Archived: Roseneath Medical Practice

Updated 26 November 2018

Roseneath Medical Practice provides a private general practice and paediatrics service in Richmond, South West London to approximately 1070 patients. The practice is owned by a two-person partnership, who also own the dental practice which is located in the same building (which was not inspected on this occasion). There is one GP and one, recently appointed, paediatrician working for the practice, who are supported by an administrator/receptionist.

The practice provides appointments seven days a week by appointment. Appointments were available from 8:30am to 5:30pm Monday to Friday with extended hours opening until 8pm on Tuesdays. On Saturdays the practice was open from 9am to 1pm and on Sundays from 10am to 2pm. We were also told that the practice could accommodate appointments outside of these times if required by a patient.

We carried out this comprehensive 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.

The inspection was led by a CQC inspector who had access to advice from a specialist advisor.

To get to the heart of patients’ experiences of care and treatment, we always ask the following five questions:

• Is it safe?
• Is it effective?
• Is it caring?
• Is it responsive to people’s needs?
• Is it well-led?

The previous comprehensive inspection of this service in March 2018 found that the service was providing a safe, effective, caring and responsive service; therefore we did not look in detail at these areas during this inspection, which focussed on considering whether the service was well led. 

Updated 26 November 2018

We carried out an announced comprehensive inspection at Roseneath Medical Practice in March 2018. We found that this service was not providing well-led care in accordance with the relevant regulations and we issued a Requirement Notice in respect of Regulation 17 (Good governance) of the Health and Social Care Act 2000. The full report for the comprehensive inspection can be found by selecting the ‘all reports’ link for Roseneath Medical Practice on our website at www.cqc.org.uk.

Following the comprehensive inspection the practice submitted an action plan, outlining the action they would take in order to comply with regulations. This inspection was an announced focused inspection, carried out on 25 October 2018 to confirm that the practice had effectively implemented their plan. We carried out this inspection under Section 60 of the Health and Social Care Act 2008 as part of our regulatory functions. This report covers our findings in relation to those requirements and also additional improvements made since our last inspection.

Roseneath Medical Practice provides a private GP and paediatrics service to patients. The practice is situated in premises which are shared with a dental practice, which is owned by the same partnership but did not form part of the inspection.

One of the partners 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.

Our findings were:

Are services well-led?

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

Our key findings were:

• There were formal arrangements in place to signpost patients to alternative sources of medical care when doctors at the practice were absent. We were told that when the GP was absent from the practice they would check and action incoming test results remotely; however, there were no safety netting arrangements in place to ensure that incoming test results requiring urgent action were processed in circumstances where the GP was unable to work (e.g. if they were unexpectedly very ill).
• Failsafe processes had been put in place to ensure that correspondence with, and about, patients conducted outside of the patient records system was promptly saved to the patient’s record.
• The practice followed GMC guidance in dealing with patients who did not consent for details of their care and treatment to be shared with their registered NHS GP.
• The practice had a clearly defined process for managing patient safety and medicines alerts, and maintained records of action taken in response to these.
• The practice monitored their service to ensure that care was delivered in accordance with guidance and best practice. They had carried out audits on re-calling patients for cervical screening and ensuring that patient records contained a comprehensive audit trail of all correspondence and actions taken.
• Processes were in place to remind patients that they were due for a routine cervical smear.
• Processes were in place to ensure that all staff kept up to date with the training required for their role.
• All clinical equipment was calibrated in order to ensure that it was working correctly.
• Arrangements had been put in place to allow patients to access language translation services where required.
• Appropriate operational policies were in place and were followed,
• Processes were in place to ensure that the practice knew the identity of patients, and checks were carried-out to ensure that adults providing consent to treatment on behalf of children had the authority to do so.

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

• Include all members of clinical staff on the log of medicines and safety alerts to ensure a complete audit trail of alerts being read and actioned.
• Review the need for safety netting arrangements to ensure that incoming test results requiring urgent attention can be actioned in instances where clinicians are away from the practice and unable to check the system remotely.

Professor Steve Field CBE FRCP FFPH FRCGP

Chief Inspector of General Practice