Letter from the Chief Inspector of General Practice

We carried out an announced comprehensive inspection at Riley House Surgery on 2 June 2016. The overall rating for the practice was requires improvement, specifically the practice were rated requires improvement for providing safe, effective and caring services. The full comprehensive report on the June 2016 inspection can be found by selecting the ‘all reports’ link for Riley House Surgery on our website at www.cqc.org.uk.

The practice submitted an action plan shortly after the 2016 inspection outlining how it intended meeting the regulations.

This inspection was a focused inspection carried out on 13 June 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 2 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:

• Patient Group Directions were in place in place for appropriate staff.

• The practice had improved their recruitment procedures and were able to provide evidence that the new procedures were followed for new members of staff.

• All staff at the practice had been appraised; the practice kept a log of upcoming appraisal dates to ensure staff were appraised annually.

• The practice put a focus on identifying carers and increased the carers register to more than one percent of the patient population.

• The practice had systems in place to manage significant events and complaints; the practice were able to evidence that complaints and significant events were investigated and lessons were learned.

• The practice had a comprehensive system in place for infection control audits including an audit checklist, a set of practice specific infection control audit forms, a detailed action plan with named leads deadlines and progress updates and an annual infection control statement that reported the findings.

• The practice had appropriate levels of emergency supplies and medicines. The practice had a system in place for checking stocks of emergency medicines and staff at the practice knew where to access all emergency supplies.

• The practice survey 100 patients on a monthly basis to evaluate progress on improving patient satisfaction.

However, there was one area of practice where the provider needs to make an improvement.

The provider should:

• To review the process for coding patients identified as carers to ensure the carers register is an accurate reflection of that patient cohort.

At our previous inspection on 2 June 2016, we rated the practice as requires improvement for providing safe, effective and caring services. At the inspection on 2 June 2016 we found that not all non-medical prescribers had Patient Group Directions in place, not all staff had been through appropriate recruitment checks and not all staff had been appraised on an annual basis. At this inspection we found that there were Patient Group Directions in place for all non-medical prescribers, the practice had updated the recruitment process and were able to evidence this process was followed for new members of staff and we found that all staff had been appraised. Additionally, the practice had improved the system for managing staff appraisals and training. Consequently, the practice is now rated good for providing safe, effective and caring services.

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 Riley House Surgery on 2 June 2016. The overall rating for the practice was requires improvement, specifically the practice were rated requires improvement for providing safe, effective and caring services. The full comprehensive report on the June 2016 inspection can be found by selecting the ‘all reports’ link for Riley House Surgery on our website at www.cqc.org.uk.

The practice submitted an action plan shortly after the 2016 inspection outlining how it intended meeting the regulations.

This inspection was a focused inspection carried out on 13 June 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 2 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:

• Patient Group Directions were in place in place for appropriate staff.

• The practice had improved their recruitment procedures and were able to provide evidence that the new procedures were followed for new members of staff.

• All staff at the practice had been appraised; the practice kept a log of upcoming appraisal dates to ensure staff were appraised annually.

• The practice put a focus on identifying carers and increased the carers register to more than one percent of the patient population.

• The practice had systems in place to manage significant events and complaints; the practice were able to evidence that complaints and significant events were investigated and lessons were learned.

• The practice had a comprehensive system in place for infection control audits including an audit checklist, a set of practice specific infection control audit forms, a detailed action plan with named leads deadlines and progress updates and an annual infection control statement that reported the findings.

• The practice had appropriate levels of emergency supplies and medicines. The practice had a system in place for checking stocks of emergency medicines and staff at the practice knew where to access all emergency supplies.

• The practice survey 100 patients on a monthly basis to evaluate progress on improving patient satisfaction.

However, there was one area of practice where the provider needs to make an improvement.

The provider should:

• To review the process for coding patients identified as carers to ensure the carers register is an accurate reflection of that patient cohort.

At our previous inspection on 2 June 2016, we rated the practice as requires improvement for providing safe, effective and caring services. At the inspection on 2 June 2016 we found that not all non-medical prescribers had Patient Group Directions in place, not all staff had been through appropriate recruitment checks and not all staff had been appraised on an annual basis. At this inspection we found that there were Patient Group Directions in place for all non-medical prescribers, the practice had updated the recruitment process and were able to evidence this process was followed for new members of staff and we found that all staff had been appraised. Additionally, the practice had improved the system for managing staff appraisals and training. Consequently, the practice is now rated good for providing safe, effective and caring services.

Professor Steve Field CBE FRCP FFPH FRCGP

Chief Inspector of General Practice

At our last inspection in October 2013 we found that the provider was non-compliant with standards relating to infection control. We identified that that the cleaning specification of the practice did not take account of areas of risk and we found no infection control risk assessment or audit had been completed. We found that there had not been any recent infection control training and staff were not clear about roles and responsibilities in relation to infection prevention and control. Policies and procedures did not reflect the latest essential requirements.

During this inspection we reviewed infection control practices at the surgery. We saw that audits had now been put in place and these related to updated cleaning schedules and specifications for cleaning all areas of the surgery. We found that the provider was now taking account of risks associated with cleanliness. Contractual cleaning arrangements were now in line with essential requirements. Informal training for the new infection prevention and control lead had taken place and full training is planned for May 2014 for all staff at the surgery. We saw that all protocols for infection control had been updated since we last visited the surgery.

At the last inspection in October 2013 we found that the provider was non-compliant with standards relating to the management of medicines. We found that fridge temperatures were not being monitored consistently and there were no policies or protocols for managing medication at the surgery.

During this inspection visit we found that a new system for recording fridge temperatures was in place. Records were now stored electronically and an audit process was being carried out. This was not supported by daily paper records and we were not able to determine how the electronic version was updated daily. We saw that a protocol for the management of all medication had been developed which meant that the provider was able to ensure that appropriate arrangements were in place for managing medication at the surgery.

Patients understood the care and treatment choices available to them. The surgery was open Monday to Friday with extended opening hours on a Saturday morning and a Tuesday evening. Patients told us they did not mind seeing different GP's at the practice. One patient told us " I have been coming here for years and they are all good GP's here"

Patients expressed their views and were involved in making decisions about their care and treatment. The registered manager explained how the length of appointments varied depending on patients’ needs. For example, longer time periods were allocated to patients who required explanations about their long-term conditions or whose first language was not English.

Patients’ needs were assessed and care and treatment planned and delivered in line with their individual plan of care. We looked at five people's medical records. We saw that there were summaries of their consultations with the GP and any proposed treatment. There were arrangements in place to deal with medical emergencies.

Patients told us they felt safe at the practice and that they trusted the staff to take care of them. One patient told us that "my family have had faith in the doctors here and they have been looked after for over 64 years. We feel safe here especially when we feel vulnerable due to our serious health conditions."

A patient described the surgery as “as clean and pleasant.” And another said the level of hygiene was “fairly good.” Patients said they had seen clinical staff washing their hands before examining them or carrying out any procedures. The surgery was cleaned daily. However, there was no up to date policy or procedure in place in relation to infection control and no audits had been undertaken to assess the level of infection risk at the surgery.

Medicines were prescribed appropriately. The arrangements for obtaining repeat prescriptions of medication were effective and patients were happy with this service.

The practice had a patient participation group (PPG) who met to discuss the service. We saw minutes of the most recent meeting, which included examples of how patient’s comments had been taken into consideration and the changes that had occurred as a direct result.

Patients were made aware of the complaints system. There was a complaints policy available and information located in the surgery and on the surgery website about how to complain.