, the information I get and the manner in which I get it is reassuring.”

Care and treatment was planned and delivered in a way that was intended to ensure people's safety and welfare. One patient said: "It’s a welcoming place, I really appreciate the familiarity." Another patient told us: “We get all the time we need with the GPs, they are very thorough.”

People were protected from the risk of infection because appropriate guidance had been followed. People were cared for in a clean, hygienic environment.

People were cared for by staff who were supported to deliver care and treatment safely and to an appropriate standard. One staff member told us: “There is a good and open culture here amongst all the staff, it’s really supportive.”

The provider had an effective system to regularly assess and monitor the quality of service that people receive.