The Care Quality Commission
  • Doctor
  • GP practice

Richmond Medical Centre

Overall: Requires improvement read more about inspection ratings

Moor Lane, North Hykeham, Lincoln, Lincolnshire, LN6 9AY (01522) 500240

Provided and run by:
Richmond Medical Centre

Important: We are carrying out a review of quality at Richmond Medical Centre. We will publish a report when our review is complete. Find out more about our inspection reports.

All Inspections

06 December 2023

During a routine inspection

We carried out an announced inspection at Richmond Medical Centre on 25 May 2023, the practice was rated inadequate overall and for providing safe and well led services, requires improvement for providing effective and responsive services and good for providing caring services. The practice was placed into Special Measures and Warning Notices were issued in respect of breaches of Regulations 12 and 17 of the Health and Social Care Act 2008 (Regulated Activities) Regulations 2014.

We carried out an announced follow up inspection on 6 December 2023 to review actions taken regarding compliance with the Warning Notices and instigation of Special Measures following the inspection in May 2023. Whilst progress had been made in relation to the Warning Notices, insufficient improvements had been made to comply with all aspects. Therefore the Warning Notices remain in place. There remains a rating of inadequate for the safe key question and the provider remains in Special Measures. The service will be kept under review and where necessary, another inspection will be conducted in line with our priorities. If needed this could lead to further enforcement action.

Overall, the practice is now rated as requires improvement.

Safe - inadequate.

Effective - requires improvement.

Caring - not inspected, rating of good carried forward from previous inspection.

Responsive – requires improvement.

Well-led - requires improvement.

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

Why we carried out this inspection

We carried out this inspection to follow up findings from our previous inspection in line with our inspection priorities.

Focus of inspection to include:

  • Safe
  • Responsive
  • Effective
  • Well Led

How we carried out the inspection/review

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.
  • Requesting feedback from patients.
  • Completing interviews with key stakeholders.

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.
  • information from the provider, patients, the public and other organisations.

We found that:

  • Safeguarding systems and processes had been improved; further development was required to assure the providers patients were safe from abuse.
  • Systems and processes in place to manage environmental risks were not always effective and monitoring of risks was not always undertaken by appropriately trained staff who fully understood the requirements to ensure safety in relation to Legionella risk.
  • The system for processing information relating to new patients including the summarising of new patient notes had not been effective.
  • Management of medicines and patients who are prescribed medicines who required monitoring had improved: further development and consistent embedding of the processes was required.
  • Dissemination and recording of information to staff had improved but further development was required to ensure consistent information was relayed to all staff.
  • Management of safety alerts had improved; further development was required in relation to historic alerts to ensure all patients receive safe care.
  • Patient access to the services provided had improved and patients could access care and treatment in a timely way.
  • Information was not readily available to patients without digital access in the practice.
  • Leadership had improved within the practice. However, further development and assessment of effectiveness was required to ensure compassionate, inclusive and effective leadership was in place.
  • Improvements had been made to the governance processes in place. Further development, understanding and embedding of these processes was required to manage risks, communication and ensure appropriate, effective leadership.

We found 2 ongoing breaches of regulations. The provider must:

  • Ensure care and treatment is provided in a safe way to patients.
  • Establish effective systems and processes to ensure good governance in accordance with the fundamental standards of care.

The provider should:

  • Update the Safeguarding Policies and register to include up to date information and confirm this is correct.
  • Improve access to information for patients who are digitally excluded.
  • Update the management of FP 10 prescriptions transferred to the branch site.

I am leaving this service in special measures. This recognises that further improvements need to be made to the quality of care provided by this service.

Not all of the actions had been completed or embedded to meet the Warning Notices and as a result these remain in place.

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 Health Care

25 May 2023

During a routine inspection

We carried out an announced comprehensive at Richmond Medical Centre on 25th May 2023. Overall, the practice is rated as inadequate.

Safe - Inadequate

Effective -Requires improvement.

Caring - Good

Responsive -Requires improvement.

Well-led - Inadequate

Following our previous inspection on January 2016, the practice was rated good overall and for Effective, caring, responsive and well-led services. It was rated as requires improvement in safe which was subsequently rated as good in a focused inspection in February 2017.

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

Why we carried out this inspection.

We carried out this inspection in response to concerns shared with the CQC. It was a comprehensive inspection which looked at:

All 5 key questions safe, effective, caring, responsive and well-led.

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 and in person.
  • 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.
  • Interviews with a representative from the Patient Participation Group

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 rated the practice as inadequate for providing a safe service because:

  • Assurances staff employed within the practice had been recruited in accordance with regulations had not been met.
  • Systems for assessing the immunisation status of clinical and non-clinical staff were not in place.
  • Findings from the practice’s infection control and prevention audits and risk assessments had not been acted on in a timely manner.
  • A system of clinical supervision or peer review was not in place for non-clinical prescribers.
  • There were significant gaps in training which the Practice deemed mandatory such as safeguarding and infection control.
  • Several of the policies we reviewed were out of date.
  • There were some outstanding blood results which had not been actioned for three days.
  • Some patients on long term medication had not had annual blood tests to ensure it was safe to continue prescribing their medicines.
  • Monitoring and recording of the fridge temperatures was not carried out daily.
  • There were out of date vaccinations and immunizations stored within the fridge.
  • The emergency trolley did not have all required medicines in case of an emergency.

We rated the practice as requires improvement for providing an effective service because:

  • There were 127 patients with a potential undiagnosed long term condition following blood results.
  • Most clinical staff had not had an appraisal in the previous 12 months.
  • Out of five clinical records viewed three patients had not being consulted or consented having a Do Not Attempt Cardiac Pulmonary Resuscitation request (DNACPR) put in place, although their records indicated they did not want to be resuscitated in the event of their death.
  • Formal clinical supervision was not in place to support staff working in advanced roles.

We rated the practice as good for providing a caring service because:

  • Staff treated patients with kindness, respect and compassion and helped patients to be involved in decisions about care and treatment.

We rated the practice as requires improvement for providing a responsive service because :

  • Patients were unable to access care in a timely manner especially via the phone.
  • However the practice responded to complaints and made changes to the service as a result.

We rated the practice as inadequate for providing a well-led service because:

  • Staff told us they did not feel part of the overall practice but were managing within their teams without leadership. Staff told us the GP partners were not visible within the practice and there was a disconnect between the management and GP Partners
  • Governance arrangements and policies were not always up to date, lacked clarity or not complied with.
  • There was no available time for leadership within teams to support and develop staff, or non-clinical time to complete administrative tasks within the practice.
  • There was a lack of systems in place to provide appropriate onsite supervision of non-medical prescribers, locum GPs and nurses, increasing risk to patients.
  • There was a vision for the practice and staff we spoke to were aware of this, however there was no strategy to achieve it or monitor its delivery.
  • Practice risk registers and action plans had been put in place however, they did not reflect all the risks we identified as part of our inspection.

We found two breaches of regulations. The provider must:

  • Ensure care and treatment is provided in a safe way to patients.
  • Establish effective systems and processes to ensure good governance in accordance with the fundamental standards of care.

The provider should:

  • Improve their cervical screening uptake which was below the national target of 80%
  • Continue to improve their system for patients to be able to access the practice by phone.

I am placing this service in special measures. Services placed in special measures will be inspected again within 6 months. If insufficient improvements have been made such that there remains a rating of inadequate for any key question or overall, we will take action in line with our enforcement procedures to begin the process of preventing the provider from operating the service. This will lead to cancelling their registration or to varying the terms of their registration within 6 months if they do not improve.

The service will be kept under review and if needed could be escalated to urgent enforcement action. Where necessary, another inspection will be conducted within a further 6 months, and if there is not enough improvement, we will move to close the service by adopting our proposal to remove this location or cancel the provider’s registration.

Special measures will give people who use the service the reassurance that the care they get should improve.

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 Health Care

21 February 2017

During a routine inspection

Letter from the Chief Inspector of General Practice

We carried out an announced comprehensive inspection at Richmond Medical Centre on 05 January 2016. The overall rating for the practice was good and the rating for the safe domain was requires improvement. The full comprehensive report on January 2016 inspection can be found by selecting the ‘all reports’ link for Richmond Medical Centre on our website at www.cqc.org.uk.

This inspection was a desk-based review carried out on 21 February 2017 to confirm that the practice had carried out their plan to meet the legal requirements in relation to the breaches in regulations that we identified in our previous inspection on 05 January 2016. This report covers our findings in relation to those requirements and also additional improvements made since our last inspection.

Overall the practice is now rated as good.

Our key findings were as follows:

  • An external contractor was employed to clean and sanitise all carpets within the practice following our initial inspection in January 2016.

  • Internal cleaning policies specific to the cleaning of carpets were updated.

  • A formal system had been implemented to provide clinical supervision and mentorship to independent nurse prescribers.

  • Significant events detailed what had been learnt as a result of the incident as well as the action taken. We saw minutes of meetings with the partners which discussed the significant events and the actions taken.

  • Meeting minutes were recorded for all primary health care team meetings which demonstrated the attendance of relevant health and social care professionals, including community nursing team, health visitors and MacMillan nurses.

Professor Steve Field (CBE FRCP FFPH FRCGP) 

Chief Inspector of General Practice

5 January 2016

During a routine inspection

Letter from the Chief Inspector of General Practice

We carried out an announced comprehensive inspection at Richmond Medical Centre on 5 January 2016. Overall the practice is rated as good.

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

  • Data from the Quality and Outcomes Framework showed patient outcomes were above average for the locality and the national average.

  • There was robust safeguarding systems in place for both children and adults at risk of harm or abuse.

  • All staff had received Gillick Competence / Fraser Guidelines training.

  • All members of staff including GPs had received Dementia Friends training.

  • The practice had systems in place to keep all clinical staff up to date. Staff had access to guidelines from NICE and used this information to deliver care and treatment that met peoples’ needs. All GPs, nurses and health care assistants had signed up to the NICE website and received email alerts of NICE updates.

  • Flu vaccination rates for the over 65s were 80.75%, and at risk groups 52.16%. These were above national averages.

  • The practice had up to date fire risk assessments and carried out regular fire drills. A fire action plan was on display informing patients and staff what to do in the event of a fire. The practice had a fire warden. We saw evidence that weekly tests of the fire alarm panel were carried out.
  • Staff assessed patients’ needs and delivered care in line with current evidence based guidance. Staff had 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.
  • Patients said they found it easy to make an appointment with a named GP and that there was continuity of care.
  • 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.
  • Not all risks to patients were assessed and well managed. The practice did not have a carpet cleaning schedule in place. Not all areas of the practice were cleaned in line with the practice cleaning schedule and guidelines.
  • The provider was aware of and complied with the requirements of the Duty of Candour.

The areas where the provider must make improvement are:

  • Ensure appropriate systems and processes are in place relating to infection control in line with national guidance, ensuring consulting and treatment rooms are cleaned as per practice cleaning schedule and guidelines and implementation of carpet cleaning schedules.

  • Ensure a system of clinical supervision/mentorship is in place for nurse independent prescribers.

The areas where the provider should make improvement are:

  • Ensure actions agreed to ensure lessons learned following discussion of a significant event are documented with timely review dates.

  • Ensure records are kept of all completed significant event report forms received.

  • Ensure multi-disciplinary meetings are recorded.

Professor Steve Field (CBE FRCP FFPH FRCGP) 

Chief Inspector of General Practice

8 May 2014

During a routine inspection

The Richmond Medical Centre provides general practitioner services to a population of approximately 8,750 patients in West Lincolnshire. The practice provides for patients living in North Hykeham, South Hykeham and in the surrounding villages of Whisby, Thorpe on the Hill and Eagle.

The practice manager had a reflective approach to their work which involved regular critical analysis of the performance of the practice. The provider listened to patient comments and had used feedback to improve their service. The practice had effective systems in place to help protect people from avoidable harm and abuse. There were effective systems for the oversight of the practice including medicine management. The building was visibly clean.

Clinical decisions followed best practice. The services were safe and effective. The staff had access to research based practice materials such as the National Institute for Health and Care Excellence (NICE) guidance. The practice worked collaboratively with other agencies and health care teams including specialist consultants, district nursing services, mental; health teams and local care homes.

The feedback we received from all patients was mainly positive. The clinical team gave examples of how they considered patients views about the way the practice was run and with regard to their individual health needs and treatments.

Patients told us their urgent needs were met in a timely way by the practice but a majority also said that the appointment booking system could present delays and be frustrating. A range of appointments were available, including routine and urgent appointments and telephone consultations. People could book appointments either in person, over the phone or on-line.

There was an open culture at the practice and a clear complaints process and effective patient feedback system in place. There were effective systems in place to monitor the quality of the services provided. Governance and risk management measures were in place and staff took action to learn from any incidents that occurred within the practice.