Letter from the Chief Inspector of General Practice

We carried out an announced comprehensive inspection at Richmond Lock Surgery on 19 April 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.
• 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 assessed and well managed.
• 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.

• 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. For example, following a complaint from a patient about having to attend the practice on different occasions for different blood tests, they had taken steps to reconcile the scheduling of blood tests so that patients could attend one appointment for all of the tests they required.
• 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.
• The practice had strong and visible clinical and managerial leadership and governance arrangements.

We saw some areas of outstanding practice:

• The practice had analysed their performance for the management for patients with diabetes and had re-designed its process for monitoring these patients to ensure that it had the capacity to review the care of all these patients. This involved introducing nurse-led care but also making changes to the appointment system to ensure that patients identified by the nurse as needing to be seen by a doctor or dietician could be seen the same day.

The areas where the provider should make improvement are as follows. They should:

• Ensure that they have processes in place to monitor that staff are up to date with mandatory training.
• Ensure that they have processes in place to ensure that locum staff are up to date with training and professional registrations.
• Ensure that they are taking all reasonable action to identify carers.
• Advertise their translation service to patients at the surgery.

Professor Steve Field CBE FRCP FFPH FRCGP 

Chief Inspector of General Practice