Archived: Richmond House Surgery

Updated 8 September 2016

Richmond House Surgery was established in 1987. Approximately six years ago, the two establishing partners retired and the current three GPs formed the new partnership. Richmond House Surgery provides primary medical services to approximately 4,000 patients living in the Whitchurch area of Shropshire. The practice also provides GP services to the local community hospital, where they have five community care beds, and for a Safe house where there are five residents.

The surgery is currently in a converted residential house. The building is set over two floors with patient services provided on the ground floor. The practice were given notice to vacate the premises approximately four years ago and the GPs have proactively attempted to locate suitable alternative premises without success. Unless a solution is found the practice is due to close at the end of October 2016.

Services to patients are provided under a General Medical Services (GMS) contract with NHS England. The practice has expanded its contractual obligations to provide enhanced services to patients. An enhanced service is above the contractual requirements of the practice and is commissioned to improve the range of services available to patients.

The practice team included three GP partners, one male and two female, two practice nurses, a practice manger, deputy practice manager and administrative staff.

The practice is open between 8.30am and 6pm Mondays to Fridays. Appointments are available between 8.45 and 5.30pm Mondays to Fridays. The arrangements to ensure patients receive medical assistance when the practice is closed during the out of hours period is provided by Shropdoc. Shropdoc have access to all the GP partners mobile contact details to discuss patient needs if required.

Updated 8 September 2016

Letter from the Chief Inspector of General Practice

We carried out an announced comprehensive inspection at Richmond House Surgery on 7 July 2016. 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 report incidents and near misses. All opportunities for learning from internal and external incidents were maximised.

• The practice utilised the National Report and Learning System (NRLS) to report and share important significant events. For example, one significant event concerned a rare and serious complication related to a facial haemangioma, that few clinicians were aware of. The GP recorded this in extensive detail and informed colleagues locally and nationally of this complication. The practice took a proactive approach to ensure that awareness regarding this complication was raised nationally.

• The practice used innovative and proactive methods to improve patient outcomes. Clinical audits had been triggered by new guidance and from learning from significant events.

• Data showed that the practice was performing highly compared to the CCG and national averages.

• Feedback from patients about their care was consistently positive. Patients said they were treated with compassion, dignity and respect.

• Patients said they were able to get an appointment with a GP when they needed one, with urgent appointments available on the same day.

• The practice implemented suggestions for improvements and made changes to the way it delivered services as a consequence of feedback from patients and from the patient participation group.
• The practice had good facilities and was well equipped to treat patients and meet their needs.
• The practice actively reviewed complaints and how they are managed and responded to, and made improvements as a result.
• The practice had a clear vision which had quality and safety as its top priority.
• The practice had strong and visible clinical and managerial leadership and governance arrangements. Staff felt supported by management and staff throughout the practice worked well together as a team.

Professor Steve Field (CBE FRCP FFPH FRCGP) 

Chief Inspector of General Practice

Updated 8 September 2016

The practice is rated as good for the care of people with long-term conditions.

• Nationally reported Quality Outcomes Framework (QOF) data showed the practice had achieved good outcomes in relation to conditions commonly associated with this population group. Performance for diabetes related indicators was 100% compared to the CCG average of 93% and the national average of 89%. Exception rates were in line with CCG and national averages.

• We saw evidence of regular reviews of patients with long term conditions, in line with current guidance. Patients frequently admitted received regular reviews at home, and we saw details of thorough assessment and involvement of other healthcare professionals and social care to improve management.

• All these patients had a named GP and nursing staff had lead roles in chronic disease management and patients at risk of hospital admissions were identified as a priority.

• Care plans were extremely detailed and demonstrated a holistic approach to assessing and delivering care.

Updated 8 September 2016

The practice is rated as good for the care of families, children and young people.

• The practice’s uptake for the cervical screening programme was 100%, which was above the CCG average of 99% and the national average of 82%. The exception rate was 2% which was below the CCG average of 4% and the national average of 6%.

• Practice childhood immunisation rates for the vaccinations given to under two year olds was 100% compared to the CCG and national average of 98% and for five year olds ranged from 95% to 98% which was comparable to the CCG average of 92% to 97%.

• One of the female GPs specialised in women’s health. The practice provided an intrauterine device (IUD) fitting service, and we saw evidence of pre-assessments and reviews and audits relating to this service.

• There were systems in place to identify and follow up children living in disadvantaged circumstances and who were at risk, for example, children and young people who had a high number of A&E attendances. The practice also provided services to a local home for looked after children.

Updated 8 September 2016

The practice is rated as good for the care of older people.

• Nationally reported data showed the practice had good outcomes for conditions commonly found amongst older people. For example the practice had obtained 100% of the QOF points available to them for providing care and treatment for patients with chronic obstructive pulmonary disease. This was above local and national averages.

• The practice was responsive to the needs of older people, including offering home visits. For example, regular reviews at home of patients frequently admitted to hospital with thorough assessment and involvement of other healthcare professionals including social services demonstrating diligent efforts to improve management and reduce unnecessary admission’s.

• The practice served a local community hospital and had five designated beds to support complex elderly rehabilitation patients. The GPs allocated approximately one hour a day for this work. There was no consultant led supervision and a variety of clinical problems were handled by the GPs.

• The practice maintained a palliative care register and end of life care plans which revealed attention to detail and involvement of other members of the multidisciplinary team, and communication with relatives and carers.

• The GPs worked closely with the out of hours provider, the provider had access to all the GP partners mobile contact details to discuss patient needs if required, to ensure continuity of care.

• The PPG held an annular event every September, ‘Keeping Well in Whitchurch’, where approximately 50 voluntary agencies and charities attend to promote health and disease management.

Updated 8 September 2016

The practice is rated as good for the care of working age people (including those recently retired and students).

• The needs of the working age population, those recently retired and students had been identified and the practice had adjusted the services it offered to ensure these were accessible, flexible and offered continuity of care.

• The practice was proactive in offering online services as well as a full range of health promotion and screening that reflects the needs for this age group.

Updated 8 September 2016

The practice is rated as good for the care of people experiencing poor mental health (including people with dementia).

• Nationally reported Quality Outcomes Framework (QOF) data showed the practice had achieved good outcomes for patients suffering poor mental health.

• 86% of patients diagnosed with dementia who had their care reviewed in a face to face meeting in the last 12 months, which was comparable to the CCG average of 85% and the national average of 84%.

• The practice regularly worked with multi-disciplinary teams in the case management of patients experiencing poor mental health, including those with dementia and carried out advance care planning for patients with dementia. The GPs used a neurological screening tool and patients with suspected dementia were referred to the memory clinic.

• The practice had told patients experiencing poor mental health about how to access various support groups and voluntary organisations and staff had a good understanding of how to deal with patients with mental health needs and dementia.

Updated 8 September 2016

The practice is rated as good for the care of people who circumstances may make them vulnerable.

• The practice worked with multidisciplinary care teams in the case management of vulnerable people, with comprehensive personalised care plans. Staff knew how to recognise signs of abuse and staff were aware of these responsibilities regarding sharing information and how to contact relevant agencies.

• One of the GPs was the lead for patients with learning disabilities and the practice maintained a register of patients. We saw that all patients on the register had received an annual review utilising a recognised template that had been modified by the practice to include more detail.

• Care plans were personalised, detailed and comprehensive with personalised goals identified.

• The practice had a carers’ champion and new carers were identified by the new patient registration form and leaflets and posters displayed in the waiting room. The practice’s computer system alerted GPs if a patient was also a carer. The practice had identified91 patients as carers (2% of the practice list). Written information was available to direct carers to the various avenues of support available to them. The practice offered annual and opportunistic health checks for carers. The carers’ champion contacted carers to offer support and provide information for organisations such as People2People, Shropshire Carers support Services, Shropshire Young Carers.

• The practice provided services to a local home for looked after children.