Archived: Richmond House Surgery

Updated 24 September 2015

Richmond House was inspected on Tuesday 12 May 2015. This was a comprehensive inspection.

Richmond House is situated in the seaside town of Teignmouth, Devon. The practice provides a primary medical service to approximately 2,850 patients of a diverse age group including a higher percentage of older people.

This practice has two partners, a GP and business manager. Partners hold managerial and financial responsibility for running the business. The two partners had both been on long term absence so have been supported by two salaried GPs, one of whom has increased the number of sessions offered. Including the GP partners there are one male and two female GPs. The GPs are supported by a practice manager, a nurse prescriber and a phlebotomist. The clinical team were supported by additional reception, secretarial and administration staff.

Patients using the practice also have access to community staff including community matron, district nurses, community psychiatric nurses, health visitors, physiotherapists, speech therapists, counsellors, podiatrists and midwives.

The practice is open from Monday to Friday, between the hours of 8.00am and 6.30pm and open for patients between 8.30am and 6pm. Appointments can be accessed in advance and take place between 8.30am and 5.30pm. The practice uses an appointment system called ‘Dr First’ where patients phone the surgery for an appointment and are placed on the doctors call back list. The GP then rings the patient back that day at a time specified by the patient, either dealing with the query on the phone or making a face to face appointment. Outside of these times the GPs make telephone calls and see patients that have been triaged. The practice offers extended appointments on Tuesday evenings between 6.30 and 8.00pm.

The practice has opted out of providing out-of-hours services to their own patients and refers them to an out of hour’s service.

Updated 24 September 2015

Letter from the Chief Inspector of General Practice

We carried out an announced comprehensive inspection at Richmond House Tuesday 12 May 2015.

Overall the practice is rated as good. It was also rated good for providing services for the six population groups.

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

There was a track record and a culture of promptly responding to incidents, near misses and complaints and using these events to learn and change systems so that patient care could be improved.

Staff were aware of their responsibilities in regard to consent, safeguarding and the Mental Capacity Act 2005 (MCA).

The practice was clean and tidy and there were infection control procedures in place.

Medicines were generally managed well at the practice and there were effective systems in place to deal with emergencies.

The GPs and other clinical staff were knowledgeable about how the decisions they made improved clinical outcomes for patients and kept patient care plans under review.

Data outcomes for patients were either equal to or above the average locally.

Patients were complimentary about the staff and how their medical conditions were managed.

Practice staff were professional and respectful when providing care and treatment.

The practice planned its services to meet the diversity of its patients. Adjustments were made to meet the needs of the patients and there was an effective appointment system in place which enabled a good access to the service.

There were clear recruitment processes in place. There were robust induction processes in place for all staff.

The practice had a vision and mission statement which were understood by staff.

There was a leadership structure in place and staff felt supported by the practice manager and each other.

However there were areas of practice where the provider needs to make improvements

The provider should:

• Consider introducing arrangements or assessments to plan for the risk of sudden staff changes or to cover staff absence, including nursing and administrative staff.
• Consider ways of improving awareness of screening opportunities for chlamydia.
• Introduce a programme of internal appraisal and support for the practice manager.

Professor Steve Field (CBE FRCP FFPH FRCGP) 

Chief Inspector of General Practice

Updated 24 September 2015

The practice had systems to identify patients with long term conditions, who might be vulnerable or have complex and long term needs. These patients were discussed at monthly MDT meetings and were referred to the community matron and hub if required for further support.

Patients with long term conditions such as diabetes, heart disease, kidney disease, asthma, chronic obstructive pulmonary disease, rheumatoid arthritis and hypertension were invited for annual health reviews at a time to suit the patient. The practice nurses had the skills and knowledge to care for these patients and liaised with other health professionals if appropriate.

The practice nurse/nurse prescriber advised patients for weight management, smoking cessation and promoted independence and self-care where appropriate. The GPs visited patients who were housebound and unable to visit the practice.

Systems were in place for out of hours (OOH) providers to access summary care records for patients with long term conditions if the patient had given permission. The OOH provider then had up to date details of the patient’s conditions and would be able to provide continuity of care.

Updated 24 September 2015

Antenatal care was provided by local midwives who held a clinic at the practice every other Thursday morning. The midwives had access to the practice clinical system and a GP for advice. The health visiting and school nurse team attended the monthly MDT meetings to discuss any child who was on the at risk register and any patients/families that the health visitor/school nurse or GP have concerns about.

The practice held child vaccination clinics every other Friday but could also book the child into a slot that was more convenient to the parent.

Updated 24 September 2015

All patients aged 75 or over had an allocated GP, but also a choice as to which GP they see. The practice offered vaccinations against Influenza, pneumonia and shingles. The doctors and nurses undertook home visits for those patients who are unable to visit the surgery.

Practice staff held a Multi-Disciplinary Team (MDT) meeting once a month to discuss all patients that were particularly vulnerable or who were on the practice patient management list and referred patients to the community matron and team to assess and visit where necessary. The MDT group also discuss any palliative care patients to try and avoid unnecessary admissions to hospital. The practice referred patients to the local hub where health care professionals met and the community hospital if the patient required more care than they are able to get in their own home or a residential home but don’t need to go into the district general hospital.

Updated 24 September 2015

Patients requesting a call back from the GP were able to request this to be done at certain times of the day to suit their lifestyle and work pattern. The practice held a surgery on a Tuesday evening for those that were working during the day.

Patients were able to make online bookings and request a prescription and view their notes online following a formal request.

The practice offered NHS health checks, smoking cessation, weight management, well woman/man checks and carer’s checks to eligible patients.

Patients were able to order their prescriptions online, through the website, via email, post or fax if they were unable to visit the surgery. They were able to pick up the script at the chemist of their choice which could be nearer to their workplace.

Updated 24 September 2015

The practice had a mental health and dementia register. These patients were offered an annual health and medication review either at the practice or in the patient’s home if they were unable to attend the practice.

The practice had an in house counsellor and referred to the Depression and Anxiety Service who used a room a surgery if the patients could not go to them. The GPs referred patients to the drug and alcohol services and child and adolescent mental health service when required.

Regular blood tests were performed for patients on certain mental health drugs and recalls were set up to make sure that these patients were invited.

The practice had identified all patients who were thought to be at risk of dementia. This system was updated regularly and a popup was placed on the patients notes to remind the clinical staff to offer a screening test for dementia.

Updated 24 September 2015

Vulnerable patients were discussed at the MDT meeting if the GP or nurses had any concerns to raise with other MDT members.

The practice cared for two learning disabilities care homes and a care home for patients with Korsakoffs syndrome (alcoholic dementia). The GPs visit these patients when they are acutely unwell and also visit annually to do a health check and medication review for each patient. Patients with learning disabilities or with mental health problems were offered an annual review.

All staff were up to date on the appropriate level of safeguarding.