We carried out an announced comprehensive inspection at AW Surgeries on 14 January 2019 as part of our inspection programme.

At the last inspection in March 2018 we rated the practice as requires improvement for providing responsive services because:

• Patient feedback highlighted problems in gaining access to care and treatment from the practice within an acceptable timescale for their needs, of note; problems when trying to contact the practice by telephone.

At this inspection, we found that the provider had satisfactorily addressed these areas. However, it was too early to tell if the changes made had resulted in improvement.

We based our judgement of the quality of care at this service on a combination of:

• what we found when we inspected
• information from our ongoing monitoring of data about services and
• information from the provider, patients, the public and other organisations.

We rated this practice as good overall except for responsive.

We rated the practice requires improvement for responsive because:

• Although the practice had taken positive action, the patient feedback for telephone access was significantly below local and national averages.

We rated all the population groups as good.

We found that:

• The practice provided care in a way that kept patients safe and protected them from avoidable harm.
• Patients received effective care and treatment that met their needs.
• Staff dealt with patients with kindness and respect and involved them in decisions about their care.
• The practice organised and delivered services to meet patients’ needs. The practice had plans in place to improve access to appointments.
• The way the practice was led and managed promoted the delivery of high-quality, person-centre care. Changes within the practice were managed effectively.

We saw several areas of outstanding practice including:

• The practice provided a ‘wellness centre that supported both registered and non-registered patients. Projects within the centre provided a support structure for patients living with life changing conditions.
• The practice provided a safe haven for vulnerable groups such as refugees and asylum seekers.

Whilst we found no breaches of regulations, the provider should:

• Risk assess the range of medicines held in case of an emergency.
• Continue to monitor the patient feedback on access following the implementation of the new telephone system and the new rota for staff.

Details of our findings and the evidence supporting our ratings are set out in the evidence tables.

Professor Steve Field CBE FRCP FFPH FRCGP
Chief Inspector of General Practice

Letter from the Chief Inspector of General Practice

This practice is rated as Good overall. We previously inspected this practice on 24 March 2016 and rated it Good overall.

The key questions are rated as:

Are services safe? – Good

Are services effective? – Good

Are services caring? – Good

Are services responsive? – Requires Improvement

Are services well-led? - Good

As part of our inspection process, we also look at the quality of care for specific population groups. The population groups are rated as:

Older People – Good

People with long-term conditions – Good

Families, children and young people – Good

Working age people (including those recently retired and students – Good

People whose circumstances may make them vulnerable – Good

People experiencing poor mental health (including people with dementia) - Good

We carried out an announced comprehensive inspection at A W Surgeries on 12 March 2018 as part of our inspection programme.

At this inspection we found:

• The practice had clear systems to manage risk so that safety incidents were less likely to happen. When incidents did happen, the practice learned from them and improved their processes.
• The practice had developed systems to safeguard children and vulnerable adults from the risk of abuse and staff were aware of these. These systems were being adopted by Dudley Clinical Commissioning Group (CCG) to use as a model for other practices to adopt.
• The practice regularly reviewed the effectiveness and appropriateness of the care it provided. It ensured that care and treatment was delivered according to evidence based guidelines.
• Staff worked extensively with other health and social care professionals to deliver effective care and treatment. Separate and dedicated meetings were held for palliative patients, patients experiencing poor mental health and patients identified as at higher risk of hospital admission.
• Staff involved and treated patients with compassion, kindness, dignity and respect.
• Patients found the access a problem, most notably when trying to contact the practice by telephone. Data from the national patient survey showed that 28% of patients described their experience of making an appointment as good.
• The management team were aware of the challenges the practice faced and had implemented plans to address them. For example, they had implemented plans to improve access with the procurement of a new telephone system and upskilling of existing staff.
• The leadership, governance and culture are used to drive and improve the delivery of high-quality person-centred care.
• There was a strong focus on continuous learning and improvement at all levels of the organisation.
• Staff we spoke with were aware of the practice’s vision to deliver a high quality, safe patient centred service. They were aware of their roles in achieving this.

We saw several areas of outstanding practice including:

• A single point of contact had been assigned to support patients and their families nearing end of life. The service offered a direct line for contact and an open door to those in need of support.
• A ‘wellness centre’ had been introduced to provide support for both registered and non-registered patients. Projects within the centre provided a support structure for patients living with life changing conditions.
• The practice had implemented a development plan for the diagnosis and treatment of dementia and committed to extensive training for clinicians and support for the carers of people with dementia.
• Members of the leadership team had been awarded for their work in primary care and support was provided to other practices. The practice used its resources to support primary care development and promote better outcomes for both its own patients and those within the Dudley area.
• A fibromyalgia project had been carried out to proactively support and manage patients with high attendances. Outcome data for the five patients who had completed the project showed a significant decrease in attendances at the surgery.

However there were areas of practice where the provider should make improvements:

• Explore ways to improve the uptake of vaccines for eligible patients.
• Continue to monitor the patient feedback on access following the implementation of the new telephone system.
• Ensure Patient Group Directions are completed.
• Review recruitment checks completed to ensure that they meet all requirements as set out in schedule three of the health and social care act.

Professor Steve Field (CBE FRCP FFPH FRCGP) 

Chief Inspector of General Practice

Letter from the Chief Inspector of General Practice

We carried out an announced comprehensive inspection at AW Surgeries, Albion House Surgery on 24 March 2016. Overall the practice is rated as good.

Our key findings across all the areas we inspected were as follows:

• Risks to patients were assessed and well managed. Patients’ needs were assessed and care was planned and delivered following best practice guidance. The practice had clearly defined and embedded systems, processes and practices in place to keep people safe and safeguarded from abuse.

• The practice was proactive in identifying and managing significant events. All opportunities for learning from internal and external incidents were maximised.

• Patients said they were treated with compassion, dignity and respect and they were involved in their care and decisions about their treatment.

• Patients’ needs were assessed and care was planned and delivered following best practice guidance. Clinical audits were carried out to demonstrate quality improvement and to improve patient care and treatment

• The practice had a regular programme of practice meetings and there was an overarching governance framework which supported the delivery of the practice’s strategy and good quality care. Governance and performance management arrangements were proactively reviewed to reflect best practice.

• Staff we spoke with said they felt valued, supported and that they felt involved in the practices plans. Staff worked with multidisciplinary teams to understand and meet the range and complexity of patients’ needs.

• The practice offered a range of clinical services which included care for long term conditions such as diabetes, a range of health promotion and the GPs also offered minor surgery to registered patients and for patients who were locally referred from their own GP. An in-house dermatologist worked with the practice on a weekly basis to offer general dermatology services.

• The practice offered proactive care to meet the needs of its population. The practice was focusing on a proactive and preventative care method and we saw how staff had conducted a thorough analysis across long term condition registers in order to improve current systems and care for patients with comorbidities.

• The practice proactively sought feedback from staff and patients, which it acted on. The practice had an active patient participation group which influenced practice development.

We saw some areas of outstanding practice:

• The practice had a dedicated children’s hour at 8:30am and 3:30pm for on call GPs to see children who for example, woke up unwell or were collected from school unwell. Staff explained that due to the popularity of this, appointments were increased to six morning appointments and six afternoon appointments for the GP on call to see children during this appointment window. Children under the age of five were also seen as a priority.

• Members of the management team held a number of outside posts; this was used to benefit the practice through shared learning and for leading on projects to benefit patients. For example, the practice were exploring ways of identifying vulnerable patients who may be in need of extra support, this included identifying any ex-military patients through a veterans health initiative. The veteran’s health initiative was developed by one of the practices GPs who had carried out research in to this area through their role as associate dean for the Black Country.

• An in-house dermatologist worked with the practice on a weekly basis to offer general dermatology services. Practice data demonstrated that 1754 appointments were offered to local patients and filled with the dermatologist during 2015, 308 of appointments were attended by patients of the practice. Use of this service avoided patients having to travel to other community clinics and secondary care services.

Professor Steve Field (CBE FRCP FFPH FRCGP) 

Chief Inspector of General Practice