Richmond Medical Centre

Updated 2 February 2017

Richmond Medical Centre’s practice is located in Solihull, an area of the West Midlands. The original practice was opened in 1993 and during the past few months the practice premises has gone through an extensive renovation.This was achieved through funding by the Primary Care Infrastructure Funding programme. The practice has increased the number of consultation rooms available from five to ten and has increased the number of services available to patients, including a consultant led chemotherapy clinic. The practice has a General Medical Services contract (GMS) with NHS England. A GMS contract ensures practices provide essential services for people who are sick as well as, for example, chronic disease management and end of life care and is a nationally agreed contract. The practice also provides some enhanced services such as minor surgery, childhood vaccination and immunisation schemes.

The practice provides primary medical services to approximately 5,600 patients in the local community. The practice is run by a sole practitioner GP (female), with the support of two salaried GPs (both female) and a long term locum (male). The nursing team consists of two practice nurses and one health care assistant. The non-clinical team consists of administrative and reception staff and a practice manager.

Based on data available from Public Health England, Richmond Medical Centre is located in an area of relatively low deprivation.

The practice is open between 8am and 6.30pm Mondays to Fridays. Extended hours appointments are available between 6.30pm to 7.20pm on Tuesdays and 7am to 8am on Wednesdays. Telephone consultations are also available and home visits for patients who are unable to attend the surgery. When the practice is closed, primary medical services are provided by Badger, an out of hours service provider and NHS 111 service and information about this is available on the practice website.

Updated 2 February 2017

Letter from the Chief Inspector of General Practice

We carried out an announced comprehensive inspection at Richmond Medical Centre in Solihull on 1 December 2016. Overall the practice is rated as good.

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

• Staff understood and fulfilled their responsibilities to raise concerns, and to report incidents and near misses. The practice had identified, recorded and analysed significant events in order to identify areas of learning and improvement and so mitigate the risk of further occurrence.
• There were arrangements to safeguard children and vulnerable adults from abuse, and local requirements and policies were accessible to all staff.
• Staff assessed patients’ needs and delivered care in line with current evidence based guidance. Staff had been trained to provide them with 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. Improvements were made to the quality of care as a result of complaints and concerns.
• Patients said they found it easy to make an appointment with a named GP and there was continuity of care, with urgent appointments available the same day.
• The practice had good facilities and was well equipped to treat patients and meet their needs. The practice offered a community service known as Care Navigator to help older people maintain their independence.
• Clinical audits were carried out to demonstrate quality improvement and to improve patient care and treatment.
• The practice had been through a period of change with the complete renovation of the premises during 2016. Patients told us that services had been continuous during this period and staff had worked very hard to accommodate patients.
• The practice worked closely with other organisations in planning how services were provided to ensure that they meet patients’ needs. For example, a consultant led clinic was held twice a week for patients receiving chemotherapy.
• Staff worked with multidisciplinary teams to understand and meet the range and complexity of patients’ needs. We saw evidence that multidisciplinary team meetings took place every month. Staff spoke positively about the team and about working at the practice
• 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.
• The provider was aware of the requirements of the duty of candour.

There were also areas of practice where the provider should make improvements:

• Update staff on key policies to ensure a clear understanding of the practice procedures.
• Review current processes for the identification and recording of carers.
• Consider the systems in place to record staff appraisals and development plans so that they can be referred to and reviewed as necessary.

Professor Steve Field (CBE FRCP FFPH FRCGP) 

Chief Inspector of General Practice

Updated 2 February 2017

• Nursing staff had lead roles in chronic disease management and patients at risk of hospital admission were identified as a priority.
• Longer appointments and home visits were available when needed and patients unable to attend the practice, received reviews at home. For example, blood tests for some high risk medicines were carried out by the practice nurse.
• All patients, with long-term conditions had 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.
• Patients had a named GP. We saw evidence that meetings were held every month with community nurses.
• The practice ran prostate clinics to support patients by offering blood tests and prostate-specific antigen (psa) monitoring.
• The practice offered a range of services to support the diagnosis and management of patients with long term conditions and offered health promotion support, for example stop smoking services.

Updated 2 February 2017

• There were systems in place to identify and follow up children living in disadvantaged circumstances and who were at risk, for example, children and young people who had a high number of accident and emergency (A&E) attendances.
• Appointments were available outside of school hours and the premises were suitable for children and babies.
• There were policies, procedures and contact numbers to support and guide staff should they have any safeguarding concerns about children. The practice held multi disciplinary safeguarding meetings every month with health visitors
• We saw positive examples of joint working with midwives, health visitors and school nurses. The midwife provided antenatal care every week at the practice.
• Childhood immunisation rates for under two year olds ranged from 85% to 99% compared to the CCG averages which ranged from 88% to 97%. Immunisation rates for five year olds ranged from 84% to 99% compared to the CCG average of 90% to 96%.
• The practice’s uptake for the cervical screening programme was 83% which was higher than the national average of 82%.

Updated 2 February 2017

• 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. This included blood tests and vaccinations for those patients who were unable to attend the practice.
• The practice had systems in place to identify and assess patients who were at high risk of admission to hospital. Patients who were discharged from hospital were reviewed to establish the reason for admission and care plans were updated.
• The practice worked closely with multidisciplinary teams so patients’ conditions could be safely managed in the community.
• Staff from the Care Navigator Service met weekly with the practice to discuss patients who required support within the community. The care co-ordinator supported patients to access relevant services to meet their needs.

Updated 2 February 2017

• 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 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.
• The practice provided a health check to all new patients and carried out routine NHS health checks for patients aged 40-74 years.
• The practice offered extended hours surgeries for people who had difficulty attending during normal working hours, with early morning appointments on Wednesdays and late appointments available on Tuesday evenings.
• The practice provided an electronic prescribing service (EPS) which enabled GPs to send prescriptions electronically to a pharmacy of the patient’s choice.
• Results from the national GP survey in July 2016 showed 72% of patients were satisfied with the surgery’s opening hours which was comparable to the local average of 78% and the national average of 79%.

Updated 2 February 2017

• The latest published data from the Quality and Outcomes Framework (QOF) of 2015/16 showed 98% of patients diagnosed with dementia had their care reviewed in a face to face meeting in the last 12 months, which was higher than the national average of 84%.
• The practice regularly worked with multidisciplinary teams in the case management of patients experiencing poor mental health, including those with dementia.
• The practice had told patients experiencing poor mental health about how to access various support groups and voluntary organisations.
• Data supplied by the practice showed 35 patients were on the mental health register and 92% had care plans agreed.
• Staff had a good understanding of how to support patients with mental health needs and dementia and a counsellor from Improving Access to Psychological Therapies (IAPT) service held a clinic once a week to support patients.
• The practice had devised its own templates for dementia screening to ensure patients were offered the appropriate reviews.

Updated 2 February 2017

• The practice held a register of patients living in vulnerable circumstances including with a learning disability. The practice offered longer appointments for patients with a learning disability. Data provided by the practice showed that of the 24 patients who were on the learning disability register 15 had received their annual health check. The practice sent regular appointment opportunities to patients and encouraged patients to attend their health review .

• The practice regularly worked with other health care professionals in the case management of vulnerable patients and held meetings with the district nurses and community teams every month.

• 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.
• The practice’s computer system alerted GPs if a patient was also a carer. There were 46 patients on the practices register for carers; this was 0.8% of the practice list. On speaking with the provider, they told us that they added carer’s information to a patient’s record but in a format that searching for data was difficult.