We carried out an announced comprehensive inspection at Waterloo Medical Centre on 27 November 2018 as part of our inspection programme. We rated the practice as requires improvement for providing safe services and good overall.

The full comprehensive report on the November 2018 inspection can be found by selecting the ‘all reports’ link for Waterloo Medical Centre on our website at www.cqc.org.uk.

At our inspection in November 2018 we rated the practice as requires improvement for providing safe services because:

• Safeguarding systems were incomplete.
• Systems to record the monitoring information for patients taking blood-thinning medicines needed review.
• Not all staff who acted as chaperones had been risk assessed for the role.
• Actions taken as a result of infection prevention and control (IPC) audits and checks made on the practice defibrillator were not recorded.
• Workflow management systems were not comprehensive.

We also indicated improvements should be made as follows:

• Review processes used to enrol patients in the practice patient participation group (PPG) to establish and engage with a new PPG.
• Document discussions with new staff members in relation to pre-existing health conditions.

On 6 March 2019, we carried out a focused, desk-based inspection of the safe key question. We reviewed evidence submitted by the practice to confirm it had carried out the plan to meet the legal requirements in relation to the breaches in regulations identified in our previous inspection on 27 November 2018. This report covers our findings in relation to those requirements and also additional improvements made since our last inspection.

At this inspection, we found that the provider had satisfactorily addressed all legal requirements and suggestions for improvements.

We have rated this practice as good for providing safe services.

We found that:

• The practice provided care in a way that kept patients safe and protected them from avoidable harm.
• Safeguarding systems had been strengthened and only staff named in the practice chaperoning policy acted as chaperones.
• The system for recording the monitoring of patients taking blood-thinning medicines had been strengthened.
• An action plan had been produced for the IPC audit and all actions had been completed. Documented checks were made on the practice defibrillator.
• The workflow management system had been reviewed.
• A new “work health assessment” process had been introduced for newly-recruited staff.
• The practice had produced a plan to initiate a new PPG which was already underway.

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

Dr Rosie Benneyworth BM BS BMedSci MRCGP

Chief Inspector of Primary Medical Services and Integrated Care

This practice is rated as Good overall. (Previous rating July 2015 – Outstanding overall; Safe Good, Effective Outstanding, Caring Good, Responsive Outstanding, Well-led Outstanding)

The key questions at this inspection are rated as:

Are services safe? – Requires Improvement

Are services effective? – Good

Are services caring? – Good

Are services responsive? – Good

Are services well-led? - Good

We carried out an announced comprehensive inspection at The Waterloo Medical Centre on 27 November 2018. This inspection was carried out under Section 60 of the Health and Social Care Act 2008 as part of our regulatory functions. The inspection was planned to check whether the provider was meeting the legal requirements and regulations associated with the Health and Social Care Act 2008, to look at the overall quality of the service and to provide a rating for the service under the Care Act 2014.

At this inspection we found:

• The practice generally 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 routinely reviewed the effectiveness and appropriateness of the care it provided. It ensured care and treatment was delivered according to evidence- based guidelines.
• Staff involved and treated patients with compassion, kindness, dignity and respect.
• The practice was sensitive to the needs of the patient population and tailored services in response to those needs.
• Patients found the appointment system easy to use and reported they were able to access care when they needed it.
• There was a strong focus on continuous learning and improvement at all levels of the organisation.

We saw areas of outstanding practice:

• The practice was sensitive to the needs of young people. They had appointed a named member of staff as a first point of contact for these patients.
• Clinicians at the practice offered a sexual health clinic for all patients in the local area. This clinic was held at different times in order to maximise attendance and staff offering the service were able to share learning with other clinicians in the practice to increase their skills.

The area where the provider must make improvements is:

• Ensure care and treatment is provided in a safe way to patients

The areas where the provider should make improvements are:

• Review processes used to enrol patients in the practice patient participation group (PPG) to establish and engage with a new PPG.

• Document discussions with new staff members in relation to pre-existing health conditions.

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

Please refer to the detailed report and the evidence tables for further information.

Letter from the Chief Inspector of General Practice

We carried out an announced comprehensive inspection at Waterloo Medical Practice on 14th July 2015. Overall the practice is rated as outstanding

Specifically, we found the practice to be outstanding for providing, effective, responsive and well led services. We have rated the practice as good for providing safe and caring services to patients.

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.
• The practice was actively involved in local and national initiatives to enhance the care offered to patients. They were proactive in trialling new ways of working to ensure they continued to meet the needs of the patients registered with the practice.
• Risks to patients were assessed and well managed.
• Patients’ needs were assessed and care was planned and delivered after considering best practice guidance.
• Staff had received training appropriate to their roles and any further training needs had been identified and planned.
• Patients said they were treated with compassion, dignity and respect and they were involved in their care and decisions about their treatment. Information was provided to help patients understand the care available to them.
• The practice implemented suggestions for improvements and made changes to the way it delivered services as a consequence of feedback from patients
• The practice had a clear vision that had improvement of service quality and safety as its top priority. High standards were promoted and there was good evidence of team working

We saw several areas of outstanding practice including:

• The practice took a proactive role in working collaboratively under a neighbourhood scheme to clinically co-ordinate hospital and community care for patients deemed to be at risk within the practice.
• The practice offered a referral to a family nurse practitioner to all teenage pregnancy mothers to support and coach them through their pregnancy and first year of their child’s life.
• The practice had achieved the Navajo Kite Mark as a Lesbian, Gay, Bisexual and Transgender friendly practice.
• The practice had a comprehensive sexual health programme that they could demonstrate reached all areas of the local population even those not registered with the practice.
• Smoking cessation clinics run by the practice pharmacist demonstrated a higher than Clinical Commissioning Group (CCG) average success rate over a four week period. (Practice 49% success against a CCG average of 36%)
• The GPs offered medical cover for three intermediate care beds in a local nursing home, this assisted patients awaiting intermediate care beds to be moved out of local NHS hospitals and free up beds.
• The practice phone line were open 8am - to 8pm Monday to Fridays except Thursday when they close at 6.30pm. Appointments are offered between 8.am and 8pm every day except Friday when they offered appointments until 6.30pm. They also offered Saturday morning clinics for long term conditions management.

However, there were also areas of practice where the provider needs to make improvements;

The provider should;

• Ensure the practice leaflet on the website is updated to reflect changes in staff.

Professor Steve Field (CBE FRCP FFPH FRCGP) 

Chief Inspector of General Practice