This practice is rated as Good overall. (Previous inspection August 2017 – Requires improvement)

The key questions are rated as:

Are services safe? – Good

Are services effective? – Requires improvement

Are services caring? – Good

Are services responsive? – Good

Are services well-led? - Good

In August 2017 we undertook a comprehensive inspection at The Wellington Practice. As a result of the inspection we issued requirement notices and issued a rating of requires improvement for providing safe, effective and well-led services. We carried out an announced follow up comprehensive inspection at The Wellington Practice on 12 September 2018 as part of our inspection programme and to identify if improvements required at our previous inspection had been made. We found significant improvement to services had been achieved. However, the practice still requires improvements in providing effective services to patients.

At this inspection we found:

• The practice had clear systems to manage risks to patients and staff. When incidents occurred, the practice learned from them and improved their processes.
• The practice did not consistently monitor the effectiveness and appropriateness of the care it provided to ensure treatment was always appropriate. National data indicators showed there was poor performance in some clinical areas. The practice has a challenges in terms complex disease profiles and the transient nature of its population.
• Staff involved and treated patients with compassion, kindness, dignity and respect.
• Patients found the appointment system easy to use and reported that they could access care when they needed it.
• There was an improved focus on learning and improvement since 2017.
• The practice continuously reviewed the needs of its patient population and adapted processes to improve services for its population.

We saw one area of outstanding practice:

The practice had enlisted the expertise of an external GP to help with reviewing and deciding on which action to take following significant events. This was aimed at providing an independent and objective review of events which may enhance the learning culture of the practice. The external GP attended the meetings where events were discussed. We saw this led to improvements in process being identified and implemented.

The areas where the provider must make improvements are:

• Improve the monitoring and processes to drive improvement in patient care.

Additionally, the provider should:

• Review the process for ensuring spirometers are accurate and fit for use.
• Review the location of oxygen cylinders which may be required in an emergency is known to all staff.
• Identify means of identifying carers’ who may require additional support.

Professor Steve Field CBE FRCP FFPH FRCGPChief Inspector of General Practice

Letter from the Chief Inspector of General Practice

We carried out an announced comprehensive inspection at The Wellington Practice on 29 August 2017. Overall the practice is rated as requires improvement.

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

• The practice had undergone a complete restructuring process resulting in a change to practice management and new registration with the CQC on 26 June 2016. Staff spoke of feeling more supported under this new structure.
• Staff understood and fulfilled their responsibilities to raise concerns, and to report incidents and near misses. Reviews and investigations were completed and patients received an apology.
• Risks to patients were usually assessed and managed, some improvements were needed, for example ensuring that chaperones were appropriately checked.
• Although some audits had been carried out, we saw limited evidence that audits were driving improvements to patient outcomes.
• All the patients spoken to said they were treated with compassion, dignity and respect. However, not all felt cared for, supported and listened to.

• Information about services was available but not everybody would be able to understand or access it. 30% of the practice population was from Nepal or similar. Translation services were available but the practice acknowledged a need to do more for this patient group.

• Not all staff had received training in infection control, Mental Capacity Act (2005), equality and diversity or health and safety.

• The practice had a number of policies and procedures to govern activity, which had recently been created. Some of these were in need of a further review and there was no information governance policy.

• Staff felt supported by the management team.

The areas where the provider must make improvements are:

• Ensure care and treatment is provided to patients in a safe way.
• Establish effective systems and processes to ensure good governance in accordance with fundamental standards of care.
• Ensure sufficient numbers of suitably qualitied, competent, skilled and experienced persons are deployed to meet the fundamental standards of care and treatment.
• Ensure recruitment procedures are established and operated effectively to ensure only fit and proper persons are employed.

In addition the provider should:

• Continue to review the needs of patients whose first language is not English.

• Continue to review the results of the GP patient survey and decide appropriate actions.

Professor Steve Field (CBE FRCP FFPH FRCGP) 

Chief Inspector of General Practice