Richmond Medical

We carried out an announced comprehensive inspection at Richmond Medical on 10 and 11 August 2022. Overall, the practice is rated as good.

The ratings for each key question are as follows:

Safe - Good

Effective -Good

Caring - Good

Responsive – Requires Improvement

Well-led - Good

Following our previous inspection on 11 November 2022 the practice was rated requires improvement overall and for all key questions except for the key question responsive which was rated good. We issued the practice with requirement notices for breaches of regulation 12(1) Safe care and treatment and regulation 17(1) Good governance.

The full reports for previous inspections can be found by selecting the ‘all reports’ link for Richmond Medical on our website at www.cqc.org.uk

Why we carried out this inspection:

This inspection was a comprehensive follow-up inspection to assess improvement in areas of concern identified at our last inspection which included two breaches of regulations, and to update the practice’s rating accordingly.

We found that the issues identified at inspection in November 2021 had been addressed. These included:

• Records of staff training were now available and these provided evidence that staff were trained in safeguarding to the appropriate level.
• An up to date infection and prevention control audit was in place.
• Systems to monitor clinical decision making for those working in advanced clinical roles were in place and this complemented the informal systems in place.
• Emergency medicines were available and a risk assessment was in place for those medicines on order from the pharmacist.
• A quality improvement strategy was established.
• Action was being implemented to improve patient access and the patient experience. A Patient Participation Group (PPG) had been re-established and patients’ views were being actively canvassed.

How we carried out the inspection

Throughout the pandemic CQC has continued to regulate and respond to risk. However, taking into account the circumstances arising as a result of the pandemic, and in order to reduce risk, we have conducted our inspections differently.

This inspection was carried out in a way which enabled us to spend a less amount of time on site. This was with consent from the provider and in line with all data protection and information governance requirements.

This included

• Conducting staff interviews using video conferencing and face to face.
• Completing clinical searches on the practice’s patient records system and discussing findings with the provider.
• Reviewing patient records to identify issues and clarify actions taken by the provider.
• Requesting evidence from the provider.
• A site visit

Our findings

We based our judgement of the quality of care at this service on a combination of:

• what we found when we inspected
• information from our ongoing monitoring of data about services and
• information from the provider, patients, the public and other organisations.

We have rated this practice as Good overall.

We found that:

• The practice recognised patient dissatisfaction with telephone access and a new telecommunication system to improve access for patients had been commissioned.
• The practice was part of the NHS England Time to Care initiative. The focus of this was the implementation of a strategy to improve patient access and patient satisfaction with the service.
• The practice team were working hard to improve performance data such as cervical screening and childhood immunisations.
• Staff dealt with patients with kindness and respect and involved them in decisions about their care.
• The practice team were positive and enthusiastic. They told us they were all working together to provide a quality service with patients.
• The practice had implemented systems to ensure they provided care in a way that kept patients safe and protected them from avoidable harm. This included implementing and following national and local guidelines to keep people safe throughout the COVID-19 pandemic.

Whilst we found no breaches of regulations, the provider should:

• Continue to seek ways to improve patient satisfaction with the service and continue to build the patient participation programme.
• Continue implementing strategies to improve patient uptake in areas of cervical screening and child immunisations.
• Explore best practice guidance and review patients prescribed more than two courses of steroids to treat asthma with a view to issuing a steroid card.
• Include the contact details of the Parliamentary and Health Service Ombudsman (PHSO) at the end of final written complaint responses.

Details of our findings and the evidence supporting our ratings are set out in the evidence tables.

Dr Sean O’Kelly BSc MB ChB MSc DCH FRCA

Chief Inspector of Hospitals and Interim Chief Inspector of Primary Medical Services