We carried out an announced comprehensive inspection at The Willow Tree Surgery on 19 December 2017. The overall rating for the practice was good. The practice was rated as requires improvement for providing effective services as performance in relation to mental health care, the management of chronic conditions, childhood immunisations, and cervical cancer screening was below local and national averages. The full comprehensive report on the December 2017 inspection can be found by selecting the ‘all reports’ link for The Willow Tree Surgery on our website at www.cqc.org.uk.

After our inspection in December 2017 the practice wrote to us with an action plan outlining how they would make the necessary improvements to comply with the Requirement Notice served.

This inspection was an announced comprehensive inspection carried out on 13 November 2018 to confirm that the practice had carried out their plan to meet the legal requirements in relation to the breaches in regulations that we identified in our previous inspection on 19 December 2017. This report covers our findings in relation to those requirements and additional areas for improvement since our last inspection.

Our judgement of the quality of care at this service is based 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.

This practice is now rated as requires improvement overall.

The key questions at this inspection are rated as:

Are services safe? – Good

Are services effective? – Requires improvement

Are services caring? – Requires improvement

Are services responsive? – Good

Are services well-led? - Good

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.
• Since our last inspection the practice had implemented safety systems to improve the monitoring of uncollected prescriptions and the documenting of significant events.
• The practice routinely reviewed the effectiveness and appropriateness of the care it provided. It ensured that care and treatment was delivered according to evidence-based guidelines.
• Whilst performance in relation to mental health care and the management of some chronic conditions had improved, there had not been sufficient improvement in childhood immunisation uptake rates or exception reporting for many long-term conditions.
• Feedback from patients we spoke with and CQC comment cards stated staff involved and treated patients with compassion, kindness, dignity and respect. However, results from the national GP patient survey were mixed, with patients rating some questions about the way staff treated people as below local and national averages.
• Feedback from patients we spoke with and CQC comment cards showed patients found the appointment system easy to use and reported that they could access care when they needed it. Some patients reported difficulties accessing the GP of their choice.
• There was a focus on continuous learning and improvement at all levels of the organisation.

The areas where the provider must make improvements are:

• Establish effective systems and processes to ensure good governance in accordance with the fundamental standards of care.

The areas where the provider should make improvements are:

• Continue to review and improve uptake rates for cervical cancer screening.
• Take action to restart the patient participation group.

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

Please refer to the evidence tables for further information.

Letter from the Chief Inspector of General Practice

This practice is rated as Good overall.

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

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 The Willow Tree Surgery on 19 December 2017. We carried out this inspection under Section 60 of the Health and Social Care Act 2008 as part of our regulatory functions. The new provider had not been inspected before and that was why we included them.

At this inspection we found:

• The practice had systems to manage risk so that safety incidents were less likely to happen. However, there were weaknesses in monitoring uncollected repeat prescriptions and the practice’s business continuity plan.
• When incidents did happen, the practice learned from them and improved their processes. However, we noted the documenting of significant events lacked detail of the lessons learned and follow-up of the event.
• The practice routinely reviewed the effectiveness and appropriateness of the care it provided. It ensured that care and treatment was delivered according to evidence-based guidelines. However, the coding of exception reporting and the prevalence of long term conditions was not accurate.
• Staff involved and treated patients with compassion, kindness, dignity and respect.
• Patients found the appointment system easy to use and reported that they were able to access care when they needed it.
• There was a focus on continuous learning and improvement at all levels of the organisation. Although we found the practice’s vision and strategy had not been shared with staff.

The areas where the provider must make improvements as they are in breach of regulations are:

• Establish effective systems and processes to ensure good governance in accordance with the fundamental standards of care.

The areas where the provider should make improvements are:

• Review the process for recording significant events.
• Review the system for checking uncollected repeat prescriptions.
• Review the business continuity plan.
• Continue to review patient satisfaction with the availability and punctuality of appointments.
• Share the practice’s vision and strategy with staff.

Professor Steve Field (CBE FRCP FFPH FRCGP) 

Chief Inspector of General Practice