The Red House

Updated 7 August 2017

The Red House provides a range of primary medical services from its premises at The Red House Surgery, 124 Watling Street, Radlett, Hertfordshire, WD7 7JQ and Gateways Surgery, 17 Andrew Close, Shenley, Radlett, Hertfordshire, WD7 9LP and Park Street Surgery, 10 Withy Place, Park Street, St Albans, Hertfordshire, AL2 2SN. The practice has a registered manager in place. (A registered manager is an individual registered with CQC to manage the regulated activities provided).

The practice serves a population of approximately 20,254 and is a training practice. The area served is less deprived compared to England as a whole. The practice population is mostly white British with a significant Jewish population at the main surgery in Radlett. The practice serves a slightly above average population of those aged from 5 to 19 years and 35 to 54 years. There is a lower than average population of those aged from 20 to 34 years.

The clinical team includes five male GP partners, three female and two male salaried GPs, one trainee GP, one nurse practitioner, three practice nurses and two healthcare assistants. The team is supported by a practice manager, an assistant practice manager, one surgery manager, one surgery supervisor and 20 other managerial, secretarial, administration and reception staff. The practice provides services under a General Medical Services (GMS) contract (a nationally agreed contract with NHS England).

The Red House Surgery is fully open (phones and doors) from 8.30am to 1.30pm and 2pm to 6pm Monday to Friday. Between 1.30pm and 2pm daily the doors are closed and phones switched to Gateways Surgery. There is extended opening until 9pm on Mondays and from 7am on Wednesdays and Thursdays. The practice also opens every Saturday from 8am to 11am for GP and nurse pre-bookable appointments.

Park Street Surgery is fully open (phones and doors) from 9am to 1.30pm and 2pm to 6pm Monday to Friday. Between 1.30pm and 2pm daily the doors are closed and phones switched to Gateways Surgery. Gateways Surgery is fully open (phones and doors) from 8.30am to 1pm and 1.30pm to 6pm Monday to Friday. Between 1pm and 1.30pm daily the doors are closed and phones switched to The Red House Surgery.

Across the three surgeries, appointments are available from 8.30am to 11am (9am to 11.30am at Park Street Surgery) and 3pm to 5.30pm daily, with slight variations depending on the doctor and the nature of the appointment.

An out of hours service for when the practice is closed is provided by Herts Urgent Care.

Updated 7 August 2017

Letter from the Chief Inspector of General Practice

We carried out an announced comprehensive inspection at The Red House on 26 October 2016. The overall rating for the practice was good. However, we identified a breach of legal requirements. Improvements were needed to systems, processes and procedures to ensure the practice provided safe services. Consequently the practice was rated as requires improvement for providing safe services. The full comprehensive report from the 26 October 2016 inspection can be found by selecting the ‘all reports’ link for The Red House on our website at www.cqc.org.uk.

After the comprehensive inspection, the practice wrote to us and submitted an action plan outlining the actions they would take to meet legal requirements in relation to;

• Regulation 18 Health & Social Care Act 2008 (Regulated Activities) Regulations 2014

- Staffing.

The area identified as requiring improvement during our inspection in October 2016 was as follows:

• Ensure that staff who act as chaperones are appropriately trained.

In addition, we told the provider they should:

• Implement a system to monitor the temperature of vaccines transported between the three surgeries to ensure they stay within the required levels.
• Ensure that comprehensive fire safety records and logs are maintained at all three surgeries.
• Ensure that water temperature checks are completed.
• Ensure that all appropriate medical equipment is checked and calibrated within the required timescales.

• Ensure that all staff employed are supported by receiving appropriate supervision and appraisal and are completing the essential training relevant to their roles, including infection prevention and control training.
• Continue to identify and support carers in its patient population.
• Ensure that, where practicable and appropriate, all reasonable adjustments are made for patients with a disability in line with the Equality Act (2010).

We carried out an announced focused inspection on 19 July 2017 to confirm that the practice had carried out their plan to meet the legal requirements in relation to the breach of regulation that we identified in our previous inspection on 26 October 2016. This report covers our findings in relation to those requirements and also additional improvements made since our last inspection.

Our key finding on this focused inspection was that the practice had made improvements since our previous inspection and were now meeting the regulation that had previously been breached.

The practice is now rated as good for providing safe services.

On this inspection we found:

• All staff who acted as chaperones were trained for the role.

Additionally where we previously told the practice they should make improvements our key findings were as follows:

• All staff had completed infection control training.
• A system was in place and adhered to for monitoring the temperature of vaccines when they were transported between the surgeries and ensure they stayed within the required levels.
• Fire safety logs and records were appropriately maintained.
• All clinical equipment was checked to ensure it was working properly.
• Water temperature checks were completed and recorded.
• A programme was in place to ensure all staff received an appraisal on an annual basis and this was on schedule. We found that of the nine non-clinical staff previously overdue their annual appraisals and who were still employed by the practice, all had received or been offered a fully documented appraisal between December 2016 and March 2017.

• Through a proactive approach from staff the practice had increased the amount of carers identified in its patient population. As of July 2017 the practice had identified 335 patients on the practice list as carers. This was approximately 1.7% of the practice’s patient list and was an increase of around 50% from our inspection in October 2016. The practice held a carers’ event in January 2017 and another event was planned for September 2017. The practice’s Patient Participation Group (the PPG is a community of patients who work with the practice to discuss and develop the services provided) was actively engaged with this.

• We saw that following our comprehensive inspection in October 2016 the practice had installed a support rail in the accessible toilet facility at Park Street Surgery. A baby change mat was purchased for the surgery and a notice was displayed in the toilet to promote this facility. We saw that hearing loops were provided in the reception areas at Gateways Surgery and Park Street Surgery (one was available at The Red House Surgery during our October 2016 inspection). The staff we spoke with said they were confident in using the equipment if the need arose and written guidance was available to them.

Professor Steve Field (CBE FRCP FFPH FRCGP) 

Chief Inspector of General Practice

Updated 17 March 2017

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

• Patients at risk of hospital admission were identified as a priority.
• 74% of patients on the asthma register had their care reviewed in the last 12 months. This was similar to the CCG average of 75% and the national average of 76%.
• Performance for diabetes related indicators was the same as the CCG and national average. The practice achieved 90% of the points available compared to the CCG and national average of 90%.
• All newly diagnosed patients with diabetes were managed in line with an agreed pathway.
• 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 GPs worked with relevant health and care professionals to deliver a multi-disciplinary package of care.
• For the past year the practice had established a pre-diabetes and diabetes screening programme, during which time 249 new diagnoses of pre-diabetes and 73 new diagnoses of type two diabetes were recorded by the practice. A similar programme was in place for patients with Atrial Fibrillation. (Atrial Fibrillation is a heart condition that causes an irregular and often abnormally fast heart rate).
• An in-house audiology service had been provided at The Red House Surgery since 2012. An audiologist was available for two sessions each week and 195 hearing aids had been fitted between January and July 2016.
• A weight management service was provided at The Red House Surgery twice each week. As part of this the practice offered advice to patients on diet and exercise programmes with follow ups over a 13 week period. At the time of our inspection, 506 patients had participated in the programme with 48% achieving a weight loss of between 5kg and 10kg. 

Updated 17 March 2017

The practice is rated as good for the care of families, children and young people.

• There were systems in place to identify and follow up children living in disadvantaged circumstances and who may be at risk, for example, children and young people who had a high number of A&E attendances.
• Immunisation rates were comparable to other practices in the local area for all standard childhood immunisations.
• 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.
• The practice’s uptake for the cervical screening programme was 94% which was above the CCG and national average of 82%.
• Appointments were available outside of school hours and the premises were suitable for children and babies. However, no baby changing facilities were available at Park Street Surgery.
• There were six week post-natal checks for mothers and their children.
• A range of contraceptive and family planning services were available.
• Approximately 25% of The Red House Surgery’s patient population was Jewish and the practice offered a preconception screening programme for Tay-Sachs disease. (Tay-Sachs disease is a rare genetic disorder that causes progressive damage to the nervous system and is more prevalent in the Ashkenazi Jewish population).

Updated 17 March 2017

The practice is rated as good for the care of 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.
• Older people had access to targeted immunisations such as the flu vaccination. The practice had 3,441 patients aged over 65 years. Of those 2,397 (70%) had received the flu vaccination at the practice in the 2015/2016 year.
• There were four care homes in the practice’s local area. The GPs visited as and when required to ensure continuity of care for these patients. For one of the homes for residents with increased needs visits were usually completed on a daily basis and scheduled quarterly visits were in place to complete patient health reviews. 

Updated 17 March 2017

The practice is rated as good for the care of working-age people (including those recently retired and students).

• 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 offered online services such as appointment booking and repeat prescriptions as well as a full range of health promotion and screening that reflects the needs for this age group.
• There was additional out of working hours access to appointments to meet the needs of working age patients. There was extended opening at The Red House Surgery until 9pm on Mondays and from 7am on Wednesdays and Thursdays. The practice also opened every Saturday from 8am to 11am for GP and nurse pre-bookable appointments.

Updated 17 March 2017

The practice is rated as good for the care of people experiencing poor mental health (including people with dementia).

• 84% of patients diagnosed with dementia had their care reviewed in a face to face meeting in the last 12 months. This was similar to the CCG average of 85% and national average of 84%.
• Performance for mental health related indicators was similar to the CCG and national averages. The practice achieved 92% of the points available compared to the CCG average of 95% and the national average of 93%.
• The practice regularly worked with multi-disciplinary teams in the case management of people 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 support groups and voluntary organisations.
• Staff had a good understanding of how to support patients with mental health needs and dementia.
• Mental health trust well-being workers were based mainly at The Red House Surgery on an ad-hoc basis. Patients could self-refer to these.
• There was a GP lead for dementia.

Updated 17 March 2017

The practice is rated as good for the care of people whose circumstances may make them vulnerable.

• The practice held a register of patients living in vulnerable circumstances including those with a learning disability. There were 39 patients on the practice’s learning disability register at the time of our inspection. Of those, all were invited for and 11 (28%) had accepted and received a health review in the past 12 months.
• The practice offered longer appointments for patients with a learning disability and there was a GP lead for these patients.
• The practice regularly worked with multi-disciplinary teams in the case management of vulnerable people.
• The practice informed vulnerable patients about how to access 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.
• Additional information was available for patients who were identified as carers and there was a nominated staff lead for these patients.
• The practice had identified 223 patients on the practice list as carers. This was approximately 1.1% of the practice’s patient list. Of those, 193 had been invited for and 74 (33%) had accepted and received a health review in the past 12 months.