Background to this inspection
Updated
17 October 2018
Dr Antoine Sayer provides primary medical services from Richmond Green Surgery in Richmond to approximately 1600 patients and is one of 29 practices in Richmond Clinical Commissioning Group (CCG).
The practice population is in the second least deprived decile in England. The proportion of children registered at the practice who live in income deprived households is 7%, which is lower than the CCG average of 9%, and for older people the practice value is 11%, which is the same as the CCG average. The practice has a larger proportion of patients aged 25-54 years than the CCG average, and a smaller proportion of patients aged 0-25 years.
The practice operates from an old converted building and comprises a reception, waiting area, doctors consulting room, examination room and healthcare assistant’s room on the ground floor; on the first floor is a further consultation room (used by the nurse when they have one in place) and practice manager’s room; and on the second floor is a meeting room and a storage room.
The practice team at the surgery is made up of one full time male GP, one long-term locum GP, and one temporary part time male healthcare assistant and a female phlebotomist. The practice team also consists of a practice manager and reception/administrative staff.
The practice operates under a General Medical Services (GMS) contract, and is signed up to a number of local and national enhanced services (enhanced services require an enhanced level of service provision above what is normally required under the core GP contract).
The practice is open between 8am and 1pm and between 2pm and 6:30pm on all weekdays. Extended hours appointments are available from 6:30pm to 7:15pm on Mondays. Patients can also access appointments via the CCG seven-day opening Hub, which offers appointments from 8am until 8pm every day.
When the practice is closed patients are directed to contact the local out of hours service.
The practice is registered as a sole provider with the Care Quality Commission to provide the regulated activities of diagnostic and screening services; maternity and midwifery services; and treatment of disease, disorder or injury.
Updated
17 October 2018
This practice is rated as Inadequate overall. (Previous inspection November 2017 – Requires Improvement).
The key questions are rated as:
Are services safe? – Inadequate
Are services effective? – Requires Improvement
Are services caring? – Good
Are services responsive? – Good
Are services well-led? – Inadequate
We carried out an announced focused inspection at Dr Antoine Sayer (also known as Richmond Green Medical Centre) on 3 July 2018. This inspection was carried-out to follow up on breaches of regulations identified at the previous inspection in November 2017. During day one we identified areas where further evidence was required to ensure that the care being delivered was safe and effective, and the decision was made that the scope should be extended to become a comprehensive inspection. We therefore returned to the practice on 12 July 2018 to collect the further evidence and to inspect areas not originally included as lines of enquiry.
At this inspection we found:
- The practice had some systems to manage risk so that safety incidents were less likely to happen; however, when safety risks were identified, these were not always well addressed. When incidents did happen, the practice learned from them and improved their processes.
- The practice had equipment and arrangements in place to deal with medical emergencies; however, they did not have medicines available to treat a patient having a seizure. The practice had provided their reception staff with guidance about when patients should be prioritised for medical attention; however, they had not provided training on how to identify the symptoms of sepsis.
- Staff at all levels were aware of their responsibilities in respect of safeguarding; however, one member of the clinical team had not completed safeguarding training within the guideline timescale.
- The practice carried-out some reviews of the effectiveness and appropriateness of the care it provided; however, there were some areas, such as antibiotic prescribing, where the practice’s review was insufficient to provide assurance that the care being provided was safe and appropriate.
- Staff involved and treated patients with compassion, kindness, dignity and respect.
- Patients found the appointment system easy to use and reported that they were able to access care when they needed it.
- Structures, processes and systems to support good governance and management were not always clearly set out, understood and effective. For example, the practice did not have clear processes for the handling of incoming patient information (e.g. test result and hospital letters); each clinician had their own process, and the provider had failed to ensure that these processes were safe and effective.
The areas where the provider must make improvements as they are in breach of regulations are:
- Systems or processes must be established and operated effectively to ensure good governance.
- Provide care and treatment in a safe way for service users
The areas where the provider should make improvements are:
- Review arrangements in place to enable staff to respond to medical emergencies, in particular, the emergency medicines available, and the ability of reception staff to identify patients with sepsis.
- Review arrangements for monitoring when staff are due for mandatory training updates.
I am placing this service in special measures. Services placed in special measures will be inspected again within six months. If insufficient improvements have been made such that there remains a rating of inadequate for any population group, 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 six 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 six 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.
Professor Steve Field CBE FRCP FFPH FRCGP
Chief Inspector of General Practice