This practice is rated as requires improvement overall.

(At the previous inspection in February 2015 the practice was rated as good overall but the safe domain was rated as requires improvement).

The key questions are rated as:

Are services safe? - Requires improvement

Are services effective? - Requires improvement

Are services caring? - Good

Are services responsive? - Good

Are services well-led? - Good

We carried out an announced comprehensive inspection at Roxbourne Medical Centre on 21 November 2018. We carried out this inspection under Section 60 of the Health and Social Care Act 2008 as part of our regulatory functions. This inspection was planned to check whether Roxbourne Medical Centre was meeting the legal requirements and regulations associated with the Health and Social Care Act 2008.

At this inspection we found:

• Risks to patients were assessed and well managed in most areas, with the exception of those relating to the management of blank prescription forms for use in printers and handwritten pads.
• Staff understood and fulfilled their responsibilities to raise concerns, and report incidents and near misses. 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.
• The practice had taken steps to improve the access to the service, however, there was further improvement required to monitor and review the appointment booking system (regarding five calendar days arrangement), long waiting times in the waiting area and the waiting time it takes to get through to the practice by telephone.
• The practice was encouraging patients to register for online services and 58% of patients were registered to use online Patient Access.
• Some staff had not received all the required training that was relevant to their role.
• The practice was aware of and complied with the requirements of the Duty of Candour.
• There was a clear leadership structure and staff felt supported by management. The practice proactively sought feedback from staff and patients, which it acted on.
• There was a strong 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:

• Establish effective systems and processes to ensure good governance in accordance with the fundamental standards of care.

The areas where the provider should make improvements are:

• Improve engagement with the local community to encourage the uptake for the national cancer screening programme for cervical screening.
• Continue to encourage the uptake for the national cancer screening programme for breast and bowel cancer screening.
• Continue to monitor and take action as necessary on patient satisfaction with the appointment booking system, long waiting times in the waiting area and the waiting time it takes to get through to the practice by telephone.

Professor Steve Field CBE FRCP FFPH FRCGPChief Inspector of General Practice

Letter from the Chief Inspector of General Practice

We carried out a comprehensive inspection of Roxborne Medical Centre on 4th February 2015. Overall the practice is rated as good.

Specifically, we found the practice to be good for providing effective, caring, responsive and well-led services. We found some improvements were needed to ensure they provide safe care. It was also good for providing services for the care provided to older people, people with long term conditions, families, children and young people, working age people (including those recently retired and students), people living in vulnerable circumstances and people experiencing poor mental health (including people with dementia).

Our key findings were as follows:

• Arrangements were in place to ensure patients were kept safe. For example, staff understood and fulfilled their responsibilities to raise concerns, and report incidents and near misses
• Patients’ needs were suitably assessed and care and treatment was delivered in line with current legislation and best practice guidance.
• We saw from our observations and heard from patients that they were treated with dignity and respect.
• The practice understood the needs of their patients and was responsive to them. There was evidence of continuity of care and people were able to get urgent appointments on the same day.
• The practice was well-led, had a defined leadership structure and staff felt supported in their roles.

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

• The practice should undertake a review of health check for patients with LD and MH to increase the percentage having annual health checks and care plans.

• The practice should ensure that all learning disability patients receive a follow-up review every year.

• The practice should ensure that all staff that act as chaperones receive chaperone training.

• The practice should ensure all staff receive training on infection control.

• The practice should ensure that fridge temperatures are taken daily and accurately recorded

• The practice should ensure all staff receive an appraisal

• The practice should ensure an automated external defibrillator (used to attempt to restart a person’s heart in an emergency) is available or should carry out a risk assessment to identify what action would be taken in an emergency.

• The practice should ensure that regular fire alarm tests and fire drills are carried out.

• The practice should review their business continuity plan to ensure it gives clear instruction to staff about what actions to take in the event of an emergency and the section for relevant contact details should be completed

• The practice should develop a clear vision and strategy to deliver high quality care and promote good outcomes for patients and ensure all staff are aware of it.

• The practice should ensure notes are taken for their monthly governance meetings which are attended by the partners and the practice manager.

Professor Steve Field (CBE FRCP FFPH FRCGP) 

Chief Inspector of General Practice