Letter from the Chief Inspector of General Practice

We carried out an announced comprehensive inspection at Richmond Medical Centre on 05 January 2016. The overall rating for the practice was good and the rating for the safe domain was requires improvement. The full comprehensive report on January 2016 inspection can be found by selecting the ‘all reports’ link for Richmond Medical Centre on our website at www.cqc.org.uk.

This inspection was a desk-based review carried out on 21 February 2017 to confirm that the practice had carried out their plan to meet the legal requirements in relation to the breaches in regulations that we identified in our previous inspection on 05 January 2016. This report covers our findings in relation to those requirements and also additional improvements made since our last inspection.

Overall the practice is now rated as good.

Our key findings were as follows:

• An external contractor was employed to clean and sanitise all carpets within the practice following our initial inspection in January 2016.

• Internal cleaning policies specific to the cleaning of carpets were updated.

• A formal system had been implemented to provide clinical supervision and mentorship to independent nurse prescribers.

• Significant events detailed what had been learnt as a result of the incident as well as the action taken. We saw minutes of meetings with the partners which discussed the significant events and the actions taken.

• Meeting minutes were recorded for all primary health care team meetings which demonstrated the attendance of relevant health and social care professionals, including community nursing team, health visitors and MacMillan nurses.

Professor Steve Field (CBE FRCP FFPH FRCGP) 

Chief Inspector of General Practice

Letter from the Chief Inspector of General Practice

We carried out an announced comprehensive inspection at Richmond Medical Centre on 5 January 2016. Overall the practice is rated as good.

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

• Data from the Quality and Outcomes Framework showed patient outcomes were above average for the locality and the national average.

• There was robust safeguarding systems in place for both children and adults at risk of harm or abuse.

• All staff had received Gillick Competence / Fraser Guidelines training.

• All members of staff including GPs had received Dementia Friends training.

• The practice had systems in place to keep all clinical staff up to date. Staff had access to guidelines from NICE and used this information to deliver care and treatment that met peoples’ needs. All GPs, nurses and health care assistants had signed up to the NICE website and received email alerts of NICE updates.

• Flu vaccination rates for the over 65s were 80.75%, and at risk groups 52.16%. These were above national averages.

• The practice had up to date fire risk assessments and carried out regular fire drills. A fire action plan was on display informing patients and staff what to do in the event of a fire. The practice had a fire warden. We saw evidence that weekly tests of the fire alarm panel were carried out.

• Staff assessed patients’ needs and delivered care in line with current evidence based guidance. Staff had the skills, knowledge and experience to deliver effective care and treatment.

• Patients said they were treated with compassion, dignity and respect and they were involved in their care and decisions about their treatment.

• Information about services and how to complain was available and easy to understand.

• Patients said they found it easy to make an appointment with a named GP and that there was continuity of care.

• There was a clear leadership structure and staff felt supported by management. The practice proactively sought feedback from staff and patients, which it acted on.

• Not all risks to patients were assessed and well managed. The practice did not have a carpet cleaning schedule in place. Not all areas of the practice were cleaned in line with the practice cleaning schedule and guidelines.

• The provider was aware of and complied with the requirements of the Duty of Candour.

The areas where the provider must make improvement are:

• Ensure appropriate systems and processes are in place relating to infection control in line with national guidance, ensuring consulting and treatment rooms are cleaned as per practice cleaning schedule and guidelines and implementation of carpet cleaning schedules.

• Ensure a system of clinical supervision/mentorship is in place for nurse independent prescribers.

The areas where the provider should make improvement are:

• Ensure actions agreed to ensure lessons learned following discussion of a significant event are documented with timely review dates.

• Ensure records are kept of all completed significant event report forms received.

• Ensure multi-disciplinary meetings are recorded.

Professor Steve Field (CBE FRCP FFPH FRCGP) 

Chief Inspector of General Practice

The Richmond Medical Centre provides general practitioner services to a population of approximately 8,750 patients in West Lincolnshire. The practice provides for patients living in North Hykeham, South Hykeham and in the surrounding villages of Whisby, Thorpe on the Hill and Eagle.

The practice manager had a reflective approach to their work which involved regular critical analysis of the performance of the practice. The provider listened to patient comments and had used feedback to improve their service. The practice had effective systems in place to help protect people from avoidable harm and abuse. There were effective systems for the oversight of the practice including medicine management. The building was visibly clean.

Clinical decisions followed best practice. The services were safe and effective. The staff had access to research based practice materials such as the National Institute for Health and Care Excellence (NICE) guidance. The practice worked collaboratively with other agencies and health care teams including specialist consultants, district nursing services, mental; health teams and local care homes.

The feedback we received from all patients was mainly positive. The clinical team gave examples of how they considered patients views about the way the practice was run and with regard to their individual health needs and treatments.

Patients told us their urgent needs were met in a timely way by the practice but a majority also said that the appointment booking system could present delays and be frustrating. A range of appointments were available, including routine and urgent appointments and telephone consultations. People could book appointments either in person, over the phone or on-line.

There was an open culture at the practice and a clear complaints process and effective patient feedback system in place. There were effective systems in place to monitor the quality of the services provided. Governance and risk management measures were in place and staff took action to learn from any incidents that occurred within the practice.