Riverport Medical Practice

The key questions are rated as:

Are services safe? – Inadequate

Are services effective? – Requires Improvement

Are services caring? – Requires Improvement

Are services responsive? – Good

Are services well-led? – Requires Improvement

We carried out a comprehensive inspection of Orchard Surgery - St Ives on 21 March 2019. The practice was rated as good overall with a rating of requires improvement for providing safe services and good for providing effective, caring, responsive and well-led services. As a result of the findings on the day of the inspection the practice was issued with a requirement notice for Regulation 17 (Good governance).

This inspection was an announced comprehensive inspection. This inspection was carried out to review in detail the actions taken by the practice to improve the quality of care and to confirm that the practice was now meeting legal requirements.

At this inspection, the practice was rated as inadequate for providing safe services because:

• We found not all staff had received the appropriate level of safeguarding training to their role or completed basic life support training.
• The practice did not evidence that recruitment checks such as; the verification of identify documents, DBS and references were always obtained prior to employment. In addition to this, the practice was unable to evidence that dispensary staff were appropriately trained.
• The practice did not provide evidence of any risk assessments being in place for oxygen and other flammable gasses or control of substances hazardous to health (COSHH).
• We found the practice did not have oversight of the progress of actions arising from a fire risk assessment and infection prevention and control audit. Following the inspection, the practice provided a copy of their fire risk assessment action plan for all three sites, which evidenced oversight of the required actions.
• We found the monitoring of patients in waiting areas was not effective. The practice did not provide any evidence that the risks to patients had been risk assessed or mitigated.
• We found the monitoring of prescription stationery was not always effective.
• The system and process to ensure all appropriate emergency medicines were available needed to be improved as we found a missing item (Dexamethasone) at two of the sites (Orchard & Fenstanton). This was previously raised as a concern at our March 2019 inspection.

At this inspection, the practice was rated as requires improvement for providing effective services because:

• We found the practice did not have complete oversight of training records of staff. We saw some staff were overdue training that the practice had deemed mandatory and the practice did not have oversight of the qualifications of staff. This was raised as a concern during our March 2019 inspection and a requirement notice was issued identifying that improvements were required to the training.
• We reviewed five staff personnel files and found that four of the five files did not contain evidence that members of staff had completed an induction program. The practice did not demonstrate completion of the Care Certificate for Health Care Assistants employed since April 2015.
• The practice’s approach to care planning was inconsistent. Therefore, patients did not always have documented care plans which were easily accessible by the patients and other services, such as out of hours services or care homes.
• We found the number of patients receiving a learning disability health check and 40-74 health check were considerably lower than the number of patients eligible and health checks offered.

At this inspection, the practice was rated as requires improvement for providing caring services because:

• The practice had identified 40 carers, 0.7% of the practice population. The practice told us no specific services were available to carers, other than signposting to relevant support groups and services. The carers register was not fully up to date and accurate at the time of our inspection.
• We found one treatment room at the Parkhall site did not aid patient confidentiality and the practice did not provide any evidence that the risks to patient confidentiality had been assessed or mitigated.

At the previous inspection, the practice was rated as good for providing responsive services.

At this inspection, the practice was rated as requires improvement for providing well-led services because:

• We found a lack of leadership capacity to successfully manage challenges and implement and sustain improvements.
• The practice could not evidence that risks, issues and performance were effectively managed to ensure that services were safe.

The areas where the provider must make improvements are:

• Ensure care and treatment is provided in a safe way to patients.
• Ensure sufficient numbers of suitably qualified, competent, skilled and experienced persons are deployed to meet the fundamental standards of care and treatment.

The areas where the provider should make improvements are:

• Review and improve the number of health assessments and checks provided to patients.
• Review and improve the practice’s cervical screening uptake.
• Formalise the oversight, supervision and competence checks for non-medical prescribers and staff employed in advanced clinical practice.

Dr Rosie Benneyworth BM BS BMedSci MRCGPChief Inspector of Primary Medical Services and Integrated Care

In November 2018, four local practices joined together and formed a new partnership called Riverport Medical Practice. They became the provider for Orchard Surgery St. Ives and three other branch sites, Park Hall and Northcote House and Fenstanton.

The address and inspection history of each site is;

• Orchard Surgery St. Ives (the registered location), Constable Road, St. Ives, Cambridgeshire. PE27 3ER. Previous inspections were:

A comprehensive inspection was carried out in July 2017 and the practice was rated as good overall. A comprehensive inspection was carried out in November 2016 and the practice was rated as inadequate and placed in special measures.

• Parkhall site, 2C, Parkhall Road, Somersham, Cambridgeshire. PE28 3EU.

A focussed inspection was carried out in December 2016 and the practice was rated as good for providing safe services. A comprehensive inspection was carried out in May 2016 and the practice was rated as good overall and requires improvement for providing safe services.

• Northcote House site, 8 Broad Leas, St Ives, Cambridgeshire. PE27 5PT and Fenstanton site, 7E, High Street, Fenstanton, Cambridgeshire. PE28 9LQ

A comprehensive inspection was carried out in December 2016 and the practice was rated as good overall. A comprehensive inspection was carried out in April 2016 and the practice was rated as inadequate and placed in special measures.

The key questions are rated as:

Are services safe? – Requires improvement

Are services effective? – Good

Are services caring? – Good

Are services responsive? – Good

Are services well-led? - Good

We carried out an announced comprehensive inspection at Orchard Surgery St Ives on 21 March 2019 as part of our inspection programme.

At this inspection we found:

• In November 2018 the GP partners acknowledged that as three individual practices they were struggling to meet patient demands and to sustain services, the three practices merged to form a new partnership Riverport Medical Practice. This had resulted in the leaders having confidence to share resources, skills and expertise to benefit patients and staff.
• The practice had met the challenges of implementing a new clinical system to enable all sites to access to the patient records, staff changes and co-ordinated standard working procedures across all sites.
• The management team recognised the significant work that had been undertaken and recognised there were still systems and processes to fully embed and others that required further improvement.
• Staff we spoke with told us they were proud of the improvements the merger had made for their patients. For example, greater skill mix and expertise shared across the sites.
• The practice had systems to manage risk so that safety incidents were less likely to happen. When incidents did happen, the practice learned from them and improved their processes. They recognised that the recording of these events lacked detail to be fully assured that trends would be identified and actions monitored.
• 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.
• Patients found the appointment system easy to use and reported that they were able to access care when they needed it.
• There was a strong focus on continuous learning and improvement at all levels of the organisation.

We rated the practice as requires improvement for delivering safe services because;

• The system and process to ensure all medicines were stored safely needed to be improved as we found some out of date medicines, gases and equipment. The practice took immediate action to address the issues.
• The system and process to ensure all appropriate emergency medicines were available needed to be improved as we found missing items at two of the sites. The practice took immediate action and obtained them.
• We saw the practice had a programme of training but some staff were overdue training that the practice had deemed mandatory.
• The practice was knowledgeable about the patients on their safeguarding register but they did not have a formalised approach to multi-disciplinary team management of safeguarding concerns.
• We found no concerns relating to infection prevention and control but the policies needed to be improved to ensure all information was easily available to all staff to maintain the standards required.

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 the systems and processes in place to ensure significant events and complaints are recorded in detail to record actions taken, learning identified and to monitor improvements made.
• Review the practice performance, including clinical oversight for exception reporting and consistent coding of medical records to ensure all patients receive appropriate follow up in a timely manner.
• Review and further develop systems and processes to encourage the uptake of the childhood immunisation programme.
• Continue to work with patients to encourage the development of a patient participation group.

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