The Ridgeway Surgery

Updated 6 July 2018

The Ridgeway Surgery is an NHS GP practice located in Harrow, Middlesex. The practice is part of NHS Harrow Clinical Commissioning Group (CCG) and provides GP led primary care services through a Personal Medical Services (PMS) contract to approximately 15,700 patients. (PMS is one of the three contracting routes that have been available to enable commissioning of primary medical services).

We visited both the main practice and branch surgery as part of this inspection. Patients registered with the practice may attend either surgery.

Services are provided from:

• Main practice: 71 Imperial Drive, Harrow, Middlesex, HA2 7DU
• Branch surgery: Alexandra Avenue Health & Social Care Centre, 275 Alexandra Avenue , Harrow, Middlesex, HA2 9DX

Online services can be accessed from the practice website:

• www.ridgeway-surgery.co.uk

The practice is led by five GP partners (three male and two female) who are supported by: eight salaried GPs; three GP locums; four practice nurses; two advanced nurse practitioners; two extended practice nurses; two health care assistants; a practice manager; a reception manager; an administration manager; and 21 administrators / receptionists.

The age range of patients is predominantly 15 to 64 years and is comparable to the national average. The practice population is ethnically diverse with 46% Asian, 41% white, 6% black, 4% mixed race and 3% from other ethnic groups. The practice area is rated in the tenth deprivation decile (one is most deprived, ten is least deprived) of the Index of Multiple Deprivation (IMD).

The practice is registered with the Care Quality Commission to provide the regulated activities of: diagnostic and screening procedures; surgical procedures; and treatment of disease disorder and Injury.

Updated 6 July 2018

This practice is rated as Good overall. (Previous inspection 02/2015 – Good)

The key questions are rated as:

Are services safe? – Good

Are services effective? – Good

Are services caring? – Good

Are services responsive? – Outstanding

Are services well-led? - Good

We carried out an announced comprehensive inspection at The Ridgeway Surgery on 1 May 2018 as part of our inspection programme.

At this inspection we found:

• The practice had clear systems to manage risk so that safety incidents were less likely to happen. When incidents did happen, the practice learned from them and improved their processes.
• The practice routinely reviewed the effectiveness and appropriateness of the care it provided. It ensured that care and treatment was delivered according to evidence-based guidelines.
• The most recent published QOF results showed the practice performed above local and national averages.
• The GP partners and management team were forward thinking. There was a strong commitment towards development and integrated care and the practice was involved in innovative projects both internally and within the locality.
• Staff involved and treated patients with compassion, kindness, dignity and respect.
• Patients could access care at the main practice, branch surgery and a walk-in centre which was run by the practice. Some clinical staff worked across all three services which offered continuity of care for patients
• Feedback from patients and comment cards showed patients found the appointment system easy to use and reported that they were able to access care when they needed it.
• Data from the GP patient survey showed some patients reported difficulties getting through to the practice by phone and delays in the punctuality of appointments. The practice had reviewed patient feedback and implemented new strategies to improve these areas.
• There was a strong focus on continuous learning and improvement at all levels of the organisation. The practice supported members of staff to upskill and progress within their careers.
• There were systems to manage most risks within the practice. However, we found the process for monitoring emergency medicines at the branch surgery was not robust and some clinicians were not adhering to the practice’s infection control policy.

We saw areas of outstanding practice:

• The practice employed two enhanced practice nurses who visited patients in their own home for a review. Triggers for a review included: admission to hospital on more than one occasion; increased frailty; new development of co-morbidities; becoming housebound; dementia; patients in the last phase of life; and carers. The practice had evidence to demonstrate the positive impact these nurses had on patient care. For example, case studies demonstrating positive outcomes for patients and a reduction in A&E attendances for patients over 75 years. The practice shared the concept of enhanced practice nurses with their locality group and four local practices agreed to appoint nurses for similar roles.
• The practice undertook a pharmacy project to improve communication with local pharmacies, improve patient care, and explore the educational needs of pharmacists and clinicians. The project developed into quarterly meetings with integrated multi-professional education for GPs and pharmacists and joint educational sessions with patients. Patients rated the educational session highly and the practice had seen an increase in the usage of repeat dispensing via the electronic prescription service. The practice shared learning from the project with the wider GP community and were presented with an award from Health Education England for Excellence in Education and Training in recognition of their work with local pharmacists.
• The practice worked with representatives of a local learning disability charity to improve health outcomes and access for patients with learning disabilities. Staff were given training and a representative was elected to the patient group committee. Improvements made as a result included: updating the learning disability annual review template; creating easy-read leaflets and satisfaction surveys with pictures; and appointing a member of staff as learning disability champion. Learning from the scheme was shared at a local practice managers meeting.

The areas where the provider should make improvements are:

• Review the systems in place for recording all significant events and monitoring emergency medicines.
• Review staff members’ knowledge of infection prevention and control guidance relating to the disposal of urine samples.

Professor Steve Field CBE FRCP FFPH FRCGP
Chief Inspector of General Practice

Updated 6 July 2018

Updated 6 July 2018

Updated 6 July 2018

Updated 6 July 2018

Updated 6 July 2018

Updated 6 July 2018