Red Lion Road Surgery

Letter from the Chief Inspector of General Practice

We carried out an announced comprehensive inspection of Red Lion Road Surgery on 11 May 2016. The practice was rated as requires improvement overall. A breach of legal requirements was found relating to the Safe, Caring, Responsive and Well-led domains. After the comprehensive inspection, the practice submitted an action plan, outlining what they would do to meet the legal requirements in relation to the breach of regulations 12 (Safe care and treatment), 17 (Good governance) and 16 (Receiving and acting on complaints) of the Health and Social Care Act 2008 (Regulated Activities) Regulations 2014.

During the comprehensive inspection we found that the practice had failed to ensure that all significant events were fully recorded and that lessons were learned from incidents, they had failed to monitor patients in line with prescribing guidelines, they had failed to put processes in place to ensure that results were received for all clinical samples sent for analysis, they had failed to ensure that they had sufficient medicines available to be able to effectively respond to a medical emergency, they had failed to analyse and address concerns raised via the NHS GP Patient Survey, and they had failed to operate effectively an accessible system of identifying, receiving and recording complaints. We also identified areas where improvements should be made, which included reviewing how they identified patients with caring responsibilities, ensuring staff had clear guidance on the allocation of emergency appointments, ensuring that a locum pack was available, reviewing access to toilet facilities to patients, and ensuring that all staff were aware of how to use the electronic record system effectively.

We undertook this announced focussed inspection on 28 March 2017 to check that the practice had followed their plan and to confirm that they now met the legal requirements. This report covers our findings in relation to those requirements. You can read the report from our last comprehensive inspection by selecting the ‘all reports’ link for Red Lion Road Surgery on our website at www.cqc.org.uk.

Following the focussed inspection, we found the practice to be good for providing safe, caring, responsive and well-led services.

Our key findings were as follows:

• The practice had an effective system in place for reporting and recording significant events. Learning from significant events was shared with staff in order to make improvements to safety.
• Since the initial inspection, the practice had conducted a comprehensive search of their patient records system to identify patients with caring responsibilities. They had identified 124 patients, which represented 4% of the practice list, and we saw that these patients were flagged on the system so that staff could easily recognise them.
• The practice had an effective system for recording verbal complaints. We saw evidence that all staff were engaged in this process and that complaints were discussed in practice meetings in order that learning could be shared.
• The practice had sufficient stocks of all medicines necessary to respond to a medical emergency on the premises.
• The practice had introduced a new process for tracking uncollected prescriptions, which was administered by a nominated member of reception staff, who checked for uncollected prescriptions weekly and took appropriate action on each prescription, as directed by a GP. A record was kept which showed the action taken in respect of each uncollected prescription.
• The practice had processes in place to ensure that all relevant staff received medicines updates and safety alerts.
• The practice had systems in place to ensure that patients were only prescribed medicines once the appropriate monitoring had been completed, in line with current guidance on the prescribing of medicines.
• The practice had auditable systems in place to ensure that results were received for all clinical samples sent for analysis.
• The practice had introduced written guidance for reception staff on the criteria for offering patients emergency appointments; however, there was a lack of consistent understanding amongst staff about the way that this guidance should be applied, and the practice had not actively sought feedback from staff about the effectiveness of this guidance.
• A locum pack was available to ensure that temporary GPs had easy access to information they needed.
• The practice had considered the access to toilet facilities for patients but had decided that the arrangements in place were appropriate.
• We observed that all staff were competent at using the electronic patient record system and that an ongoing programme of training was undertaken by the practice manager in order to keep up with changes to the system.
• The practice had carried-out its own patient survey using the same questions as the National GP Patient Survey in order to gather patients’ views on their service following changes they had made in response to the national survey. This survey showed a significantly higher rate of patient satisfaction compared to the national survey.

The areas where the practice should make improvements are:

• Continue to analyse the results of the national NHS GP Patient Survey when they are published, and consider ways to address areas of low satisfaction.
• Ensure that all staff are clear about the process for allocating emergency appointments, and consider seeking feedback from staff about the effectiveness of the new guidance.

Professor Steve Field CBE FRCP FFPH FRCGP 

Chief Inspector of General Practice