Richmond Road Medical Centre

On this page

• Overview
• Learning culture
• Safe systems, pathways and transitions
• Safeguarding
• Involving people to manage risks
• Safe environments
• Safe and effective staffing
• Infection prevention and control
• Medicines optimisation

There was a proactive and positive safety culture, underpinned by openness and honesty. Safety concerns were actively heard, and incidents were thoroughly investigated and appropriately reported. Lessons learned were used to inform and embed best practices across the service. Medicines management was exceptionally safe, with robust systems for high‑risk medicines, near‑universal monitoring compliance, prompt action where risks were identified, and proactive oversight aligned with national guidance. Robust emergency management processes were in place, and safety netting measures were integrated into the triage system to help mitigate clinical risks. Infection prevention and control were consistently monitored, with timely and appropriate actions taken to safeguard individuals. The premises and equipment were safely maintained, and safe recruitment practices were consistently followed. A structured learning and development programme supported staff in upholding high standards of safety and care.

This service scored 84 (out of 100) for this area. Find out what we look at when we assess this area and How we calculate these scores.

The service demonstrated a strong and well‑embedded learning culture, underpinned by openness, transparency and continual improvement. Staff described leadership as approachable and responsive, creating an environment where concerns could be raised and learning was actively encouraged.

A key strength was the structured and routine approach to shared learning. Daily briefings were used to highlight immediate risks, reinforce clinical priorities (such as QOF targets, opportunistic reviews and referral safety‑netting), and ensure staff were consistently aligned to safe, high‑quality care delivery. These were complemented by regular multidisciplinary meetings and twice‑weekly learning sessions, where significant events, clinical cases and service updates were reviewed alongside formal educational presentations.

Meeting minutes evidenced a highly effective learning system in action. Clinical teaching was regularly embedded into these sessions, with presentations on topics such as optimising diabetes management, appropriate use of referral pathways, and recognising conditions such as interstitial lung disease. Learning was clearly translated into practice through discussion, reinforcement of guidance, and application to real patient scenarios.

Significant events were openly reviewed, including incidents such as delayed urgent referrals, with Duty of Candour applied and clear, practical learning identified. Actions focused on improving systems and clinician behaviours, such as reverting to manual processes during IT failures and completing urgent referrals within consultation workflows. Learning was shared widely and embedded through follow-up actions.

Clinical case discussions further demonstrated reflective, multidisciplinary learning. Complex patients were considered collectively, incorporating clinical risk, safeguarding, ethical considerations and patient-centred decision-making. These discussions resulted in clear, accountable action plans, showing how shared learning directly informed patient care. There was also evidence of proactive population health management and targeted interventions for vulnerable and hard-to-reach groups.

Following the factual accuracy process, the provider submitted additional evidence demonstrating strengthened arrangements for learning and reflective practice, which supported an uplift in score from 3 to 4.

Overall, the consistency of daily briefings, depth of discussion within meetings, integration of formal education presentations, and clear evidence that learning was translated into practice demonstrate a culture that is continuous, embedded and impactful. Taken together, this provides strong evidence of an outstanding learning culture.

The service worked collaboratively with individuals and healthcare partners to establish and maintain safe systems of care, where safety was actively managed and monitored. Efforts were made to ensure continuity of care, including during transitions between different services.

The national GP Patient Survey conducted between December 2024 and April 2025 received 101 responses. Of these, 90% of patients reported being involved as much as they wanted to be in decisions about their care and treatment, and 84% felt their needs were met during their last general practice appointment.

Leaders and staff reported that a designated team was responsible for managing referrals through the NHS e-Referral Service. Staff monitored the system to ensure referrals to specialist services were accurately documented, included the correct information, and were processed without delay. Safety netting procedures were in place to ensure all patients were appropriately followed up. Routine referrals were monitored to confirm whether patients still required specialist input or if their condition had deteriorated.

Leaders also explained that they maintained oversight of workflow tasks to ensure timely responses. A system was in place to summarise patient records effectively.

Monthly multidisciplinary team (MDT) meetings were held to review and improve outcomes for people with complex needs; alongside separate monthly MDT meetings focused on child and adult safeguarding. The local Integrated Care Board confirmed that they had no concerns about the service.

The service demonstrated a commitment to taking immediate action to protect people from abuse and neglect, working collaboratively with partners to achieve this. A safeguarding GP lead, deputy and an administration lead were in place; all of whom were allocated time to review patients where safeguarding concerns had been identified. Non-clinical staff were aware of the appropriate channels for reporting safeguarding concerns.

Systems, services, and processes were established to keep people safe and safeguarded from abuse. The service worked effectively with individuals and healthcare partners to understand what safety meant to them and how best to achieve it. There was a clear focus on improving people’s lives while protecting their right to live safely, free from bullying, harassment, abuse, discrimination, avoidable harm, and neglect. Concerns were consistently shared in a timely and appropriate manner. A review of patient records confirmed that the service had a system in place to flag vulnerable adults and children to staff. Safeguarding policies were in place and well understood by staff, who were appropriately trained in safeguarding procedures.

Staff worked with individuals to understand and manage risks holistically. They delivered care that was safe, supportive, and tailored to meet people’s needs, enabling them to engage in activities that mattered to them.

Emergency equipment was available and properly maintained. Staff were able to recognise when a patient’s condition was deteriorating and understood the appropriate actions to take. Patients were advised about risks related to their condition and were given guidance on what to do if their condition worsened.

The service had a comprehensive business continuity plan that addressed various risks, including fire, flooding, loss of computer or telephone systems, and staff shortages.

During our on-site assessment, we observed that the premises was clean, well maintained, and conducive to safe care. Patients we spoke with confirmed that this was consistently their experience.The service had effective systems in place to monitor and comply with mandatory risk assessments, including fire safety and legionella testing, which helped ensure the safety of both patients and staff. Records confirmed that medical equipment was regularly maintained, calibrated, and tested. A business continuity plan was in place and was regularly reviewed and monitored to ensure the service remained prepared for potential disruptions.

The service ensured there were sufficient numbers of suitably qualified, skilled and experienced staff who were well supported, supervised and developed. Staff worked effectively together to deliver safe care that met people’s needs, supported by a structured daily safety model, a strong development infrastructure and a clear culture of internal progression.

The service operated a three-discipline daily clinical safety model, with a duty GP, duty nurse and duty clinical pharmacist available throughout the working day. This ensured urgent clinical need could be assessed promptly and that non-clinical staff had immediate access to clinical support. Daily briefings identified staffing levels, pressures and mitigation plans, providing clear operational oversight and defined accountability.

Rotas were designed to support safe working and staff well-being. Reception staff worked across calls, front desk and administrative duties, and GPs had protected time for clinical and administrative work. Staff survey results from 2026 showed that 96% of staff felt able to work safely consistently or most of the time, with no staff reporting they were unable to do so.

The service demonstrated a strong and sustainable approach to workforce development. Healthcare assistants, supervisors and senior leaders had been developed internally through structured training and progression pathways. A sustained trainee nurse programme had produced qualified nurses, most of whom were retained by the service. Non-medical prescribers received structured supervision, with named educational supervisors and daily on-site clinical oversight to support safe practice and development.

Staff retention was high, with a significant proportion of staff remaining with the service long term, reflecting a positive and supportive working culture. The service also had a dedicated Head of HR, ensuring robust oversight of recruitment, workforce planning, staff well-being and compliance.

Training was up to date and staff worked within their competencies. Appraisals supported development and well-being, and staff were encouraged to take on additional roles, including primary care network and system-level responsibilities.

Safe recruitment processes were followed. The service ensured that all staff, including those not directly employed, were appropriately recruited, trained and supported to work within their roles.

During the factual accuracy process, the provider submitted additional evidence regarding staffing arrangements and workforce planning, which supported an uplift in score from 3 to 4.

Taken together, the consistently safe staffing model, high levels of staff confidence, strong internal development pathways and effective workforce planning demonstrate a service that not only maintains safe staffing, but sustains and improves it over time. This proactive, well‑led and highly resilient approach to staffing provides clear evidence of an outstanding level of safe staffing.

People we spoke with told us they found the premises clean and tidy and had no concerns relating to Infection Prevention and Control (IPC). The service had a designated IPC lead, and all staff had received relevant training. Cleaning schedules were in place and followed consistently. Risk assessments and audits were completed, with actions taken to mitigate identified risks.

Leaders described the service's processes to ensure appropriate clinical oversight and told us how they monitored patients' health, including their use of high-risk medicines (such as warfarin, methotrexate, and lithium). We found that staff had good knowledge of current and relevant best practice and professional guidance.

There was an effective system to evidence the competence of non-clinical medical prescribers, including clinical supervision. The service had appropriate policies and procedures to govern prescribing effectively. The provider held regular GP clinical meetings to discuss patient cases, share knowledge about new medical information, review clinical practices, identify areas for improvement, and ultimately enhance the quality and safety of patient care within a service.

Staff received training in medicines management and reported feeling confident in handling the storage, administration, and documentation of medicines. They held the necessary authorisations to administer medicines, including Patient Group Directions and Patient Specific Directions. Medicines-related stationery was managed securely, and staff followed established protocols to ensure safe prescribing practices.

The service ensured that medicines and treatments were safe, person-centred, and aligned with individuals’ needs, capacities, and preferences. People were actively involved in planning their care, including when changes to their medicines occurred. Staff supported patients in understanding and managing their medicines safely and knew who to contact if their condition worsened or unexpected symptoms arose.

Staff were regularly trained and assessed for competency in medicines optimisation. Prescription stationery was stored securely, and medicines, were kept at appropriate temperatures. Stock levels and expiry dates were routinely checked.

The provider had robust systems in place to manage safety alerts and medicine recalls. Staff took proactive steps to ensure prescribing was appropriate and aimed at optimising care outcomes, including the responsible use of antibiotics. Prescribing data reviewed during the assessment supported this, showing that the provider issued significantly fewer hypnotics, antibiotics and psychotropics compared to local and national averages.

A programme of regular clinical audits focused on prescribing practices, aiming to continuously improve care and treatment. For example, we reviewed a re-audit of bisphosphonate prescribing (medicines for bone strength) was completed in January 2026. This compared data from November 2022, December 2023, February 2025, and January 2026.

The audit showed major improvements following changes made by the service. These changes included flagging prescriptions for automatic annual blood tests and having pharmacy technicians actively recall patients. As a result, the proportion of patients who received their required annual monitoring and medication review rose to over 90%, a substantial increase from previous years.

All patients who needed a review three to four months after starting the medicine were reviewed, as were all patients who had been on the medicine for five or ten years to assess whether a drug holiday was appropriate.

However, the audit found that checks completed before a patient starts the medicine (baseline monitoring) still need improvement, although the number of new patients started during the final audit cycle was very small. One patient was identified as needing a review due to their kidney function.

The re-audit confirmed that the actions taken were effective. Further actions were agreed, including adding alerts for patients on a bisphosphonate drug holiday. A further re-audit is scheduled for January 2027.

As part of the assessment, a series of clinical record searches were carried out by a CQC GP specialist advisor, with the provider’s consent. These searches aimed to assess whether the service was delivering care and treatment in line with current legislation, standards, and evidence-based guidance.

We found that monitoring and use of high‑risk medicines had been consistently excellent, with near‑universal compliance across all searches. All patients prescribed disease-modifying antirheumatic drugs, including methotrexate, azathioprine and leflunomide, had been fully and appropriately monitored, with no evidence of inappropriate pre‑inspection activity identified. Monitoring of directoral anticoagulants had been robust, with creatinine clearance calculated for all patients in the preceding year and only one patient marginally overdue for renal blood tests following an unsuccessful sampling attempt. Other high‑risk medicines, including ACE inhibitors, ARBs, aldosterone antagonists, lithium, amiodarone and warfarin, had all been fully monitored.

Compliance with MHRA safety alerts had been excellent, including for women of childbearing age prescribed teratogenic medicines; appropriate advice and documentation were in place in nearly all cases, with one valproate patient identified where effective contraception required further clarification. Searches for missed diagnoses identified no inappropriate coding. Medication reviews had been undertaken regularly, with pharmacist‑led reviews demonstrating gold‑standard documentation and GP reviews meeting acceptable standards within wider frailty assessments.

Medicines usage indicators were outstanding, with no evidence of excessive use of short‑acting treatments, there were regular reviews and safe prescribing patterns throughout. Monitoring of hypothyroidism, chronic kidney disease stages 4 and 5, asthma exacerbations requiring steroids, and high‑risk diabetes had been largely optimal, with two isolated cases requiring additional follow‑up. Before the end of the assessment, the provider contacted these patients to arrange appointments. Overall, medicines optimisation processes were comprehensive, safe, and exceptionally well managed, representing the strongest performance the GP specialist advisor had encountered.