The team at Ryalls Park Medical Centre were visited by the Care Quality Commission (CQC) in July 2019. Following the inspection the CQC have published their inspection report, rating the practice as inadequate. Their primary areas of concern were:
- Clinical Coding Quality was inadequate– That we were historically unable to adequately identify that patients have particular diseases or conditions because a "code" has not been added to our computerised clinical record.We had changed our working practices in November 2018 to address this. We have, a comprehensive audit programme audits to identify patients who may have a missing code, and add this code if required.
- Long Term Conditions Management was inadequate. In 2014 the majority of Somerset practices transferred from the national General Practice Quality and Outcomes Framework (QOF) to the Somerset Practice Quality Framework (SPQS). In April 2019 we moved back to the national programme (QOF) . Therefore we re-implemented an improved annual review system for all patients with all patients with a long term condition in April 2019. We will have identified, contacted and completed reviews with all relevant patients by March 2020.
- Supervision of prescribers was inadequate. We were unable to demonstrate a process to the CQC that our prescribing team received adequate supervision. We have changed our process to capture this supervision and satisfy this requirement.
- The storage of “Management Information” was inadequate. Management information reefers to – recruitment, training, appraisal, Health &Safety, Staff Immunisation Status . This information was stored in multiple different sites. The practice will be moving to a new online platform for collating, monitoring and reviewing this information that is currently stored predominantly in paper form in several locations.
Their inspection report provides a number of positive observations about the practice these include:
- The practice followed up on older patients discharged from hospital. It ensured that their care plans and prescriptions were updated to reflect any extra or changed needs. Patients’ needs were discussed and reviewed at the staff daily meetings (huddles) so that patients need were acted upon.
- The practice had reviewed and redeveloped a new system for patients with long-term conditions to be offered a structured annual review to check their health and medicines needs were being met. This was in the process of implementation and there was information that this would be sustained. For patients with the most complex needs, the GP worked with other health and care professionals to deliver a coordinated package of care.
- The practice had arrangements to identify and review the treatment of newly pregnant women on long-term medicines. These patients were provided with advice and post-natal support in accordance with best practice guidance.
- End of life care was delivered in a coordinated way which took into account the needs of those whose circumstances may make them vulnerable.
- The practice was responsive to the needs of older patients and offered home visits and urgent appointments for those with enhanced needs and complex medical issues.
- The health coach’s role (30 hours per week) had been established at the practice for several years and were actively involved in supporting patients to live healthier lives. They took the lead with communicating with hard to reach patients and those seen at a potential of risk. They were available to provide information, signposting patients to other organisations and provided health walks, supported access to local talking groups for mental health.
- Staff were provided with the opportunity and time to obtain training and qualifications. Staff appear to have embraced the changes going ahead with quality assurance and the aims to improve the outcomes and experiences of patients.
- The practice had taken steps to respond and implement changes regarding patients experience of accessing appointments. It was clear from some of the responses from patients (CQC comment cards, NHS Choices, complaints) that there was a mixed opinion of whether the new system was working well. The practice had implemented a call monitoring system, action plans and staff prompt’s for assessing patients’ needs for appointments to ensure that they go to the right member of staff.
- PPG told us they had been included in several aspects of the reviews of the service and actions that the practice had been put in place to improve patients experience and the delivery of the service. This had included the repeat prescription process and the appointment system. They had been involved in patient surveys and were proposing the implementation of new innovative patient feedback system that had been adopted from another practice in the area. The PPG met regularly, and members of the staff team attended to share information and update the progress of changes happening at the practice.
The team has developed a comprehensive action plan to address all of the matters raised by the CQC. The "live" action plan can be found here. Ruth Lough, CQC inspector said "Good evidence that the practice has listened and acted upon concerns found on the 1st of July. Areas of development have been implemented but are not embedded at this point. Positive work was seen going into the recall and coding issues to ensure that patients will be included in the programme of reviews of their care and treatment." . The practice will be reinspected in October 2019 to ensure that we are making good progress on the action plan.
The 2019 CQC report of Ryalls Park Medical Centre. Comment by the Patient Participation Group:
The Patient Participation Group (PPG) was disappointed to read the July 2019 CQC inspection report of Ryalls Park Medical Centre. Having been through a difficult period in 2018, mainly due to a shortage of GPs at the time, the practice has made significant improvements to its performance this year. Although there is much still to be done, these improvements were generally not recognised in the report and the PPG views the CQC rating of Inadequate as a harsh verdict which does not fairly describe the current performance of the practice.
That said, Ryalls Park has accepted the report and has implemented a comprehensive action plan to address the issues identified by the CQC. The PPG fully supports the action plan and all the staff at Ryalls Park. It looks forward to a much improved rating when the CQC conducts a repeat inspection later this year.
Chair Ryalls Park PPG