Red Lion Road Surgery

Updated 13 June 2017

Red Lion Road Surgery and its branch, Alexandra Drive Surgery, provide primary medical services in Tolworth and Surbiton to approximately 3000 patients and is one of 27 practices in Kingston 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 13%, which is comparable to the CCG average of 12%, and for older people the practice value is 13%, which is the same as the CCG average. The practice has a larger proportion of patients aged 25 to 45 years than the CCG average, and a smaller proportion of patients aged 45 to 84 years. Of patients registered with the practice, the largest group by ethnicity are white (73%), followed by asian (19%), mixed (3%), black (3%) and other non-white ethnic groups (2%).

The Red Lion Road Surgery operates from a two-storey converted residential premises. Car parking is available in the surrounding streets. The reception desk, main waiting area, patient toilet and consultation rooms are situated on the ground floor. The first floor has a “patient privacy room”, computer server room, administrative room and staff kitchen. The practice has access to two doctors’ consultation rooms and one nurse consultation room.

The branch surgery, Alexandra Drive, is located approximately a mile away from the main surgery. It is housed in a purpose-built single storey premises which includes a reception area, patient waiting area, one doctor’s consultation room and one nurse’s consultation room.

The practice team is made up of one full time female GP and full time male GP who are partners, one part time male long-term locum GP and one part time female long-term locum GP; in total 13 GP sessions are available per week. In addition, the practice also has a part time female nurse. The practice team also consists of a practice manager and five reception/administrative staff.

The practice operates under a Personal Medical Services (PMS) 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 Red Lion Road Surgery is open between 8:30am and 12:30pm and between 3:00pm and 6.30pm Monday to Friday and consultations are held between 8:30am and 11:30am on Monday and Thursday mornings, between 9:00am and 11:30am on Tuesday mornings and between 8:30am and 10:30am on Friday mornings; and then from 4:30pm to 6:30pm every weekday afternoon apart from Thursday when the practice is closed.

The Alexandra Drive Surgery is open between 8:30am and 11:00am and between 4:30pm and 6.30pm on Mondays, Wednesdays and Fridays, on Tuesdays the surgery closes at 6:00pm and on Thursday afternoons the surgery is closed. Consultations are held between 9:00am and 10:30am on Mondays and between 9:00am and 11:00am on every other week day; and then from 4:30pm to 6:30pm every weekday afternoon apart from Tuesdays when the afternoon surgery is from 4:00pm to 5:00pm and Thursdays when the practice is closed.

Extended hours appointments are provided at the Red Lion Road Surgery from 6:30pm to 7:30pm on Tuesdays and from 6:30pm to 7:00pm on Fridays.

When the practice is closed during the middle of the day, a recorded message provides patients with a telephone number to call in an emergency, which is answered by one of the GPs. When the practice is closed, patients are directed to contact the local out of hours service.

The practice is registered as a partnership with the Care Quality Commission to provide the regulated activities of diagnostic and screening services; maternity and midwifery services; treatment of disease, disorder or injury; surgical procedures; and family planning.

Updated 13 June 2017

Letter from the Chief Inspector of General Practice

We carried out an announced comprehensive inspection of Red Lion Road Surgery on 11 May 2016. The practice was rated as requires improvement overall. A breach of legal requirements was found relating to the Safe, Caring, Responsive and Well-led domains. After the comprehensive inspection, the practice submitted an action plan, outlining what they would do to meet the legal requirements in relation to the breach of regulations 12 (Safe care and treatment), 17 (Good governance) and 16 (Receiving and acting on complaints) of the Health and Social Care Act 2008 (Regulated Activities) Regulations 2014.

During the comprehensive inspection we found that the practice had failed to ensure that all significant events were fully recorded and that lessons were learned from incidents, they had failed to monitor patients in line with prescribing guidelines, they had failed to put processes in place to ensure that results were received for all clinical samples sent for analysis, they had failed to ensure that they had sufficient medicines available to be able to effectively respond to a medical emergency, they had failed to analyse and address concerns raised via the NHS GP Patient Survey, and they had failed to operate effectively an accessible system of identifying, receiving and recording complaints. We also identified areas where improvements should be made, which included reviewing how they identified patients with caring responsibilities, ensuring staff had clear guidance on the allocation of emergency appointments, ensuring that a locum pack was available, reviewing access to toilet facilities to patients, and ensuring that all staff were aware of how to use the electronic record system effectively.

We undertook this announced focussed inspection on 28 March 2017 to check that the practice had followed their plan and to confirm that they now met the legal requirements. This report covers our findings in relation to those requirements. You can read the report from our last comprehensive inspection by selecting the ‘all reports’ link for Red Lion Road Surgery on our website at www.cqc.org.uk.

Following the focussed inspection, we found the practice to be good for providing safe, caring, responsive and well-led services.

Our key findings were as follows:

• The practice had an effective system in place for reporting and recording significant events. Learning from significant events was shared with staff in order to make improvements to safety.
• Since the initial inspection, the practice had conducted a comprehensive search of their patient records system to identify patients with caring responsibilities. They had identified 124 patients, which represented 4% of the practice list, and we saw that these patients were flagged on the system so that staff could easily recognise them.
• The practice had an effective system for recording verbal complaints. We saw evidence that all staff were engaged in this process and that complaints were discussed in practice meetings in order that learning could be shared.
• The practice had sufficient stocks of all medicines necessary to respond to a medical emergency on the premises.
• The practice had introduced a new process for tracking uncollected prescriptions, which was administered by a nominated member of reception staff, who checked for uncollected prescriptions weekly and took appropriate action on each prescription, as directed by a GP. A record was kept which showed the action taken in respect of each uncollected prescription.
• The practice had processes in place to ensure that all relevant staff received medicines updates and safety alerts.
• The practice had systems in place to ensure that patients were only prescribed medicines once the appropriate monitoring had been completed, in line with current guidance on the prescribing of medicines.
• The practice had auditable systems in place to ensure that results were received for all clinical samples sent for analysis.
• The practice had introduced written guidance for reception staff on the criteria for offering patients emergency appointments; however, there was a lack of consistent understanding amongst staff about the way that this guidance should be applied, and the practice had not actively sought feedback from staff about the effectiveness of this guidance.
• A locum pack was available to ensure that temporary GPs had easy access to information they needed.
• The practice had considered the access to toilet facilities for patients but had decided that the arrangements in place were appropriate.
• We observed that all staff were competent at using the electronic patient record system and that an ongoing programme of training was undertaken by the practice manager in order to keep up with changes to the system.
• The practice had carried-out its own patient survey using the same questions as the National GP Patient Survey in order to gather patients’ views on their service following changes they had made in response to the national survey. This survey showed a significantly higher rate of patient satisfaction compared to the national survey.

The areas where the practice should make improvements are:

• Continue to analyse the results of the national NHS GP Patient Survey when they are published, and consider ways to address areas of low satisfaction.
• Ensure that all staff are clear about the process for allocating emergency appointments, and consider seeking feedback from staff about the effectiveness of the new guidance.

Professor Steve Field CBE FRCP FFPH FRCGP 

Chief Inspector of General Practice

Updated 13 June 2017

The provider had resolved the concerns relating to the issues identified in the safe, caring, responsive and well-led domains identified at our inspection on 11 May 2016 which applied to everyone using this practice, including this population group. The population group ratings have been updated to reflect this.

Updated 13 June 2017

The provider had resolved the concerns relating to the issues identified in the safe, caring, responsive and well-led domains identified at our inspection on 11 May 2016 which applied to everyone using this practice, including this population group. The population group ratings have been updated to reflect this.

Updated 13 June 2017

The provider had resolved the concerns relating to the issues identified in the safe, caring, responsive and well-led domains identified at our inspection on 11 May 2016 which applied to everyone using this practice, including this population group. The population group ratings have been updated to reflect this.

Updated 13 June 2017

The provider had resolved the concerns relating to the issues identified in the safe, caring, responsive and well-led domains identified at our inspection on 11 May 2016 which applied to everyone using this practice, including this population group. The population group ratings have been updated to reflect this.

Updated 13 June 2017

The provider had resolved the concerns relating to the issues identified in the safe, caring, responsive and well-led domains identified at our inspection on 11 May 2016 which applied to everyone using this practice, including this population group. The population group ratings have been updated to reflect this.

Updated 13 June 2017

The provider had resolved the concerns relating to the issues identified in the safe, caring, responsive and well-led domains identified at our inspection on 11 May 2016 which applied to everyone using this practice, including this population group. The population group ratings have been updated to reflect this.