Archived: Rawnsley Surgery

Updated 25 June 2015

Rawnsley Surgery is situated within the village of Rawnsley in Cannock, Staffordshire. The area has strong and historical links to industry, in particular coal mining.

The area has similar outcomes to the England averages in area profile data from Public Health England from 2011-2013. The data compares outcomes living in the area including life expectancy and deprivation.

The practice has an all-male partnership of two GPs, who also employ a female GP to provide two clinic sessions each week. There is a female full time practice nurse. The administrative team comprises seven staff including the practice manager who looks after the day to day running of the practice. A part time domestic cleaner works on a daily basis to clean the premises.

There are currently 4,300 patients registered at the practice. The number of patients has risen by nearly 1,000 in the last four years.

The practice holds a Personal Medical Services (PMS) contract with NHS England and has extended its contracted obligations to provide enhanced services with both Cannock Chase Clinical Commissioning Group (CCG) and Public Health England. Enhanced services offered include minor surgery, avoiding unplanned admissions and extended opening hours.

The GPs at the practice also provide contracted medical services each day to a local prison. Those services did not form part of the inspection we carried out.

The practice does not provide medical cover for its patients out of working hours. These services are undertaken by Staffordshire Doctors Urgent Care Ltd by contacting 111.

Updated 25 June 2015

Letter from the Chief Inspector of General Practice

We carried out an announced comprehensive inspection at Rawnsley Surgery on 27 April 2015. Overall the practice is rated as requires improvement.

Specifically, we found the practice to be inadequate for providing safe services and for people whose circumstances may make them vulnerable, requiring improvement for effective and well-led services and good for caring and responsive services. The concerns that led to these ratings apply to everyone using the practice including the population groups of older people, people with long-term conditions, families, children and young people, working age people (including those recently retired and students) and people experiencing poor mental health (including people with dementia).

Our key findings were as follows:

• Patients were at risk of harm because systems and processes were not in place to keep them safe. For example, some incidents that may affect patient safety were not investigated.
• The practice did not have effective processes in place to minimise the risks from infections including those that are healthcare associated.
• We saw poor record keeping. We were told that patients had been offered assessments or treatment, but the actions were not recorded.
• We saw that the care offered to some patients with a learning disability did not meet their needs.
• Patients said they found it easy to make an appointment with a named GP and that there was continuity of care, with urgent appointments available the same day.
• Staff were not always supported to review their performance using appraisals. We saw records where a member of staff had identified personal training needs and felt under supported, little action had been taken to address the situation.

There were several areas of practice where the provider needs to make improvements.

Importantly, the provider must:

• Ensure that the recording, investigation and dissemination of significant events is robust.
• Ensure that risks that may affect patient safety are acted upon to minimise the risk of harm to patients.
• Ensure that risks to patients and staff from infection are minimised by adopting best practice infection, prevention and control guidance. This includes completing, recording and acting upon findings from regular infection control audits.
• Ensure that recruitment checks for staff reflect legislative guidance.
• Provide all staff at the practice with appraisals and the regular opportunity to explore individual training needs relevant to their role.
• Ensure that assessment and care that is offered to patients is recorded and reflects recognised guidance.

In addition the provider should:

• Improve security for the issue and tracking of blank prescription forms to reflect nationally accepted guidelines as detailed in NHS Protect.
• Review the emergency medicines held at the practice, to ensure that they are age appropriate for patients and cover the range of conditions that may be encountered in general practice. .
• Provide all staff with training in the Mental Capacity Act 2005.
• Review the process for recalling patients who require annual health checks to ensure all patients are included and that any refusal is followed up and documented.
• Use a team approach to ensure that the feedback collected from patients is recorded, discussed and used to plan and modify services.

Where, as in this instance, a provider is rated as inadequate for one of the five key questions or one of the six population groups it will be re-inspected no longer than six months after the initial rating is confirmed. If, after re-inspection, it has failed to make sufficient improvement, and is still rated as inadequate for any key question or population group, we will place it into special measures. Being placed into special measures represents a decision by CQC that a service has to improve within six months to avoid CQC taking steps to cancel the provider’s registration.

Professor Steve Field (CBE FRCP FFPH FRCGP) 

Chief Inspector of General Practice

Updated 25 June 2015

The provider was rated as good for caring and responsive services overall and this includes for this population group. The provider was rated as inadequate for safe services and requires improvement for effective and well-led services. The concerns which led to these ratings apply to everyone using the practice, including this population group.

Nursing staff had lead roles in chronic disease management and patients at risk of hospital admission were identified as a priority. Longer appointments and home visits were available when needed. The practice offered annual reviews for patients in this group who needed them. For example, 90% of patients with chronic obstructive pulmonary disease (COPD) had received an annual health assessment. For those patients who had complex needs, practice staff worked with relevant health and social professionals to deliver a combined package of care to meet their needs.

Updated 25 June 2015

The provider was rated as good for caring and responsive services overall and this includes for this population group. The provider was rated as inadequate for safe services and requires improvement for effective and well-led services. The concerns which led to these ratings apply to everyone using the practice, including this population group.

There were systems in place to identify and follow up children living in disadvantaged circumstances and who were at risk, for example, children and young people who were subject to child protection plans. Immunisation rates were in line for all standard childhood immunisations. Patients told us that children and young people were treated in an age-appropriate way and were recognised as individuals, and we saw evidence to confirm this. Appointments were available outside of school hours and the premises were suitable for children and babies.

Updated 25 June 2015

The provider was rated as good for caring and responsive services overall and this includes for this population group. The provider was rated as inadequate for safe services and requires improvement for effective and well-led services. The concerns which led to these ratings apply to everyone using the practice, including this population group.

Nationally reported data showed that outcomes for patients were good for conditions commonly found in older people. The practice offered proactive, personalised care to meet the needs of the older people in its population and provided a range of enhanced services. For example, in dementia and end of life care. It was responsive to the needs of older people, and offered home visits and rapid access appointments for those with enhanced needs.

Updated 25 June 2015

The provider was rated as good for caring and responsive services overall and this includes for this population group. The provider was rated as inadequate for safe services and requires improvement for effective and well-led services. The concerns which led to these ratings apply to everyone using the practice, including this population group.

The needs of the working age population, those recently retired and students had been identified and the practice had adjusted the services it offered to ensure these were accessible, flexible and offered continuity of care. The practice offered online services as well as a full range of health promotion and screening that reflected the needs for this age group. The practice held late opening evening appointment clinics each week. They also offered NHS Health Checks to patients aged 40-75 years of age and had performed 302 health checks in the previous year. This performance was 58% higher than the expected levels.

Updated 25 June 2015

The provider was rated as good for caring and responsive services overall and this includes for this population group. The provider was rated as inadequate for safe services and requires improvement for effective and well-led services. The concerns which led to these ratings apply to everyone using the practice, including this population group.

Eighty-two per cent of patients experiencing poor mental health had received an annual physical health check. The practice regularly worked with multi-disciplinary teams in the case management of patients experiencing poor mental health, including those with dementia. The practice had told patients who experienced poor mental health about how to access various support groups and voluntary organisations. It had a system in place to follow up patients who had attended accident and emergency (A&E) where they may have experienced poor mental health

Updated 25 June 2015

The practice held a register of patients living in vulnerable circumstances. We saw examples of when patients had not been offered annual health screening or when a refusal to an invite had not been recorded. We saw that all of the patients in this group had been reported as exceptions by the practice for receiving annual health checks and tests. (An exception is recorded when it is not appropriate for a patient to receive the review or they have failed to attend an invite for an appointment on three or more occasions). We reviewed records and saw no documentation of invitations or refusals, although practice staff told us they had invited patients. The records we reviewed showed no evidence of engagement to encourage patients to attend health checks to promote their well-being.