Riverside Medical Practice

We carried out an announced inspection at Riverside Medical Practice on 20 June 2022. Overall, the practice is rated as Requires Improvement. We rated the key questions:

Safe: Requires improvement

Effective: Requires improvement

Caring: Good

Responsive: Good

Well-led: Good

Riverside Medical Practice was previously registered at a different address. It was inspected on 4 November 2019 and rated good overall and in all key questions. The previous report was archived in March 2021.

The full reports for previous inspections can be found by selecting the ‘all reports’ link for Riverside Medical Practice on our website at www.cqc.org.uk

Why we carried out this inspection

This inspection was a comprehensive inspection as a result in change of registered location to assess:

• All five key questions

How we carried out the inspection

Throughout the pandemic CQC has continued to regulate and respond to risk. However, taking into account the circumstances arising as a result of the pandemic, and in order to reduce risk, we have conducted our inspections differently.

This inspection was carried out in a way which enabled us to spend a minimum amount of time on site. This was with consent from the provider and in line with all data protection and information governance requirements.

This included:

• Conducting staff interviews using video conferencing.
• Reviewing staff feedback forms
• Completing clinical searches on the practice’s patient records system and discussing findings with the provider.
• Reviewing patient records to identify issues and clarify actions taken by the provider.
• Requesting evidence from the provider.
• A short site visit.

Our findings

We based our judgement of the quality of care at this service on a combination of:

• what we found when we inspected
• information from our ongoing monitoring of data about services
• information from the provider, patients and other organisations.

We have rated this practice as Requires improvement overall

We rated the practice as requires improvement for providing safe services because:

• Systems for monitoring the safe prescribing of high-risk medicines were not always effective.
• Medicine reviews undertaken lacked structure to ensure that all monitoring requirements were checked as part of the review at least annually.
• Processes to act on Medicines and Healthcare products Regulatory Agency (MHRA) alerts were not fully incorporated into clinical practice.
• Not all staff recruitment checks were carried out in line with policy and legislation.

We rated the practice as requires improvement for providing effective services because:

• Medicine reviews lacked structure and failed to identify some patients who were overdue their monitoring.
• The clinical searches found some potential missed diagnoses of diabetes and chronic kidney disease in addition to the lack of effective monitoring of patients with long-term conditions including asthma and underactive thyroid.
• Arrangements were in place to support staff working in advanced roles and to review their consultations however, the frequency of meetings held, and completion of documentation varied.
• Improvement was needed in cervical cancer screening uptake and childhood immunisations for those aged five years.
• Quality improvement demonstrated through clinical audit was limited. The practice had identified this was an area for improvement and had developed a Quality Improvement Plan (QIP).

We rated the practice as good for providing caring, responsive and well-led services because:

• The practice had reviewed its skillset to ensure a more resilient workforce and recruited three advanced clinical practitioners to form an acute care team to meet the demands of their patient population.
• All staff were up to date with essential training requirements and were supported to undertake professional training.
• The practice achieved higher scores in the National GP patient survey 2021, in all four indicators for providing caring services compared with local and national averages.
• Staff dealt with patients with kindness and respect and involved them in decisions about their care. Feedback about the way care and treatment was provided was very positive.
• The practice understood the needs of its local population and had adjusted how it delivered services to meet the needs of patients during the COVID-19 pandemic. Patients could access care and treatment in a timely way.
• Complaints were listened and responded to and used to improve the quality of care.
• The team had experienced significant challenges in the previous two years and had adapted well to change.
• The practice demonstrated a strong focus on continuous learning, improvement and innovation.

We saw the following outstanding practice:

• The practice provided a weekly outreach healthcare service within a day centre in Shrewsbury to homeless people and those sleeping rough. The service enabled registered vulnerable patients to be reviewed within an environment they felt comfortable in without the need to attend the practice. The practice had also offered Covid-19 and flu vaccination programme to this cohort of people in addition to cervical screening and contraceptive services. During the lockdown a local hotel accommodated these people and the practice provided a daily call to the hotel to proactively address any health issues with the people. An inclusion health email address had been created to improve access to primary care.

We found a breach of regulation. The provider must:

• Ensure care and treatment is provided in a safe way to patients.

The provider should:

• Further develop clinical audit processes to demonstrate quality improvement.
• Ensure recruitment checks are completed in line with policy and legislation.
• Review and improve documentation of the oversight of staff working in advanced roles.
• Ensure all staff are made aware of the Freedom to Speak Up Guardian.

Details of our findings and the evidence supporting our ratings are set out in the evidence tables.

Dr Rosie Benneyworth BM BS BMedSci MRCGP

Chief Inspector of Primary Medical Services and Integrated Care