Archived: Dr Thomas Guilder Also known as Riverbank Surgery

Updated 24 September 2015

Letter from the Chief Inspector of General Practice

We carried out an announced comprehensive inspection of this practice on 9 June 2015. Breaches of legal requirements were found during that inspection within the safe domain. After the comprehensive inspection, the practice sent to us an action plan detailing what they would do to meet the legal requirements in relation to the following:

• Ensure equipment and medicines that may be required in an emergency are reviewed and made readily available where deemed appropriate.
• Ensure all staff working under Patient Group Directions (PGDs) are authorised to administer in line with national requirements (PGDs are written instructions for the supply or administration of medicines to groups of patients who may not be individually identified before presentation for treatment).
• Carry out regular fire drills

We undertook this focused inspection on 17 August 2015 to check that the provider had followed their action plan and to confirm that they now met legal requirements. This report only covers our findings in relation to those requirements.

You can read the report from our last comprehensive inspection, by selecting the 'all reports' link on our website at www.cqc.org.uk

Our key findings across the areas we inspected were as follows:-

• Emergency equipment and medicines were readily available.
• Nurses Patient Group Directions (PGDs) were authorised to administer vaccinations in line with national requirements.
• The practice had carried out a fire drill evacuation and had plans in place to do this on a regular basis.

Professor Steve Field (CBE FRCP FFPH FRCGP) 

Chief Inspector of General Practice

Updated 23 July 2015

The practice is rated as good for the care of people with long-term conditions. Longer appointments and home visits were available when needed. All these patients had a structured annual review to check that their health and medicine needs were being met. The GP followed national guidance for reviewing all aspects of a patient’s long term health. For those patients with the most complex needs, the GP worked with relevant health and care professionals to deliver a multidisciplinary package of care. The practice nurse was trained and experienced to support patients with managing their conditions and preventing deterioration in their health. Flu vaccinations were routinely offered to patients with long term conditions to help protect them against the virus and associated illness. The practice had the support from a nurse specialist in diabetes who ran a clinic at the practice once a fortnight.

Updated 23 July 2015

The practice is rated as good for the population group of families, children and young patients. Appointments were available outside of school hours and the premises was suitable for children and babies. Specific services for this group of patients included family planning clinics, antenatal clinics and childhood immunisations. The practice offered coil fitting and contraceptive implants. Practice staff had received training on safeguarding children relevant to their role. Safeguarding policies and procedures were readily available to staff. All staff understood the relevance of their role in relation to safeguarding children and how to respond if they suspected abuse. The practice ensured that children needing emergency appointments would be seen on the day.

Updated 23 July 2015

The practice is rated as good for the care of older people. Nationally reported data showed that outcomes for patients were good for conditions commonly found in older patients. The practice offered proactive, personalised care to meet the needs of the older patients in its population and had a range of enhanced services, for example, in dementia and end of life care. Elderly patients with complex care needs all had personalised care plans that were shared with local organisations to facilitate the continuity of care. The practice was responsive to the needs of older patients, and offered home visits and rapid access appointments for those with enhanced needs. Patients were able to speak with or see a GP when needed and the practice was accessible for patients with mobility issues. The practice had a safeguarding lead for vulnerable adults. The practice had good relationships with a range of support groups for older patients. There were arrangements in place to provide flu and pneumococcal immunisation to this group of patients. The practice supported residents at two local nursing homes and provided weekly visits.

Updated 23 July 2015

The practice is rated as good for the care of working-age patients (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. Patients were able to request a GP to telephone them instead of attending the practice. The practice opened at 7:30am two days a week to help those patients who commuted to attend appointments before work. 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. Travel advice appointments were offered at times convenient to the patient. Patients were also given smoking cessation advice.

Updated 23 July 2015

The practice is rated as good for the care of people experiencing poor mental health (including people with dementia). Patients with severe mental health needs had care plans and received an annual physical health check. New cases had rapid access to community mental health teams. The practice regularly worked with multi-disciplinary teams in the case management of patients experiencing poor mental health, including those with dementia. It 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.

Updated 23 July 2015

The practice is rated as good for the care of people whose circumstances may make them vulnerable. The practice held a register of patients living in vulnerable circumstances for example those who were housebound or with complex health needs. The practice ensured that patients classed as vulnerable were offered annual health checks. It offered longer appointments for patients when required. The practice regularly worked with multi-disciplinary teams in the case management of vulnerable patients. It had told 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. Translation services were available for patients who did not use English as a first language. The practice could accommodate those patients with limited mobility or who used wheelchairs. Carers and those patients who had carers were flagged on the practice computer system and were signposted to the local carers support team.