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Inspection Summary


Overall summary & rating

Good

Updated 20 March 2017

Letter from the Chief Inspector of General Practice

We carried out an announced comprehensive inspection at Richmond Medical Centre on 05 January 2016. The overall rating for the practice was good and the rating for the safe domain was requires improvement. The full comprehensive report on January 2016 inspection can be found by selecting the ‘all reports’ link for Richmond Medical Centre on our website at www.cqc.org.uk.

This inspection was a desk-based review carried out on 21 February 2017 to confirm that the practice had carried out their plan to meet the legal requirements in relation to the breaches in regulations that we identified in our previous inspection on 05 January 2016. This report covers our findings in relation to those requirements and also additional improvements made since our last inspection.

Overall the practice is now rated as good.

Our key findings were as follows:

  • An external contractor was employed to clean and sanitise all carpets within the practice following our initial inspection in January 2016.

  • Internal cleaning policies specific to the cleaning of carpets were updated.

  • A formal system had been implemented to provide clinical supervision and mentorship to independent nurse prescribers.

  • Significant events detailed what had been learnt as a result of the incident as well as the action taken. We saw minutes of meetings with the partners which discussed the significant events and the actions taken.

  • Meeting minutes were recorded for all primary health care team meetings which demonstrated the attendance of relevant health and social care professionals, including community nursing team, health visitors and MacMillan nurses.

Professor Steve Field (CBE FRCP FFPH FRCGP) 

Chief Inspector of General Practice

Inspection areas

Safe

Good

Updated 20 March 2017

The practice is rated as good for providing safe services.

  • An external contractor was employed to clean and sanitise all carpets within the practice following our initial inspection in January 2016.

  • Internal cleaning policies specific to the cleaning of carpets were updated.

  • A formal system had been implemented to provide clinical supervision and mentorship to independent nurse prescribers.

  • Significant events detailed what had been learnt as a result of the incident as well as the action taken. We saw minutes of meetings with the partners which discussed the significant events and the actions taken.

Effective

Good

Updated 6 April 2016

The practice is rated as good for providing effective services.

  • Data from the Quality and Outcomes Framework showed patient outcomes were at or above average for the locality and compared to the national average.

  • Staff assessed needs and delivered care in line with current evidence based guidance.

  • The practice held regular end of life care meetings.

  • Clinical audits demonstrated quality improvement.

  • There was a GP lead for clinical governance.

  • Staff had the skills, knowledge and experience to deliver effective care and treatment.

  • Staff received training relevant to their roles and were up to date with all mandatory training.

  • There was evidence of appraisals and personal development plans for all staff.

  • Staff worked with multi-disciplinary teams to understand and meet the range and complexity of patients’ needs.

Caring

Good

Updated 6 April 2016

The practice is rated as good for providing caring services.

  • Data from the National GP Patient Survey showed patients rated the practice either slightly below or comparable to others for several aspects of care.

  • Patients said they were treated with compassion, dignity and respect and they were involved in decisions about their care and treatment.

  • Information for patients about the services available was easy to understand and accessible. Patient information leaflets were available in numerous different languages for patients whose first language was not English, patients also had access to interpreter services.

  • We saw staff treated patients with kindness and respect, and maintained patient and information confidentiality.

Responsive

Good

Updated 6 April 2016

The practice is rated as good for providing responsive services.

  • Practice staff reviewed the needs of its local population and engaged with the NHS England Area Team and Clinical Commissioning Group to secure improvements to services where these were identified.

  • 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.

  • Information about how to complain was available and easy to understand and evidence showed the practice responded quickly to issues raised. Learning from complaints was shared with staff and other stakeholders.

  • The practice offered extended hours appointments on a Monday evening until 8pm with both GPs and a nurse for patients who could not attend during normal opening hours.

  • There were longer appointments available for patients with a learning disability.

  • All members of staff had received Gillick Competency / Fraser Guidelines training.

Well-led

Good

Updated 6 April 2016

The practice is rated as good for being well-led.

  • The practice had a clear vision and strategy to deliver high quality care and promote good outcomes for patients. Staff were clear about the vision and their responsibilities in relation to this.

  • There was a clear leadership structure and staff felt supported by management. The practice had a number of policies and procedures to govern activity and held regular governance meetings.

  • There was an overarching governance framework which supported the delivery of the strategy and good quality care. This included arrangements to monitor and improve quality and identify risk.

  • The provider was aware of and complied with the requirements of the Duty of Candour. The partners encouraged a culture of openness and honesty.

    The practice had systems in place for knowing about notifiable safety incidents and ensured this information was shared with staff to ensure appropriate action was taken

  • The practice proactively sought feedback from staff and patients, which it acted on. The patient participation group was active.

  • There was a strong focus on continuous learning and improvement at all levels.

Checks on specific services

Older people

Good

Updated 6 April 2016

The provider was rated as requires improvement for safety. The issues identified as requiring improvement overall affected all patients including this population group. There were, however, examples of good practice.

The practice is rated as good for the care of older people.

  • The practice offered proactive, personalised care to meet the needs of the older people in its population.

  • The practice was responsive to the needs of older people, and offered home visits and urgent appointments for those with enhanced needs.

  • The percentage of people aged 65 or over who received a seasonal flu vaccination was higher than the national average.

  • Those at high risk of hospital admission and with end of life care needs were identified and reviewed regularly, this included working with other health professionals to provide co-ordinated care.

  • The practice held regular end of life care meetings to review the needs of these patients.

  • Flu vaccination rates for the over 65s were 80.75%, and at risk groups 52.16%. These were above national averages.

People with long term conditions

Good

Updated 6 April 2016

The provider was rated as requires improvement for safety. The issues identified as requiring improvement overall affected all patients including this population group. There were, however, examples of good practice.

The practice is rated as good for the care of people with long-term conditions.

  • Nursing staff had lead roles in chronic disease management such as diabetes and patients at risk of hospital admission were identified as a priority.

  • There was a care coordinator in the practice for patients identified as at risk of hospital admission.

  • Performance for diabetes related indicators was 96.5% which was better than the national average of 89.2%.

  • Longer appointments and home visits were available when needed.

  • All these patients had a named GP and a structured annual review to check their health and medicines needs were being met. For those patients with the most complex needs, the named GP worked with relevant health and care professionals to deliver a multi-disciplinary package of care.

  • There was a nurse in the practice who specialised in diabetes management.

  • The practice provided an in-house smoking cessation service.

Families, children and young people

Good

Updated 6 April 2016

The provider was rated as requires improvement for safety. The issues identified as requiring improvement overall affected all patients including this population group. There were, however, examples of good practice.

The practice is rated as good for the care of families, children and young people.

  • 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 had a high number of A&E attendances. Immunisation rates were relatively high 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.
  • The practice’s uptake for the cervical screening programme was 94.7%, which was higher than the national average of 82%.

  • Appointments were available outside of school hours and the premises were suitable for children and babies.

  • We saw positive examples of joint working with midwives, health visitors and school nurses.

  • The practice offered an ‘adolescent’ service which included access to emergency contraception.

  • All members of staff had received Gillick Competence / Fraser Guidelines training.

  • The practice provided sexual health advice and chlamydia screening.

Working age people (including those recently retired and students)

Good

Updated 6 April 2016

The provider was rated as requires improvement for safety. The issues identified as requiring improvement overall affected all patients including this population group. There were, however, examples of good practice.

The practice is rated as good for the care of working-age people (including those recently retired and students).

  • 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.For example, extended hours appointments were available and online services such as ordering repeat prescriptions, appointment booking and access to patient care records for the convenience of patients who worked or had other commitments during the day.Patients could also view their patient care record online.

  • The practice was proactive in offering online services as well as a full range of health promotion and screening that reflects the needs for this age group.

  • A range of health promotion and screening was available including NHS health checks, smoking cessation and travel advice and vaccinations.

  • An automated arrival machine was available to give patients the opportunity to arrive themselves for their appointment rather than speak to a receptionist.

People whose circumstances may make them vulnerable

Good

Updated 6 April 2016

The provider was rated as requires improvement for safety. The issues identified as requiring improvement overall affected all patients including this population group. There were, however, examples of good practice.

The practice is rated as good for the care of people whose circumstances may make them vulnerable.

  • The practice offered longer appointments for patients with a learning disability.

  • The practice regularly worked with multi-disciplinary teams in the case management of vulnerable people and ensured care plans and regular reviews were in place.

  • The practice informed vulnerable patients about how to access various support groups and voluntary organisations.

  • Staff knew how to recognise signs of abuse in vulnerable adults and children. Staff were aware of their responsibilities regarding information sharing, documentation of safeguarding concerns and how to contact relevant agencies in normal working hours and out of hours. There were alerts on patient care records to alert clinicians of specific needs of vulnerable families and children.

  • All staff have had received safeguarding children and adults training.

  • All patients identified as vulnerable had a care plan in place which was reviewed regularly.

People experiencing poor mental health (including people with dementia)

Good

Updated 6 April 2016

The provider was rated as requires improvement for safety. The issues identified as requiring improvement overall affected all patients including this population group. There were, however, examples of good practice.

The practice is rated as good for the care of people experiencing poor mental health (including people with dementia).

  • The practice regularly worked with multi-disciplinary teams in the case management of people experiencing poor mental health, including those with dementia.
  • The practice carried out advance care planning for patients with dementia.

  • The practice had told patients experiencing poor mental health about how to access various support groups and voluntary organisations.

  • The practice had a system in place to follow up patients who had attended accident and emergency where they may have been experiencing poor mental health.

  • Staff had a good understanding of how to support patients with mental health needs and dementia.

  • All members of staff including GPs have received ‘Dementia Friends’ training.