Essex House Surgery

This service is rated as Inadequate overall.

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 comprehensive inspection of Richmond General Practice Alliance at their offices based on
the top floor of Hampton Wick Surgery as part of our inspection programme. This was the first CQC inspection of these
locations under the current CQC inspection methodology, since the service registered with CQC in 2016.

Richmond General Practice Alliance (RGPA) is a federation made up of 25 member practices across Kew, Sheen, Barnes, Richmond, Twickenham, Hampton and Teddington. The federation provides extended access for patients at Hampton Wick Surgery and Essex House. At Sheen Lane Health Centre the federation provides microsuction services. Microsuction is a specialist service for patients who require treatment for their ears.

RGPA provides regulated activities from:
Hampton Wick Surgery
Essex House Surgery
Sheen Lane Health Centre

The GP practices at these locations provide consultation rooms, equipment, patient reception and waiting areas and
reception staff, under a contract with Richmond General Practice Alliance (RGPA). Under CQC regulations, RGPA is
responsible for ensuring the quality of care of extended access delivered by its service at these sites. We visited each of
these sites to check that the premises were safe and that safety risks were being well-managed. We only reviewed the
clinical work of the extended access and microsuction services. We did not inspect the care delivered by the NHS GP
provider at these locations.

RGPA has added the three host sites as individual locations on the CQC register. Care across all three sites is managed by
each host site which then reports to RGPA based at Hampton Wick Surgery. This report therefore covers the care provided
by the whole service – taking into account the evidence from the whole inspection, including the host GP surgeries.

We are mindful of the impact of COVID-19 pandemic on our regulatory function. We will continue to discharge our
regulatory enforcement functions required to keep people safe and to hold providers to account where it is necessary for
us to do so.

One board member of the federation is the registered manager. A registered manager is a person who is registered with
the Care Quality Commission to manage the service. Like registered providers, they are ‘registered persons’. Registered
persons have legal responsibility for meeting the requirements in the Health and Social Care Act 2008 and associated
Regulations about how the service is run.

Our key findings were:

• The way the service was led and managed did not promote the delivery of high-quality care. Governance policies had been established without considering the way that care was delivered, and where policies specified processes these had not been implemented.
• The service did not have good systems to manage risks to patient and staff safety.
• There was insufficient oversight and assurance of this service which meant that care was not consistently safe and
  effective.
• The service did not have effective systems to ensure that all staff involved in delivering the service were suitable and
  appropriately qualified for their roles or to ensure that all staff received an appropriate induction and ongoing training.
• Staff dealt with patients with kindness and respect and involved them in decisions about their care.
• The service organised and delivered services to allow patients to access care and treatment in a timely way.
• The service did not have good systems to ensure that all patients received effective care and treatment.

We found two breaches of regulations. The provider must:

• Ensure care and treatment is provided in a safe way to patients.
• Establish effective systems and processes to ensure good governance in accordance with the fundamental standards of care.We found two breaches of regulations.

After the inspection, RGPA sent us a plan to improve oversight of risks associated with the premises from which care is delivered, to improve management of recruitment and training, and for clinical audits. We will follow up to ensure that the provider improves the service. This report is based on the evidence found during the inspection and that was sent to us immediately afterwards.

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 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.

Dr Rosie Benneyworth BM BS BMedSci MRCGP
Chief Inspector of Primary Medical Services and Integrated Care