Archived: The Royle

Letter from the Chief Inspector of General Practice

We carried out an announced comprehensive inspection at The Royle on14 July 2016. Overall the practice is rated as requires improvement.

Our key findings across all the areas we inspected were as follows:

• There was an open and transparent approach to safety and an effective system in place for reporting and recording significant events.
• Risks to patients and staff were not adequately assessed and there were areas where action was required to improve staff and patient safety.
• 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 effective care and treatment.
• Patient outcomes were lower than comparable practices, and the practice was aware it had further work to continuously improve quality and outcomes.
• Patients said they were treated with compassion, 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.
• Most patients 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.
• 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.
• The provider was aware of and complied with the requirements of the duty of candour.

The areas where the provider must make improvement are:

• Ensure that risks to patients and staff are adequately assessed and appropriate action taken to mitigate the risks, including fire evacuation drills and business continuity plans.
• Ensure all staff receive mandatory training on induction and that records are kept of training for all staff.
• Ensure that continuous improvement activity is used to review and improve patient outcomes including full cycle clinical audit and work to improve performance measured by the Quality Outcomes Framework (QOF).

The areas where the provider should make improvements are:

• Introduce systems to show that all nationally issued safety alerts have been considered and relevant actions taken.
• Conduct recruitment checks for all new members of staff.
• Review infection prevention and control audits to ensure that all areas have been assessed and any areas of non-compliance addressed.
• Update the complaints policy to ensure that where investigations take longer than anticipated, the patient is given an update and assured that their complaint is being investigated.
• Revise the significant event reporting form to include action taken relevant to the Duty of Candour legislation and ensure themes are identified and actions are taken to prevent recurrence.

We saw one area of outstanding practice:

Staff were actively supported and encouraged to work with charitable organisations. In 2015 the GP community nurse had worked with the Hyndburn GP community nursing team to coordinate a Christmas gift scheme for older and isolated patients within the local community. Due to high levels of support from the council, schools, families and local businesses over 2,000 vulnerable older people received gifts including those living in residential settings. This project helped raise awareness of older people who were socially isolated during the festive period.

Professor Steve Field (CBE FRCP FFPH FRCGP) 

Chief Inspector of General Practice