Archived: River Brook Medical Centre

Letter from the Chief Inspector of General Practice

We previously carried out an announced comprehensive inspection at River Brook Medical Centre on 12 December 2016. As a result of our inspection the practice was rated as good overall but required improvement for providing safe services. The full comprehensive report on the December 2016 inspection can be found by selecting the ‘all reports’ link for River Brook Medical Centre on our website at www.cqc.org.uk.

This inspection was a desk-based focused inspection carried out on 21 August 2017. This was to confirm that the practice had carried out their plan to meet the legal requirements in relation to the breach in regulations we identified in our previous inspection on 12 December 2016. This report covers our findings in relation to those requirements and also additional improvements made since our last inspection.

Overall the practice is rated as good.

Our key findings were as follows:

• The practice had introduced appropriate recruitment procedures to ensure that persons employed met the required conditions. They had sought advice from a human resource service to assist them in ensuring all the necessary checks had been included. For example, references, photographic identification, and evidence of previous employment.

• The practice had addressed coding issues in their clinical system and could demonstrate that health checks were being offered and carried out for patients with learning disabilities. This process also incorporated calling carers and patients aged over 75 for annual health checks. The practice submitted evidence to show that, for example, 71% of learning disability health checks had been completed up to August 2017. They searched their registers monthly to identify eligible patients and invited them to the practice for health checks.
• The practice provided evidence to confirm that that oxygen masks for children had been purchased for use in the event of a child emergency.
• The practice’s safeguarding policy had been reviewed and updated to include all types of potential abuse.

• The practice had carried out a comprehensive infection control audit in November 2016 and introduced the use of documentation which allowed for review and follow up in the future. All staff had received infection control training.

• The practice manager had introduced a formal programme of appraisals which involved identification of review dates for the following year at the end of each appraisal. The annual appraisal programme included a review of training needs.

Professor Steve Field CBE FRCP FFPH FRCGP

Chief Inspector of General Practice

Letter from the Chief Inspector of General Practice

We carried out an announced comprehensive inspection of River Brook Medical Centre on 12 December 2016. Overall the practice is rated as good.

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

• Staff understood and fulfilled their responsibilities to raise concerns and report incidents and near misses. Learning was shared with staff and reported to external agencies when required.
• Effective systems were in place to mitigate risks to patients who took high risk medicines.
• 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 offered extended hours, and services were available to patients seven days a week
• Feedback from patients about their care was consistently positive and was reflected in the national patient survey published in July 2016.
• The practice had reviewed the needs of its local population and engaged with the NHS England Area Team and Clinical Commissioning Group (CCG) to secure improvements to services where these were identified. For example, the practice had carried out a re-audit of A&E attendances and shared their findings with the local CCG to inform the development of future services.
• The practice had good facilities and was well equipped to treat patients and meet their needs.
• The practice actively reviewed complaints and how they were managed and responded to, and made improvements as a result.
• The practice had a vision which was to provide high quality primary care to their practice population seven days a week. There was a supporting business plan that reflected this vision to ensure the future direction of the practice was monitored and evaluated. There were clearly defined strategies in place and strong evidence of how these strategies had shaped the development of services offered.
• The practice had visible clinical and managerial leadership.
• There were some gaps in the governance arrangements. The provider had addressed a number of the on-going areas prior to the inspection and sent evidence of action taken in other areas immediately after the inspection.
• Staff had received some training but their training needs had not been identified and not all staff had received regular appraisals.
• Some staff recruitment checks had been completed but there were gaps in obtaining all of the required checks to meet the legal standards.

The areas where the provider must make improvement are:

• Put effective recruitment and selection procedures in place to ensure that persons employed meet the required conditions.
• Ensure the risks to the health and safety of patients with learning disabilities are assessed by completing annual health checks.

The areas where the provider should make improvement are:

• Update safeguarding policies to include updated categories or definitions of the types of abuse such as modern slavery.
• Arrange infection prevention control (IPC) training for staff and document and action the findings from IPC audits.
• Implement an appraisal programme for all staff
• Consider the completion of a training needs analysis to identify any skill gaps within the workforce.
• Implement a patient call/recall system to invite carers for annual health checks and flu immunisations.
• Revise the administration of annual health checks for patients aged 75 and over to provide accurate data.
• Obtain masks for children in the event of having to administer oxygen.

Professor Steve Field (CBE FRCP FFPH FRCGP) 

Chief Inspector of General Practice