Archived: Richmond Practice

We carried out an announced comprehensive inspection on 15 November 2018 to ask the service the following key questions; Are services safe, effective, caring, responsive and well-led?

Our findings were:

Are services safe?

We found that this service was providing safe care in accordance with the relevant regulations.

Are services effective?

We found that this service was providing effective care in accordance with the relevant regulations.

Are services caring?

We found that this service was providing caring services in accordance with the relevant regulations.

Are services responsive?

We found that this service was providing responsive care in accordance with the relevant regulations.

Are services well-led?

We found that this service was providing well-led care in accordance with the relevant regulations.

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 the service was meeting the legal requirements and regulations associated with the Health and Social Care Act 2008. At a previous inspection on 20 February 2018 the practice was found to be proving safe, effective, caring and responsive care. It was found not to be providing well led care, and a warning notice was issued.

The report stated where the practice must make improvements:

• Ensure that systems or processes are established and operated to ensure compliance with governance requirements. In particular:
• Safeguarding arrangements, including those in relation to the reporting of female genital mutilation.
• Management of incidents, to ensure that risks to patients were mitigated.
• Treatment being provided to patients who decline information being shared with their GP.
• Assurance that consent arrangements are in place for the treatment of children.
• Arrangements in place to assure the identity of patients.

In addition, the provider should:

• Review the approach to sharing information with affected patients when incidents occur.
• Review the need for privacy curtains in consultation rooms.
• Review whether adequate arrangements are in place to ensure that patient records can be stored for the required length of time should the service cease to trade.

The Richmond Practice is an independent provider of medical services. The service provides a full range of General Practice services. It also provides obstetrics and gynaecology, ultrasound/radiography and paediatric consultations from their clinic which is based at 17-19 Sheen Road, Richmond, London, TW9 1AD.

The service is provided by two Directors, one of whom is the practice manager, and the other is the Medical Director of the service who is also the registered manager. A registered manager is a person who is registered with the Care Quality Commission to manage the service. Like registered providers, they are ‘registered persons’. Registered persons have legal responsibility for meeting the requirements in the Health and Social Care Act 2008 and associated Regulations about how the service is run.

The premise is located on three floors. The property is leased by the provider and the premises consist of a patient reception area and three consulting rooms. It also has an assistant’s room, a clean utility room, a multipurpose room used as breakout space, quiet workspace, interview room and as a dirty utility space. There is also other offsite room space including a warehouse, call-taking room, a laundrette and administration room.

Feedback received from patients who completed comment cards about the service was positive.

The service is registered with the Care Quality Commission (CQC) to provide the regulated activity of treatment of disease, disorder or injury, family planning, maternity and midwifery services and diagnostic and screening procedures

Our key findings were:

• The service had systems to manage risk so that safety incidents were less likely to happen. This included management of safeguarding referrals and those for female genital mutilation. Infection control processes were in place, although one sharps box was in use but had not been dated.
• Medicines were stored, prescribed and managed in line with guidelines.
• The practice routinely reviewed the effectiveness and appropriateness of the care that it provided. Care and treatment were delivered according to evidence based guidelines.
• The service had systems in place for monitoring and auditing the care that had been provided.
• Staff had been trained in areas relevant to their role.
• Patients were treated with compassion, dignity and respect and they were involved in their care and decisions about their treatment.
• Information about services was available and easy to understand. The complaints system was clear and was clearly advertised.
• Patients reported that they were able to access care when they needed it.
• The practice had governance procedures in place supported by policies and protocols, and staff were aware of how to access and utilise them.

There were areas where the provider could make improvements and should:

• Review processes for monitoring clinical waste storage.

Professor Steve Field CBE FRCP FFPH FRCGP

Chief Inspector of General Practice

We carried out an announced comprehensive inspection on 20 February 2018 to ask the service the following key questions; Are services safe, effective, caring, responsive and well-led?

Our findings were:

Are services safe?

We found that this service was providing safe care in accordance with the relevant regulations; however, in some areas the provider’s governance arrangements required review in order to ensure that these supported the effective mitigation of risk.

Are services effective?

We found that this service was providing an effective service in accordance with the relevant regulations; however, improvements were required in order to ensure that consent to treatment was obtained appropriately.

Are services caring?

We found that this service was providing a caring service in accordance with the relevant regulations. ; however, improvements should be made in relation to ensuring patients’ dignity and respect.

Are services responsive?

We found that this service was providing responsive care in accordance with the relevant regulations.

Are services well-led?

We found that this service was not providing well-led care in accordance with the relevant regulations.

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 the service was meeting the legal requirements and regulations associated with the Health and Social Care Act 2008.

Richmond Practice provides private General Practice, Obstetrics & Gynaecology, and Paediatric consultations from their clinic in Richmond, South West London.

The service is run by two partners, one of whom is the Practice Manager, and the other is the Medical Clinical Director, who is the registered manager. A registered manager is a person who is registered with the Care Quality Commission to manage the service. Like registered providers, they are ‘registered persons’. Registered persons have legal responsibility for meeting the requirements in the Health and Social Care Act 2008 and associated Regulations about how the service is run.

Feedback received from patients both via the CQC comment cards and from speaking to patients in the waiting area on the day of the inspection, was positive overall about the care and treatment provided.

Our key findings were:

• The practice had some systems to manage risk so that safety incidents were less likely to happen; however, in some areas these were not sufficiently embedded into the culture of the service. 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. Overall, care and treatment was delivered according to evidence-based guidelines.
• Staff involved and treated patients with compassion, kindness, dignity and respect.
• Patients found it easy to use the appointment system and reported that they were able to access care when they needed it.
• In some areas governance arrangements were insufficient to ensure that risks to patients were mitigated.

We identified one regulation that was not being met. The provider must:

• Ensure that systems or processes are established and operated effectively to ensure compliance with the requirements of Regulation.

You can see full details of the regulations not being met at the end of this report.

There were areas where the provider could make improvements and should:

• Review the approach to sharing information with affected patients when incidents occur.
• Review the need for privacy curtains in consultation rooms.Review whether adequate arrangements are in place to ensure that patient records can be stored for the required length of time should the service cease to trade.

Enforcement action

We are now taking further action in relation to this provider and will report on this when it is completed.

Professor Steve Field CBE FRCP FFPH FRCGP

Chief Inspector of General Practice