Archived: Roxbourne Medical Centre

We carried out an announced comprehensive inspection at Roxbourne Medical Centre on 4 December 2019 as part of our inspection programme.

At this inspection, we followed up on breaches of regulations identified at a previous inspection on 21 November 2018. We rated the practice as requires improvement overall in November 2018. Previous reports on this practice can be found on our website at: https://www.cqc.org.uk/location/1-545557983.

At this inspection, we found that the practice had demonstrated improvements.

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 and
• information from the provider, patients, the public and other organisations.

We have rated this practice as good overall and good overall for all population groups, with the exception of working age people (including those recently retired and students) which is rated as requires improvement.

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

• The practice provided care in a way that kept patients safe and protected them from avoidable harm.
• The practice routinely reviewed the effectiveness and appropriateness of the care it provided.
• Staff had received required training relevant to their role.
• Feedback from most patients reflected that they were not always able to access care and treatment in a timely way.
• The practice was encouraging patients to register for online services and 57% of patients were registered to use online Patient Access.
• Information about services and how to complain was available.
• The practice’s uptake of the national screening programme for cervical and bowel cancer screening and childhood immunisations rates were below the national averages.
• The patient participation group (PPG) become less active recently due to low attendance in the recent two PPG meetings.
• 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 the management.
• The practice’s Care Quality Commission registration was non-compliance since April 2019 and they submitted relevant application forms immediately after this inspection to resolve the registration issues.

We rated all population groups as good for providing responsive services. We rated all population groups as good for providing effective services, with the exception of working age people (including those recently retired and students) which is rated as requires improvement, because of low cervical cancer screening rates.

Whilst we found no breaches of regulations, the provider should:

• Continue to encourage and monitor the childhood immunisation, cervical and bowel cancer screening uptake.
• Review patients’ feedback regarding access to the service.
• Review the governance arrangements to ensure effective monitoring of blank prescription forms in line with national guidance.
• Review staff and patients’ feedback regarding the staffing levels at the practice.
• Continue to take necessary action to resolve the CQC registration issues.

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

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