All inspections: James O'Riordan Medical Centre

We carried out a comprehensive announced inspection at James O'Riordan Medical Centre in October 2022.

Overall, the practice is rated as good.

Safe - requires improvement

Effective - good

Caring - good

Responsive - good

Well-led - good

Following our previous inspection in October 2015, the practice was rated as good overall and for all key questions.

The full reports for previous inspections can be found by selecting the ‘all reports’ link for James O'Riordan Medical Centre on our website at www.cqc.org.uk

Why we carried out this inspection

We carried out this inspection to as part of our quality assurance sampling.

The inspection was planned as a focused inspection, which was expanded to comprehensive to look at examples of care in the Responsive key question. We therefore reviewed all of the key questions.

How we carried out the inspection

This inspection was carried out in a way which enabled us to spend a minimum amount of time on site.

This included:

Conducting staff interviews using video conferencing.
Completing clinical searches on the practice’s patient records system (this was with consent from the provider and in line with all data protection and information governance requirements).
Reviewing patient records to identify issues and clarify actions taken by the provider.
Requesting evidence from the provider.
A short site visit.

Our findings

We based our judgement of the quality of care at this service on a combination of:

what we found when we inspected
information from our ongoing monitoring of data about services and
information from the provider, patients, the public and other organisations.

We found that:

Most risks were well-managed. We identified one area where the practice had not met the regulatory requirements – in obtaining satisfactory evidence of the conduct of prospective staff in previous employment in health or social care. We are satisfied that tighter processes are now in place, and will be used for future recruitment.
Patients generally received effective care and treatment that met their needs. The practice were aware that there were backlogs in routine monitoring following a period without sufficient staff, and these were now being addressed.
Staff dealt with patients with kindness and respect and involved them in decisions about their care.
Feedback about access at this practice was mixed, with some patients reporting difficulties in accessing care and treatment, but National GP Patient Survey results overall were not significantly lower than average. The practice had been short of staff, but had recently recruited new clinical and non-clinical staff members. The practice had other plans to improve access, including plans to monitor that actions taken were effective.
The way the practice was led and managed promoted the delivery of high-quality, person-centre care.

We saw an area of outstanding practice:

The practice had taken a range of initiatives, over a number of years, to support particular groups within the practice population and the practice population as a whole. These included initatives to support: patients with ADHD, patients with Chronic Kidney Disease and Diabetes, patients with a learning disability, patients from the LGBTQ+ community, patients who were new mothers, patients who were non binary or gender incongruent, older patients and patients from the Tamil community. These often arose from support given to a particular patient, and were extended – with additional staff time, training and approach to other services - when the provider recognised that there was a wider issue. Learning from the initatives was shared widely with other practices.

We found one breach of regulations. Please refer to the requirement notice section at the end of this report for more detail. The provider must:

Ensure recruitment procedures are established and operated effectively to ensure only fit and proper persons are employed.

In addition, the provider should:

Implement plans to address back-logs in monitoring and continue to improve uptake of cervical screening and childhood immunisations.
Implement plans to improve recording of learning, actions, dissemination and monitoring of actions from complaints and significant events.

Details of our findings and the evidence supporting our ratings are set out in the evidence tables.

Dr Sean O’Kelly BSc MB ChB MSc DCH FRCA

Chief Inspector of Hospitals and Interim Chief Inspector of Primary Medical Services

Letter from the Chief Inspector of General Practice

We carried out an announced comprehensive inspection at James O’Riordan Medical Centre on 27 October 2015. 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. Information about safety was recorded, monitored, appropriately reviewed and addressed.
Most risks to patients were assessed and well managed.
Patients’ needs were assessed and care was planned and delivered following best practice guidance. Most staff had received training appropriate to their roles.
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.
Patients said they found it easy to make an appointment with a named GP and that 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 very supported by management. Staff had received appraisals and attended regular staff meetings.

Policies and procedures were accessible for staff and were updated to reflect changes in practice systems.

The practice sought feedback from staff and patients, and they were in the process of developing the Patient Participation Group (PPG).

However there were areas of practice where the provider needs to make improvements.

Importantly the provider should:

Review practice systems for monitoring and recording staff training.
Proactively make effective use of coding to enhance the ability to monitor patient outcomes.
Ensure that the Patient Participation Group is formally established.

Professor Steve Field CBE FRCP FFPH FRCGP

Chief Inspector of General Practice

James O’Riordan Medical Centre is a long-established GP practice situated in Sutton, close to the borough boundary with west Merton. It is housed in purpose-built premises especially designed for general practice, and has a practice list of some 5,900 patients. The practice does not provide GP services at any other sites.

During our inspection we spoke with GPs, the Practice Manager, the Practice Nurses (one substantive and one locum), and reception and administrative staff. We also spoke with patients and their families.

Patients and their families had confidence in the treatment and care they received and they praised reception staff for being helpful, caring and polite. It was easy for patients to get through to the practice to make an appointment to see a GP, and the practice worked well with other services to ensure patients’ treatment and care was well-coordinated.

The practice had faced some challenges recently with two partners reducing the number of sessions they worked at the practice, the addition of a new partner, and the introduction of the NHS electronic medical information system for patient records. The practice had also had to contend with periods of extended unforeseen leave of absence due to ill health amongst its clinical staff. This impacted on the ability of some patients to see the GP of their choice and had also disrupted some of the practice’s plans, for example to establish the virtual Patient Participation Group to help improve its services. The day-to-day operation of the practice was well managed and patients received services that were safe, effective, caring and responsive, although we found some areas for improvement.

The practice was looking to broaden the scope and range of services it provided and to establish more robust systems for monitoring and improving the quality of its services. The practice had identified one of the GP partners to lead on the development of the practice’s plans for the future and succession planning.

Older people benefited from one of the GPs having a background in geriatric medicine and sharing their expertise with colleagues. GPs visited people at home where this was required.

The practice held disease management clinics for people with some long term conditions, for example diabetes, to keep them as well as possible. It carried out regular blood monitoring checks for patients reliant on certain drugs that have potentially serious side-effects.

A system was in place for GPs to assess how urgently children and babies needed to be seen. It was the practice’s policy to see all babies and children on the same day an appointment was requested for them.

The practice operated extended opening hours to make it easier for working age people to get an appointment to see their GP, and provided a range of services aimed at preventing disease, for example NHS Health Checks.

People in vulnerable circumstances, for example teenage parents-to-be, had access to specialist primary care services. The practice was responsive to people’s needs based on religious grounds.

People experiencing poor mental health were referred to appropriate psychological and psychiatric services. The practice completed physical health checks and offered health promotion advice to patients with a serious mental illness.

While situated in Sutton, the practice had elected to be a member of NHS Merton Clinical Commissioning Group (CCG).

The practice is registered with the Care Quality Commission (CQC) to carry on the following regulated activities:

Treatment of disease, disorder or injury
Diagnostic and screening procedures
Maternity and midwifery services

The practice has not been inspected by CQC before.

James O'Riordan Medical Centre

All Inspections

Site visit 6 October 2022, Clinical review 13 October, Interviews 14 - 21 October 2022

During an inspection looking at part of the service

27 October 2015

During a routine inspection