Archived: Richmond Hill Practice Limited

Letter from the Chief Inspector of General Practice

We carried out an announced comprehensive inspection at Richmond Hill Practice on 28 July 2016. Overall the practice is rated as good.

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 not consistently assessed and well managed. Two out of three vaccine fridge temperatures had gone over the recommended vaccine storage temperatures during operation. We did not see any evidence of this being reported as a significant event or action taken to ensure the vaccines were safe for use. The practice acted promptly when we brought this to their attention.
• There were some areas of prescribing for long term conditions which required attention
• 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.
• 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.

We saw two areas of outstanding practice:

• The practice was committed to individualised person centred care and introduced two new roles to improve care:

• The care coordinator role (non-clinical) had originated offering support to carers and grown into support for all vulnerable patients that GPs felt would benefit from one to one support. Patients were offered appointments to talk and a variety of health and social support guidance was given to them. Two health care assistants had also been trained as care navigators who contacted patients who had been discharged from hospital and patients identified as at high risk of admission. They checked whether patients required any medication, or had the necessary help at home, and asked GPs or the triage nurse to follow up if they felt the patient required additional support. There was evidence of this impacting positively on patient outcomes, with emergency readmission data for the practice reducing from 18.6% during the period September 2013 to February 2014, to 15.5% between September 2014 and February 2015.

• The practice engaged effectively with patients to increase awareness of practice services and wider health campaigns. There were over 300 patients on the virtual patient participation group (PPG) and an active face-to-face group of around 14 members who met every two months. The PPG had reviewed the format of the annual patient survey to make this more accessible to patients, and the practice had seen an increase in the numbers of patients completing annual surveys from 188 in 2012/13 to 272 in 2014/15.

The areas where the provider must make improvement are:

• Ensure that procedures for vaccine storage meet current legislation and guidance.
• Ensure the practice meets its responsibility to complete risk assessments including for lone working.
• Implement systems to monitor cleaning and hygiene including curtain replacement and ensuring no hazardous substances are in use.

The areas where the provider should make improvement are:

• Share learning from significant events and complaints with all staff.
• Ensure that fire evacuation procedures are revised to include details of how to support patients with limited mobility and all staff given adequate training in this.
• Update the complaints policy to ensure that all complainants are given details of action they can take if they are not satisfied with responses to complaints to refer to the Parliamentary and Health Services Ombudsman.
• Review calibration testing to ensure all equipment testing is in date.

Professor Steve Field (CBE FRCP FFPH FRCGP) 

Chief Inspector of General Practice