Letter from the Chief Inspector of General Practice

This inspection was a short notice announced focused inspection carried out on 5 April 2017 in response to information of concern received by CQC since February 2017. The practice had received a comprehensive inspection in June 2016 and this was followed up with a desk based exercise in February 2017. The practice was rated good following these previous inspections. The full comprehensive report, and shorter desk top review report, following the inspection on 16 June 2016 can be found by selecting the ‘all reports’ link for Ragstone Road Surgery on our website at www.cqc.org.uk.

The information received by CQC indicated:

• Inconsistent response to patient requests for a call from a practice GP.
• Information received from external sources was not being entered into patient records in a timely manner.
• The practice was not being kept tidy and clean.
• Test results were not being followed up in a timely manner.

We also reviewed how the practice responded to complaints. CQC had, in the previous four months, received copies of complaints lodged with the practice.

We have not updated the ratings for the practice as this inspection focused on specific areas of service delivery and the concerns raised.

Our key findings were as follows:

• Entry of clinical information into patient records was undertaken in a timely manner by appropriately trained staff.
• GPs called patients back on the day the patient requested to be called. Records of the return call were kept and these identified action required from the telephone consultation.
• Medical test results and correspondence from other providers of care and treatment were reviewed by the GP on duty on the day they were received. The action identified from correspondence and results was clearly documented and actioned either immediately or on the day following receipt. Records showed that the GPs clearly identified the urgency for action to be taken.
• The practice was kept clean and tidy. However, two disposable curtains around an examination couch had not been replaced in accordance with the practice replacement schedule.

The provider should:

• Ensure disposable curtains in clinical rooms are replaced every six months.

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 Ragstone Road Surgery in Chalvey, Slough on 30 June 2016. Overall the practice is rated as requires improvement.

Specifically, we found the practice to require improvement for provision of effective, caring and well-led services. The practice was rated good for providing safe and responsive services. The concerns which led to these ratings apply to all population groups using the practice with the exception of the care of people whose circumstances may make them vulnerable which was rated good.

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

• Staff understood and fulfilled their responsibilities to raise concerns and report incidents and near misses. All opportunities for learning from internal and external incidents were maximised. This included liaisons with neighbouring practices to share information about significant events and rare presentations of clinical conditions.

• 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.

• Over the previous three years the practice had seen a significant amount of change, instability and a lack of clear leadership and management. The practice was now stable; the new management team had introduced governance arrangements including a comprehensive understanding of performance. As a result of historic low performance scores the practice could evidence significant improvement.

• Feedback from patients on the day of the inspection about access to appointments was consistently positive.
• The practice worked closely with other organisations and with the local ethnically diverse community in planning how services were provided to ensure that they meet patients’ needs.
• The practice implemented suggestions for improvements and made changes to the way it delivered services as a consequence of feedback from patients and data from the national GP patient survey. This included an in-house patient survey completed in March 2016 following low scores in the national survey. Findings were used to design and implement a nine point action plan to improve patient satisfaction.
• The practice had limited facilities which had been adapted and procedures implemented to treat patients and meet their needs.
• The practice received a low number of complaints. The complaints that had been received had been reviewed, managed and responded to.
• The practice had a clear vision which had quality and safety as its top priority. The strategy to deliver this vision was regularly reviewed and discussed with staff.
• We observed the practice had strong and visible clinical and managerial leadership and governance arrangements. The practice proactively sought feedback from staff and patients, which it acted on.

We areas of outstanding practice including:

• Ragstone Road Surgery could demonstrate how they ensured role and community specific training and updating for relevant staff. For example, given the community that Ragstone Road Surgery provides GP services for, the fifth highest birth rate in the UK, high levels of child poverty, congenital birth problems, complex family cases, increased likelihood of Female Genital Mutilation (FGM) and recent examples of radicalisation. The practice had arranged all staff to complete additional specific training, for example additional Safeguarding Children training, FGM awareness training and radicalisation awareness training including warning signs and legal obligations for reporting any suspected or identified cases.

However, there was an area where the provider must make improvements:

• Continue to review patient outcomes to ensure that patients receive appropriate care and treatment. This would include a review of the system in place to promote the benefits of cervical and bowel screening in order to increase patient uptake.

There were also areas of practice where the provider should make improvements:

• Ensure extended hours appointments details are advertised on the practice website and displayed in the premises.

• Ensure there are mechanisms in place to identify and record all feedback from patients, thus ensuring the practice is responsive to all patient feedback.

• Continue to review patient’s feedback and address concerns regarding GPs listening, giving patients enough time, explaining tests and treatments, and treating them with care and concern during consultations.

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 Ragstone Road Surgery on 30 June 2016. The overall rating for the practice was requires improvement. The full comprehensive report on the June 2016 inspection can be found by selecting the ‘all reports’ link for Ragstone Road Surgery on our website at www.cqc.org.uk.

This inspection was a desk-based review carried out on 8 February 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 30 June 2016. This report covers our findings in relation to those requirements and also additional improvements made since our last inspection. Overall the practice is now rated as good.

Our key findings were as follows:

• The practice had reviewed their policies and procedures for patient reviews and was working to improve exception reporting figures. A GP had been appointed lead for QOF and was reviewing exception reporting. Improvements had been made and exception reporting had reduced with only diabetes and hypertension clinical indicators remaining above local and national averages.

• The practice had increased their communication with patients being offered health screening to improve uptake. They had asked the patient participation group to update the practice newsletter and promote patient engagement in their health. Cervical smear rates had increased from previous years, but remained below the local and national average.

• The practice had reviewed patient feedback and undertaken their own patient satisfaction surveys. Improvements had been made, although patient satisfaction scores from the GP national survey remained below local and national average for many aspects of care.

• Governance arrangements had taken into account the previous inspection report findings and the practice had engaged with staff and patients to improve outcomes.

During our inspection in June 2016 we highlighted a lack of awareness of extended hours services and availability to patients. The practice had put notices up in the waiting area and on the practice website to inform patients of these.

However, there were also areas of practice where the provider should make improvements;

• Continue to review patient feedback and work to improve patient satisfaction scores.

• Monitor exception reporting and continue to promote patient engagement in health screening and reviews to improve current figures.

• Continue to monitor and improve patient uptake of health screening through the national screening programme. In particular, cervical smears and bowel cancer screening.

Professor Steve Field (CBE FRCP FFPH FRCGP) 

Chief Inspector of General Practice