Archived: Dr Sunil Srivastava Also known as Richmond Medical Centre

Updated 22 January 2015

Richmond Medical Centre, 15 Upper Accommodation Road, Leeds. West Yorkshire, LS9 8RZ is situated in the ward of Burmantofts and Richmond Hill in Leeds. The registered patient list size of the practice is 2,167 of which 1205 are male and 962 are female.  Deprivation affecting children and older people is higher than the local and national average for deprivation.  There is one full time GP and one part time GP partner, one full time practice nurse, a practice manager and two part time administrator/receptionists.

The practice has a general medical services (GMS) Contract under section 84 of the National Health Service Act 2006.   NHS England and the practice enter into a general medical services contract under which the practice is to provide primary medical services and other services in accordance with the provisions of the Contract.

The practice has opted out of providing out-of-hours services to their own patients.  Patients use the 111 service when the practice is closed. 

Updated 22 January 2015

Letter from the Chief Inspector of General Practice

We carried out an announced comprehensive inspection at Dr Sunil Srivastava (Richmond Medical Centre) on 14 October 2014.  During the inspection we gathered information from a variety of sources. We spoke with patients, interviewed staff at all levels and checked that the right systems and processes were in place.

Overall the practice is rated as inadequate and improvements must be made. This is because we found it inadequate for providing safe, effective and responsive services and being well led. It was also inadequate for providing services for all the population groups:

• Older people
• People with long term conditions
• Families, children and young people
• Working age people (including those recently retired and students)
• People whose circumstances make them vulnerable
• People experiencing poor mental health (including people with dementia)

Improvements were also required for providing caring services. 

Our key findings were as follows:

• Risks to some patients who used services were identified and assessed but systems and processes to address these issues were not implemented in a way to identify risks and keep them safe.
• Appropriate recruitment checks on staff had not been undertaken prior to their employment, for example criminal records checks (Disclosure and Barring Service - DBS).
• Urgent appointments were usually available on the day they were requested. However, we found that the routine appointment system was not working, as patients experienced difficulty getting through on the telephone and were often waiting long periods of time when attending for their appointment.  
• There was no evidence of completed audit cycles. 
• The practice had no lead for infection control and there had been no recent infection control audits undertaken.  Actions identified by an independent contractor had not been addressed.
• Most patients were positive about their interactions with staff and said they were treated with compassion.

The areas where the provider must make improvements are:

• Ensure recruitment arrangements are in place that includes all necessary employment checks for all staff.
• Ensure review systems for assessing and monitoring the quality of the service provision and take steps to ensure risks are managed appropriately.
• Ensure there are formal governance arrangements in place and staff are aware of how to implement these to ensure the practice functions in a safe and effective manner. 
• Ensure staff have appropriate policies and guidance to carry out their roles in a safe and effective manner which is reflective of the requirements of the practice.
• Ensure that the practice understands the requirements with respect to consent and capacity and ensure they always act in accordance with the consent of patients.
• Ensure the practice has in place a sufficient number of administrative staff in order to facilitate the smooth running of the practice and to safeguard the health, safety and welfare of patients.
• Take action to address infection prevention and control to ensure the practice complies with the ‘Code of Practice for health and social care on the prevention and control of infection and related guidance’.
• Ensure patients’ dignity and privacy is maintained in relation to their care and treatment.
• Ensure patients’ medical records and personal details are held securely and remain confidential.

The practice will have six months to make the improvements required by this report.  We will carry out a further inspection at the end of that time.

Professor Steve Field (CBE FRCP FFPH FRCGP) 

Chief Inspector of General Practice

Updated 22 January 2015

The practice is rated as inadequate for the population group of people with long term conditions. 

When needed, longer appointments or home visits were available.  We were told patients were reviewed every three months.  The practice had carried out screening for chronic obstructive pulmonary disease (COPD) patients. However, there was no evidence of a structured review of these patients.  Data from the NHS England primary care information showed this practice had two level one triggers for this patient group.  For example, the high level of emergency admissions for patients with long term conditions.  There was no evidence available to show the practice had taken action to improve performance in these areas. 

Updated 22 January 2015

The practice is rated as inadequate for the population group of families, children and young people. 

Patients had access to a weekly baby clinic and midwife and a full range of immunisations, although data supporting the extent of performance in this area was not available. Appointments were available outside of school hours and we were told that emergency appointments for children were prioritised. 

However, systems were not in place for identifying and following up children living in disadvantaged circumstances and who may be at risk.  For example, with respect to children and young people who had a high number of A&E attendances or those children who were identified by the local authority as having safeguarding concerns.  There was no evidence available to show the practice had systems in place to monitor or alert clinical staff about these concerns. The practice’s performance was also significantly below that of other practices with respect to the uptake of cervical smears. While the practice was aware of this and had done some promotion of this service, it had not put in place any means of following up patients who had not attended their appointment. 

Updated 22 January 2015

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

Longer appointments and home visits were available for older people.  As this was a single handed GP practice all patients over the age of 75 years had a named GP.  Patients over the age of 75 years were identified as needing extra support and had been offered a review at the practice. 

Older patients were offered a chaperone service at the practice.  However staff offering this service were not trained and did not have a police check (Disclosure and Barring Service DBS).  There was no evidence that the leadership of the practice had started to engage with this patient group in order to look at further options to improve services for them.

Updated 22 January 2015

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

The uptake of health checks for this age range was good. The practice patient age profile was mainly those of working age but the services available did not reflect the needs of this group.  The practice offered some extended opening hours Monday to Friday. However, there was only telephone access for appointments and there was no on-line appointment system or on-line repeat prescription service available.  Health promotion advice was offered but there was limited accessible health promotion material available at the practice. 

Updated 22 January 2015

The practice is rated as inadequate for the population group of people experiencing poor mental health (including people with dementia). 

The practice had signposted patients experiencing poor mental health to various support services including the local community mental health team.  The practice offered patients extended appointment times.  However, there was no evidence to show that patients in this population group had care plans.  No systems were in place to follow up on patients who had attended accident and emergency where they may have been experiencing poor mental health. There was no evidence to show the practice had worked with multi-disciplinary teams in the case management of people experiencing poor mental health. There was also no evidence that the practice carried out advanced care planning for patients with dementia. The NHS England data also showed that the practice performed poorly (and had a level one trigger) with respect to carrying out physical health checks for patients with severe mental illness (SMI).

Updated 22 January 2015

The practice is rated as inadequate for the population group of people whose circumstances may make them vulnerable. 

While the practice held a register of patients with a learning disability there was no information about other people who may be vulnerable; such as homeless people or travellers.  Arrangements were not in place to ensure patients with a learning disability had an annual health check.  While staff knew how to recognise signs of abuse in vulnerable adults and children, not all staff were adequately trained in this regard.  Systems were not in place for recording concerns raised by the Local Authority safeguarding team.