Archived: Richford Gate Medical Centre

Updated 7 March 2017

Richford Gate Medical Centre is a single location GP service which provides primary medical services through a General Medical Services (GMS) contract to approximately 10,500 patients in the Goldhawk Road area of West London. It is part of the NHS Hammersmith and Fulham CCG. The practice registers patients from most parts of London W6 and W12. The patient population groups served by the practice include a cross-section of socio-economic and ethnic groups. The majority of patients registered with the practice are from a British or mixed British background. The next largest groups are patients from a Caribbean, Black-African, Irish, Chinese and Asian backgrounds. There are above average numbers of patients in the 25-49 age groups. Nearly half of patients are have a long-standing health condition.

The practice team is made up of four GP partners (thee female and one male) offering 24 sessions, a practice manager (0.8 whole time equivalent (WTE)); three salaried GPs (two female and one male) offering 14 sessions; a full and a part-time practice nurse (both female) offering 9 nursing sessions; a pharmacist (1 WTE), a healthcare assistant (0.8 WTE), phlebotomist (1 WTE), reception manager (1 WTE), five receptionists (3.86 WTE), five secretarial staff (4.26 WTE) including a secretary/healthcare assistant; and a caretaker. The practice is accredited as a GP Training Practice and there are three GP trainees attached to it, training to specialise in general practice.

The practice is open between 8.15am and 6.30pm Monday to Friday. Appointments are from 8.15am to 12.30pm and from 2.30pm to 6.30pm daily. In addition to bookable extended hours appointments on Wednesday evening (6.30pm to 8.00pm) and a Saturday morning surgery (9am to 12 noon), the practice offered pre-booked Monday morning telephone consultations with a GP. Pre-bookable appointments could be booked up to four weeks in advance and urgent appointments were also available for people that needed them.

The practice has out of hours (OOH) arrangements in place with an external provider and patients are advised that they can also call the 111 service for healthcare advice.

The inspection was carried out to follow up a comprehensive inspection we carried out on 1 and 2 October 2014 when we rated the practice as good overall and requires improvement for providing safe services. We found the practice had taken the action we said it should take to make improvements. We again rated the practice as good overall and now good for providing safe services, as a result of the action taken.

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Updated 7 March 2017

Letter from the Chief Inspector of General Practice

We carried out an announced comprehensive inspection at Richford Gate Medical Centre on 1 and 2 October 2014. The overall rating for the practice was good but we rated the practice as requires improvement for providing safe services. The full comprehensive report on the October 2014 inspection can be found by selecting the ‘all reports’ link for Richford Gate Medical Centre on our website at www.cqc.org.uk.

This inspection, undertaken to check on improvement, was an announced comprehensive inspection on 17 November 2016. The practice is again rated as good overall and is now rated good for providing safe services.

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

• There was an open and transparent approach to safety and an effective system in place for reporting and recording significant events.
• Risks to patients were assessed and well managed.
• 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.
• The majority of 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.
• 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 and complied with the requirements of the duty of candour.

The areas where the provider should make improvement are:

• Ensure all clinicians are aware of the practice’s updated policy on antibiotic prescribing.

• Review the system for the identification of carers to ensure all carers have been identified and provided with support.

• Consider reactivating the hearing loop in reception.

• Communicate the practice mission statement to staff and patients.

• Consider the introduction of a formal ongoing programme of quality improvement, including clinical audit.

• Re-establish regular meetings of the patient participation group (PPG).

Professor Steve Field (CBE FRCP FFPH FRCGP) 

Chief Inspector of General Practice

Updated 7 March 2017

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

• Clinical staff had lead roles in chronic disease management and patients at risk of hospital admission were identified as a priority.
• QOF performance for diabetes related indicators was below the national average for 2015/16. The practice had taken steps to improve performance in this area including a rigorous call and recall, and review and monitoring systems for diabetes.
• The practice ran a weekly diabetic clinic and employed the CCG diabetic lead to see patients and provide clinical support to the practice diabetic doctor. The practice had put in place a rigorous call and recall system for diabetes management.
• 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.
• There were arrangements in place to review medicines for patients with long term conditions, including those on high risk medicines.
• There were multidisciplinary reviews of all patients on the practice’s palliative care register at every clinical meeting.

Updated 7 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 were at risk. Access to on-site health visitors enabled informal as well as formal discussion around children and families causing concern.
• Immunisation rates were generally comparable to or above CCG averages and some above and others below national averages for standard childhood immunisations. The practice sent birthday cards inviting children aged 5 and under to remind them of their vaccine due dates.
• Children and young people were treated in an age-appropriate way and were recognised as individuals.
• The practice’s uptake for the cervical screening programme was 81%, which was above the CCG average of 73% and comparable to the national average of 82%.
• Appointments were available outside of school hours and the premises were suitable for children and babies.
• There was a duty GP available to take calls from parents/carers who had medical concerns and see children and young people who were unable to get an appointment on the day.
• We saw positive examples of joint working with midwives, and health visitors. Joint clinics were provided weekly for 6-8 week baby checks involving a GP, health visitor and practice nurse.

Updated 7 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.
• There were named GPs for patients in this group to ensure continuity of care and longer appointments were available for those with more complex needs.
• The practice provided services to residents in local extra-care sheltered accommodation
• There was close working with the local community independence service to ensure that if a patient would like to be looked after at home and was at risk of hospital admission, the practice did all it could to attain that.
• There were care plans for frail patients and special appointments and home visits to review these.

Updated 7 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 was proactive in offering online services as well as a full range of health promotion and screening that reflects the needs for this age group.
• The practice offered pre-booked Monday morning telephone consultations, Wednesday evening appointments and Saturday morning appointments with a GP.
• Telephone consultations were available with a GP of choice in the mornings after morning surgery and a duty doctor was available to give emergency advice either face to face or by phone for both morning and afternoon sessions.
• The practice recognised that people of working age often did not see their GP often so appointments were longer for these clinics so that multiple concerns could be addressed.
• The practice had responded to recent student meningitis immunisation programmes and sent invites to its young person population.

Updated 7 March 2017

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

• 76% of patients diagnosed with dementia had had their care reviewed in a face to face meeting in the last 12 months, which was comparable to other practices although below the national average of 84%.
• Overall QOF performance for mental health indicators was above the CCG and in line with the national average:
• 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.
• The practice had a system in place to follow up patients who had attended accident and emergency where they may have been experiencing poor mental health.
• The practice had engaged with ‘Shifting Settings of Care work’ to ensure the safe discharge of patients from the Community Mental Health Team.
• The practice had signed up to Out of Hospital Services (OOHS) for mental health covering patients with serious mental illness and complex common mental illness.
• One of the GP partners, the mental health lead at the practice, had recently completed a university diploma in mental health and the practice had recently been offered the role of Educational Hub for Hammersmith and Fulham GP Federation. The GP Partner was also clinical lead for mental health for the CCG.
• Staff had a good understanding of how to support patients with mental health needs and dementia. All staff were trained as ‘dementia friends’.

Updated 7 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 homeless people and those with a learning disability.
• The practice had developed close working relationships with the local learning disabilities service and accommodation and arranged learning disability health checks with the practice nurse.
• The practice offered longer appointments for patients with a learning disability.
• The practice regularly worked with other health care professionals in the case management of vulnerable patients.
• There was an on-site mental health worker and alcohol workers for GPs to refer to and enable effective monitoring. There was flexibility in access to appointments for substance misuse patients who could often be late to appointments.
• The practice informed vulnerable patients about how to access various support groups and voluntary organisations.
• The practice had established communication links to hostels and to a homeless pilot nurse. Special relationships were in place with significant keyworkers within homeless projects and organisations. Collaboration within these relationships enabled effective coordination of services.
• 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.