The Vineyard Surgery

Updated 29 November 2017

The Vineyard Surgery provides primary medical services in Richmond to approximately 4000 patients and is one of 31 practices in Richmond Clinical Commissioning Group (CCG). The practice is run by a partnership of six GPs who run three other practices in neighbouring CCGs.

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 5%, 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 majority of the practice’s patient population are aged between 25 and 50 years, and they also have a high proportion of children aged up to 10 years. The proportion of patients aged 10 to 24 years and 50+ years is significantly lower than the national average. Of patients registered with the practice, the largest group by ethnicity are white (87%), followed by Asian (6%), mixed (4%), other non-white ethnic groups (2%), and black (1%).

The practice operates from a two-storey converted residential premises. The reception desk, waiting area, and three consultation rooms are situated on the ground floor. The practice manager’s office, one consultation room and staff kitchen are situated on the first floor.

The practice team at the surgery is made up of one full time male principle GP who is a partner in the provider organisation; in addition, two part time female salaried GPs are employed by the practice. In total 18 GP sessions are available per week. The practice also employs one part time female nurse practitioner who provides a total of one clinical session and one administrative session per week, and one part time female nurse. The clinical team are supported by the Group General Manager who works across all sites, a site manager, a trainee manager, three reception staff and two administrative staff.

The practice operates under a General Medical Services (GMS) contract, and is signed up to a number of local and national enhanced services (enhanced services require an enhanced level of service provision above what is normally required under the core GP contract).

The practice is open between 8am and 6:30pm Monday to Friday. Appointments are from 8am to 1pm every morning, and 1:30pm to 6:30pm every afternoon. Extended hours surgeries are offered between 7:30am and 8am and between 6:30pm and 7:30pm on Tuesdays. Patients can also access appointments from 8am to 8pm, seven days a week, at one of the CCG’s hub practices.

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

The practice is registered as a partnership with the Care Quality Commission to provide the regulated activities of diagnostic and screening services; maternity and midwifery services; treatment of disease, disorder or injury; surgical procedures; and family planning.

Updated 29 November 2017

Letter from the Chief Inspector of General Practice

We carried out an announced comprehensive inspection at The Vineyard Surgery on 27 October 2014. The overall rating for the practice was requires improvement. We identified breaches of regulations relating to staffing and the monitoring of safety and we issued requirement notices in relation to these breaches. Following the initial inspection the practice submitted an action plan outlining how they intended to address the breaches of regulation identified.

On 20 December 2016 we carried-out a follow-up announced comprehensive inspection at the practice. During this inspection we found that the issues identified during the previous inspection had been addressed; however, we identified further regulatory breaches in respect of the safety, effectiveness, caring, and leadership at the practice. We issued requirement notices in relation to breaches of Regulation 17 (Good governance) and 18 (Staffing) of the Health and Social Care Act 2008 (Regulated Activities) Regulations 2014. 

The full comprehensive reports on both inspections can be found by selecting the ‘all reports’ link for The Vineyard Surgery on our website at www.cqc.org.uk.

This inspection was an announced focused inspection carried out on 3 September 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 20 December 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:

• Staff had the skills and knowledge to deliver effective care and treatment and a concise competency framework have been introduced for non-medical prescribers.
• Following the previous inspection in December 2016, security arrangements had been put in place to ensure that medicines and blank prescription stationery was securely stored.
• The practice had a good understanding of their performance, and had put processes in place following the previous inspection to improve. Data from the Quality and Outcomes Framework showed patient outcomes were at or above average compared to local and national averages.
• The practice had considered the results of the most recent patient satisfaction survey, but their action plan did not address concerns about the nursing service.
• During the December 2016 inspection we found that patient consent to treatment such as childhood immunisations was not always recorded in records. During the re-inspection we reviewed a sample of records and found that a record of consent had been made in all cases; however, in some records of childhood immunisations, there was no record of the identity of the person giving consent.
• Clinical audits demonstrated quality improvement.
• During the December 2016 inspection we found that there was a lack of consistency amongst staff about the process for chaperoning. When we re-inspected, we found that all staff we interviewed who acted as chaperones were clear about the process and all confirmed that they would stand inside the privacy curtain during examinations.
• During the December 2016 inspection we found that there was no record kept of cleaning completed by cleaners, and that the practice’s Infection Prevention and Control (IPC) lead was not up to date with IPC training. When we re-inspected we found that a log of cleaning had been put in place, and that the IPC lead was up to date with training; however, the practice did not keep a log of the cleaning of small clinical equipment. A recent IPC audit had been completed at the practice, and staff were in the process of considering the recommendations made.
• During the December 2016 inspection we noted that the practice had arrangements in place to provide language translation during consultations; however, this was not advertised in the waiting area. When we re-inspected we found that information was available about this service.
• During the previous inspection in December 2016 we found that the practice had identified 21 patients as carers, which represented less than 1% of the practice list. When we returned to the practice we found that there were 18 carers on their carers register. The practice had assigned a member of staff as a carers’ champion, with a view to increasing the profile of the support offered to patients.
• During the previous inspection we found that complaints about the practice were not always responded to in line with the practice’s complaints procedure. When we re-inspected we found that the practice had received one complaint since the last inspection, and this had been investigated and responded to in line with the practice’s complaints procedure. We noted that responses to complaints were co-ordinated centrally by the group manager to ensure consistency of approach and to enable shared learning across all four of the provider’s sites.
• The practice had assessed the needs of their local community, and was in the process of developing projects to address the needs of vulnerable patients. For example, they were about to begin donating GP time to a local charity for homeless people, to enable these patients to access medical care.

Areas where the practice should make improvements:

• Take action to further identify patients with caring responsibilities in order that these patients can be offered support.
• Consider the infection risks associated with the use of clinical equipment and machinery (such as stethoscopes and ear irrigators) and ensure that processes are in place to evidence that these risks have been mitigated.
• Monitor patient satisfaction of the nursing service to assess whether any further changes or improvements are required.
• Ensure that complete information is included in records of patient consent.

Professor Steve Field CBE FRCP FFPH FRCGP

Chief Inspector of General Practice

Updated 29 November 2017

The practice is rated as good for the care provided to 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.
• Overall, performance for diabetes related indicators was above the CCG and national average. The practice achieved 100% of the total QOF points available, compared with an average of 95% locally and 91% nationally. Their exception reporting rate had reduced during the 2016/17 reporting year and was below the national average for 7 out of 10 indicators.
• The practice had conducted an annual asthma review for 81% of patients, which was better than the local and national average of 76%.
• Longer appointments and home visits were available when needed.
• All these patients had a named GP and 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 29 November 2017

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

• Patients told us that children and young people were treated in an age-appropriate way and were recognised as individuals, and we saw evidence to confirm this. 
• Cervical screening had been carried-out for 81% of women registered at the practice aged 25-64, which was comparable to the CCG and national average of 81%.
• 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.

Updated 29 November 2017

The practice is rated as good for the care provided to 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.
• The practice’s achievement for the management of conditions typically found in older people was comparable to local and national averages; for example, the percentage of patients with hypertension who had well controlled blood pressure was 86% compared to a CCG and national average of 83%.

Updated 29 November 2017

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

• 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 and flexible.
• The practice was proactive in offering online services as well as a full range of health promotion and screening that reflected the needs for this age group.

Updated 29 November 2017

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

• The practice had recorded a comprehensive care plan for 95% of patients who were diagnosed with schizophrenia, bipolar affective disorder and other psychoses, compared to a CCG average of 93% and national average of 87%.

• The practice had recorded a comprehensive care plan for 92% of patients diagnosed with dementia, compared to the CCG average of 86% and national average of 84%.
• The practice regularly worked with multi-disciplinary teams in the case management of patients experiencing poor mental health, including those with dementia.
• The practice carried out advance care planning for patients with dementia.
• 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 29 November 2017

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

• The practice held a register of patients living in vulnerable circumstances including homeless people and those with a learning disability.
• The practice regularly worked with other health care professionals in the case management of vulnerable patients.
• 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.