Letter from the Chief Inspector of General Practice

We carried out an announced comprehensive inspection at Rawnsley Surgery on 25 September 2017. Overall the practice is now rated as Good.

The practice had previously been inspected on 27 April 2015. Following this comprehensive inspection the overall rating for the practice was Requires Improvement. A total of four breaches of legal requirements were found and four requirement notices were served. The practice provided us with an action plan detailing how they were going to make the required improvements in relation to:

Regulation 12 of the Health and Social Care Act 2008 (Regulated Activities) 2014: Safe care and treatment.

Regulation 17 of the Health and Social Care Act 2008 (Regulated Activities) 2014: Good Governance.

Regulation 18 of the Health and Social Care Act 2008 (Regulated Activities) 2014: Staffing.

Regulation 19 of the Health and Social Care Act 2008 (Regulated Activities) 2014: Fit and proper persons employed.

The practice has now registered as a new single handed GP having previously been a two partner GP practice.

You can read the report from our last comprehensive inspection, by selecting the 'all reports' link for Rawnsley Surgery on our website at www.cqc.org.uk.

Our key findings were as follows:

• There was an effective system in place for reporting and recording significant events. Staff understood and fulfilled their responsibilities to raise concerns, and to report incidents and near misses.
• A formal system had been implemented to record, review, discuss and act on external alerts, such as those from the Medicines and Healthcare products Regulatory Agency (MHRA).

• The provider had implemented systems for identifying and assessing the risks to the health and safety of patients, staff and visitors. However further strengthening of these systems was required.
• The practice had appropriate procedures for the storage of emergency equipment and medicines. Regular checks were undertaken to ensure they were fit for use.
• Staff assessed patients’ needs and delivered care in line with current evidence based guidance. Staff had been trained to provide them with the skills, knowledge and experience to deliver care and treatment.
• Patients said they were treated with kindness, dignity and respect and they were involved in their care and decisions about their treatment.
• Information about services and how to complain was available and easy to understand. Improvements were made to the quality of care and access to services as a result of complaints and concerns.
• Data from the national GP patient survey published in July 2017 showed patient satisfaction was comparable to local Clinical Commissioning Group (CCG) and national averages in most areas. Where results were below the national average, more recent feedback obtained highlighted improvements had been made.
• There was a clear leadership structure in place and staff felt supported by the management team. The practice responded positively to feedback from staff and patients.
• The practice proactively sought feedback from staff and patients, which it acted on.
• Most patients found it easy to make an appointment, with urgent appointments available the same day.
• Governance arrangements had improved to include the formalisation of clinical and regular practice meetings that included the wider practice team.
• The practice was limited by the size of their facilities; however it was equipped to treat patients and meet their needs.
• A recently implemented programme of clinical audits demonstrated that a commitment to quality improvement in patient outcomes was in place.

The areas where the provider must make improvements are:

• Ensure care and treatment is provided in a safe way to patients. In particular:
• Ensure patients have received the recommended monitoring before prescriptions for high risk medicines are issued.
• Implement an effective system to ensure that patients on repeat medications receive regular and appropriate medication reviews.

The areas where the provider should make improvements are:

• Strengthen the prescription tracking system to minimise the risk of fraud.
• Explore ways to increase the number of patients identified who also act as carers.
• Further improve the health and safety arrangements by documenting the fire risk assessment and completing a hard wire check for the building in line with statutory health and safety regulations.

Professor Steve Field (CBE FRCP FFPH FRCGP) 

Chief Inspector of General Practice

We previously carried out an announced comprehensive inspection at Rawnsley Surgery on 25 September 2017. The overall rating for the practice was good. The practice was rated as requiring improvement in providing safe services. A breach of legal requirement was found and a requirement notice was served in relation to safe care and treatment. The full comprehensive report on the September 2017 inspection can be found by selecting the ‘all reports’ link for Rawnsley Surgery on our website at www.cqc.org.uk

This inspection was an announced comprehensive inspection carried out on 22 October 2018 to confirm that the practice had met the legal requirements in relation to the breach in regulation that we previously identified in addition to the good practice recommendations we made.

This practice is rated as Good overall.

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

At this inspection we found:

• The practice leaders had taken the findings from the previous CQC inspection to improve the services provided and patient safety and care. Each area for improvement had been actioned and our findings at this inspection showed improvements had been made and sustained.
• The practice had systems, processes and practices in place to protect people from potential abuse.
• There were systems in place for identifying, assessing and mitigating risks to the health and safety of patients and staff. The system for the monitoring of patients on high risk medicines had improved. There was now an effective system in place to ensure that patients on repeat medications received regular and appropriate medication reviews. Also, the process used to track prescriptions across the practice had been strengthened to help minimise the risk of fraud.
• The practice had improved the health and safety arrangements in place with a written fire risk assessment and had completed a hard wire check for the building in line with statutory health and safety regulations. However, further work was required.
• The practice had 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. However, we identified one incident that had not been considered or investigated as a significant event. However, the incident did not impact on patient safety or care.
• Following the last inspection, the practice had pro-actively identified and increased the number of carers registered and were signposting carers to local support groups.
• Most patients felt staff treated them with compassion, kindness, dignity and respect.
• Some patients reported difficulties getting an appointment.
• The patient participation group (PPG) had recently been re-established to represent the needs of the patients.
• The practice was limited by the size of their facilities; however it was equipped to treat patients and meet their needs.
• Staff had access to training opportunities to equip them in their work. However, staff required updates in essential training.
• The practice management had workforce planned and reviewed the staff skill mix to meet the needs of their patient population.

The areas where the provider should make improvements are:

• Ensure staff are up to date with all essential training and effective systems are in place to monitor staff training.
• Ensure all policies are easily accessible to staff; are in line with local and national guidance and systems are in place to ensure staff have read them.
• Improve the management of incidents.
• Review the approach to meeting the Accessible Information Standard.
• Consider developing an internal patient survey.
• Review the security of clinical rooms.
• Develop a documented business plan to support the practice vison and strategy and achieve priorities.

Professor Steve Field CBE FRCP FFPH FRCGPChief Inspector of General Practice

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