This practice is rated as Good overall. (Previous rating August 2017 – Good overall). The practice was rated as requires improvement for 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 August 2017 inspection can be found by selecting the ‘all reports’ link for Red Lion Surgery on our website at www.cqc.org.uk.)

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 Red Lion Surgery on 11 October 2018. This was to follow up on breaches of regulations and confirm the practice had met the legal requirement in relation to the breach in regulation that we had previously identified.

At this inspection we found:

• The practice leaders had used the findings from the previous CQC inspection to improve the services provided and patient safety and care. The breach in regulation had been addressed and most of the best practice recommendations we made at the previous inspection had been addressed.

• The practice had clear 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 had effective systems, processes and practices in place to protect people from potential abuse and staff had received safeguarding training appropriate to their role.

• There were systems in place for identifying, assessing and mitigating risks to the health and safety of patients and staff. The system for managing patient safety alerts had improved, but had not been effectively sustained. The practice had reviewed this and were in the process of reinstating the planned improvements.

• The practice routinely reviewed the effectiveness and appropriateness of the care 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 could access care when they needed it.

• The practice actively worked with the patient participation group (PPG) to meet the needs of their patients and had increased the membership of the PPG.

• Systems had been put in place to monitor the use of prescriptions to include prescriptions pads (as recommended in the previous report).

• The practice had pro-actively identified and increased the number of carers registered and were preparing to formalise the support they could offer to carers.

• There was a strong focus on continuous learning and improvement at all levels of the organisation.

The areas where the provider should make improvements are:

• Update all core business plans which relate to the running of the service.
• Further develop clinical audit to promote quality improvement.
• Develop a written vision and strategy for the service.

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.

Letter from the Chief Inspector of General Practice

We previously carried out an announced comprehensive inspection at the Red Lion Surgery on 28 September 2016. The overall rating for the practice was requires improvement. The full comprehensive report on the 28 September 2016 inspection can be found by selecting the ‘all reports’ link Red Lion Surgery on our website at www.cqc.org.uk.

This inspection was an announced follow-up comprehensive inspection and was carried out on 21 August 2017. Overall the practice is now rated as good.

Our key findings were as follows:

• Staff understood and fulfilled their responsibilities to raise concerns, and to report incidents and near misses.
• Staff were aware of current evidence based guidance. Staff had been trained to provide them with the skills and knowledge to deliver effective care and treatment.
• Results from the national GP patient survey showed patients were treated with compassion, dignity and respect and were involved in their care and decisions about their treatment.
• Information about services and how to complain was available.
• Patients we spoke with 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.
• The practice had good facilities and was well equipped to treat patients and meet their needs.

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

Importantly, the provider must:

• Ensure specified information is available regarding each person employed.

• Ensure, where appropriate, persons employed are registered with the relevant professional body.

In addition the provider should:

• Improve the recording of action taken in response to alerts issued by external agencies, for example from the Medicines and Healthcare products Regulatory Agency (MHRA).
• Assess the need to keep emergency medicines to manage seizures.
• Obtain a copy of the electrical installation certificate.
• Extend the practice’s system for monitoring the use of prescriptions to include prescription pads.
• Improve the system for recalling patients for their review of long term conditions.
• Record and analyse verbal complaints received.
• Implement its plans for further identifying patients who are also carers.
• Carry out updated infection prevention and control audit.
• Introduce an induction pack for locum staff.
• Review the process for monitoring un-collected prescriptions.

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 Red Lion Surgery on 28 September 2016. Overall the practice is rated as requires improvement.

Our key findings were as follows:

• Patients told us during the inspection that they were treated with compassion, dignity and respect and that they were involved in their care and decisions about their treatment.
• People told us that they were able to get urgent appointments when they needed them, but they had to wait for routine appointments.
• There was a system in place for reporting and recording significant events and staff understood their responsibilities to raise concerns, and to report incidents and near misses. However, we saw an instance whereby staff had not recognised when an incident should have been reported as a significant event.
• Risks to patients were not always assessed and well managed. This included the storage of vaccines, management of spillages and risk assessments for staff without Disclosure and Barring Service checks. The practice had not assured themselves that the landlord had procedures in place for monitoring and managing risks to patient and staff safety.
• There was a lack of day to day leadership due to the practice manager vacancy and staff did not feel fully supported.
• There were no formal meetings to discuss governance and there was limited oversight of areas such as health and safety.

The areas where the provider must make improvements are:

• Ensure that the Patient Group Directions (PGDs) adopted by the practice are signed by the GP and the practice nurse.
• Ensure vaccines are always stored in line with manufacturers’ instructions.
• Assess the risks of not keeping a wider range of emergency medicines at the practice and mitigate the risks to patients.
• Ensure all equipment used in the event of an emergency is in date.
• Access whether there is a risk to patients of being cared for or treated by members of staff without Disclosure and Barring Service checks.
• Carry out risk assessments for the areas of the building used by the practice.
• Ensure all staff receive regular performance reviews.
• Ensure there are governance arrangements in place including systems for assessing and monitoring risks and the quality of the service provision.
• The practice must assure themselves that the landlord has procedures in place for monitoring and managing risks to patient and staff safety.

In addition the provider should:

• Ensure that all significant events are recorded and managed appropriately.
• Implement an effective system to monitor the use of prescription stationery.
• Have suitable arrangements in place to manage the spillage of bodily fluids.
• Ensure there are adequate numbers of appropriately skilled staff to meet the needs of patients.
• Ensure staff receive annual practical training in basic life support and cardiopulmonary resuscitation.
• Make patients aware that translation services are available.
• Adopt a more proactive approach to identifying and meeting the needs of carers.

Professor Steve Field (CBE FRCP FFPH FRCGP) 

Chief Inspector of General Practice

We visited the surgery to establish that the needs of patients using the service were being met. The service was situated at Cannock Chase Hospital. This was a temporary base for the practice whilst development of a new health centre was in the planning process. On the day of the inspection we spoke with five patients, four staff members, two doctors and the practice manager.

The patients we spoke with were complimentary about the service. We were told that the staff were helpful, friendly and polite. They told us that they received care, treatment and support that met their needs. One patient said: “The staff here have been very good to me”. They also said: “The doctor always takes the time to listen”.

Staff must be appropriately supported, trained and supervised in delivering care and treatment to patients who used the service. We saw that a schedule of training was available. This had included safeguarding vulnerable adults and children.

The practice had systems in place to assess and monitor the quality of the service it provided. There was on-going development of a patient participation group (PPG). PPGs are an effective way for patients and GP surgeries to work together to improve the service and to promote and improve the quality of the care. We saw that equipment within the surgery had been tested to ensure it was safe to use and fit for purpose.