The Paradise Road Practice

Updated 16 August 2017

The Paradise Road Practice provides primary medical services in Richmond to approximately 3000 patients, and is one of 29 practices in Richmond Clinical Commissioning Group (CCG). The practice operates under a General Medical Services contract.

The practice population is in the least deprived decile in England. The proportion of children registered at the practice who live in income deprived households is 6%, which is lower than the CCG average of 9%, and for older people the practice value is 11%, which is the same as the CCG average. The practice has a higher population of people aged between 30 and 49 years than the national average, a lower proportion of patients aged between 50 and 84 years but a higher proportion of patients aged 85 years and over. Of patients registered with the practice, the largest group by ethnicity are white (86%), followed by Asian (7%), mixed (4%), black (1%) and other non-white ethnic groups (2%).

The practice operates from a converted residential premises within a short walk from Richmond train station and a large multi-storey carpark.

The premises has a reception desk, waiting room, doctor’s consulting room, nurse’s consulting room and healthcare assistant’s consulting room on the ground floor, and a doctor’s consulting room and administrative offices on the first floor.

The practice team at the surgery is made up of a full time principal GP, one part time salaried GP and one long-term locum GP. A total of 10 GP sessions are available per week. The practice also has one part time female nurse and a female healthcare assistant. The practice team also consists of a practice manager, administrator, and three members of reception staff.

The practice is open between 8:30am and 6pm Monday to Friday. A mixture of face to face and telephone appointments are available between 9am and 6:30pm every day. The practice offers extended hours appointments from 7:30am to 8am on Mondays and Fridays and from 6:30pm to 7pm on Thursdays. Patients can also access appointments with a GP outside of normal surgery opening times via the CCG’s seven-day opening Hub, which is hosted by several local surgeries and offers appointments from 8am until 8pm every day, including weekends.

When the practice is closed patients are directed to contact the local out of hours service.

The practice is registered as an individual provider with the Care Quality Commission to provide the regulated activities of diagnostic and screening services; maternity and midwifery services, and treatment of disease, disorder or injury.

Updated 16 August 2017

Letter from the Chief Inspector of General Practice

We carried out an announced comprehensive inspection of The Paradise Road Practice 9 March 2016. A breach of legal requirements was found requirements in relation to the breaches of regulation 17 (Good governance) of the Health and Social Care Act 2008 (Regulated Activities) Regulations 2014. A follow-up focussed inspection was carried-out on 6 December 2016 where we found that the practice was in the process of addressing the breach of regulation, but that this had not been completed. The practice subsequently provided evidence that they had completed the work required to make them fully compliant with the regulations.

During the comprehensive inspection we found that the practice had failed to ensure that a complete and contemporaneous record in respect of each service user was kept. We also identified areas where improvements should be made, which included reviewing their complaints process to ensure that it is clear and accessible to all patients; taking necessary action as recommended in their Legionella risk assessment; encouraging patient feedback; advertising the availability of the language interpretation service; reviewing their appointment system to ensure that longer appointments are given to patients who need then; reviewing their systems for recording information such as staff training, complaints and safeguarding concerns; reviewing the safety arrangements of medicines kept at the practice; and ensuring that they are meeting the needs of patients who are carers. During the follow-up inspection on 6 December 2016 we found that the practice had fully addressed all of these issues with the exception of ensuring that a complete and contemporaneous record in respect of each service user was kept, where they were in the process of arranging for their paper patient records were transferred to their electronic system.

We undertook this further focussed desk-based inspection on 13 June 2017 to check that the practice had completed the work that they had started to transfer all of their paper patient records onto their electronic system. This report covers our findings in relation to this issue. You can read the report from our previous inspections by selecting the ‘all reports’ link for The Paradise Road Practice on our website at www.cqc.org.uk.

Overall the practice was rated as good following the comprehensive inspection and subsequent focussed inspection. They were rated as requires improvement for providing effective services following both inspections. Following this focussed inspection the practice is rated as good for providing an effective service.

Our key findings were as follows:

• The practice had transferred consultation summaries for all patient records onto the electronic system, and had put in place effective quality assurance arrangements to ensure that records were clearly and accurately scanned.
• The practice’s previous achievement for the Quality Outcomes Framework (QOF) was below average is several areas. There had been no additional QOF data published since the previous inspection in December 2016, as data is typically published in October; however, the practice reported that for the 2016/17 reporting year, they were not outliers for any category and had achieved 96% of the total points available.
• The practice had recruited a new chair for their Patient Participation Group (PPG), and were in the process of recruiting additional members to the group.

However, there is one area provider should make improvements.

The provider should:

• Continue the work they have started to grow and establish the PPG.

Professor Steve Field CBE FRCP FFPH FRCGP 

Chief Inspector of General Practice

Updated 22 June 2016

The practice is rated as good for the care of people with long-term conditions.

• Nursing staff had lead roles in chronic disease management and patients at risk of hospital admission were identified as a priority.
• The practice’s overall recorded performance in relation to long-term conditions for the reporting year 2014/15 was below CCG and national averages. However, they had experienced challenges in recording and reporting data, which had been resolved at the time of the inspection. We saw evidence that their year-to-date performance for 2015/16 was comparable to CCG and national averages. For 2014/15 QOF achievement for the percentage of patients with hypertension who had well controlled blood pressure was 69%, the CCG average was 83% and the national average was 84%. For asthma the practice achieved 93% of the overall QOF points available, compared with a CCG and national average of 97%. The practice had recorded having carried-out a review in the preceding 12 months of 88% of patients with chronic obstructive pulmonary disorder (COPD), which was below the CCG average of 92% and national average of 90%.
• The practice’s overall performance in relation to diabetes indicators for 2014/15 was below CCG and national averages at 74% of the total QOF points available, compared with a CCG average of 90% and national average of 89%. In particular, the number of diabetic patients who had well controlled blood pressure was 65% (CCG average was 79% and national average was 78%); and the proportion with a record of a foot examination and risk classification in the preceding 12 months was 68% (CCG average 90%, national average 88%). The percentage of diabetic patients who had received influenza immunisation was 87% (CCG average 90% and national average 94%).
• Longer appointments and home visits were available when needed.
• All these patients had a named GP, and a proportion of these patients who were most at risk of unplanned hospital admission had a care plan in place and received a structured annual review to check their health and medicines needs were being met. For those patients with the most complex needs, the named GP worked with relevant health and care professionals to deliver a multidisciplinary package of care.

Updated 22 June 2016

The practice is rated as good for the care of families, children and young people.

• There were systems in place to identify and follow up children living in disadvantaged circumstances and who were at risk, and these patients were discussed in the monthly multi-disciplinary meeting. Immunisation rates were slightly below average for some standard childhood immunisations; however, this was likely to be due to parents choosing for their children to receive these privately or having received them abroad before moving to the practice.
• The practice had recorded having carried-out an asthma review in the last 12 months for 70% of asthmatic patients, which was comparable to the CCG average of 72% and national average of 75%.
• Cervical screening had been carried-out for 82% of women registered at the practice aged 25-64, which was the same as the national average.
• Appointments were available outside of school hours and the premises were suitable for children and babies.
• We saw positive examples of joint working with midwives and health visitors.

The practice was registered to carry-out newborn baby checks on babies born at home.

Updated 22 June 2016

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

• The practice offered proactive, personalised care to meet the needs of the older people in its population.
• The practice was responsive to the needs of older people, and offered home visits and urgent appointments for those with enhanced needs.
• Nationally reported data for 2014/15 showed that outcomes for patients for conditions commonly found in older people were below CCG and national averages. For example, 69% of patients with hypertension were recorded as having well controlled blood pressure, compared to a CCG average of 83% and national average of 84%, however, the practice had had some challenges in recording and reporting data, which had been resolved at the time of the inspection.
• Longer appointments were available for older people when needed.

Updated 22 June 2016

The practice is rated as good for the care of working-age people (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.
• The practice did not have a website, however, they offered online appointment booking and repeat prescription requests via a portal on the NHS Choices website.
• Early morning and evening appointments were available, and additional appointments, including weekend appointments, were available via the CCG’s seven-day opening hub.

Updated 22 June 2016

The practice is rated as good for the care of people experiencing poor mental health (including people with dementia).

• 82% of patients diagnosed with dementia had had their care reviewed in a face to face meeting in the last 12 months, which was comparable to the CCG and national average of 84%.
• The practice had recorded a care plan in the past 12 months for 73% of patients with schizophrenia, bipolar affective disorder and other psychoses, which was below the CCG average of 92% and national average of 89%. The practice had experienced challenges in capturing data on care planning, which had been resolved at the time of the inspection, and year to date figures for 2015/16 showed an overall achievement of 80% for mental health indicators.
• The practice regularly worked with multi-disciplinary teams in the case management of people experiencing poor mental health, including those with dementia.
• The practice carried out advance care planning for patients with dementia and had completed an annual care review for all of these patients. For those patients who were housebound, the review meeting was held in the patient’s home.
• The practice had told patients experiencing poor mental health about how to access various support groups and voluntary organisations.
• Staff had a good understanding of how to support patients with mental health needs and dementia.

Updated 22 June 2016

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 including homeless people, sex workers and those with a learning disability.
• The practice did not routinely offer longer appointments for patients with a learning disability.
• The practice regularly worked with multi-disciplinary teams in the case management of vulnerable people.
• The practice informed 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.