Letter from the Chief Inspector of General Practice

This practice is rated as Requires Improvement overall (and for providing safe and well-led services). The practice is rated as Good for providing effective, caring and responsive services. This was the first inspection of the practice under the current provider.

The key questions are rated as:

Are services safe? – Requires Improvement

Are services effective? – Good

Are services caring? – Good

Are services responsive? – Good

Are services well-led? – Requires Improvement

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 – Requires Improvement

People with long-term conditions – Requires Improvement

Families, children and young people – Requires Improvement

Working age people (including those retired and students – Requires Improvement

People whose circumstances may make them vulnerable – Requires Improvement

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

We carried out an announced comprehensive inspection at Westgate Surgery on 7 December 2017. This inspection was carried out as part of our inspection programme and was the first inspection under the new provider.

At this inspection we found:

• All the practice’s policies and procedures were embedded and easily accessible to all staff.
• The practice reviewed the effectiveness and appropriateness of the care it provided. It ensured that care and treatment was delivered according to evidence based guidelines.
• There was a clear system in place for acting upon and cascading drug safety alerts.
• Staff involved patients in their care, and treated them with compassion, kindness, dignity and respect.
• Patient feedback indicated lack of satisfaction with the telephone service following the transfer of all calls to a centralised administrative call-handling team. However; the provider had taken steps to address and improve this.

The areas where the provider should make improvements are:

• Continue to identify and record significant events and incidents and improve the documentation of relevant learning within the system to support this.

• Continue to monitor and review the standard operating procedures implemented to support the central administration call-handling team.

• Continue to engage with staff through one to one meetings, appraisals and induction to provide support and leadership.

• Review and improve the system for acting upon complaints in the event of management absence.

• Review, improve and widen the scope of audits and quality improvement activities.

Professor Steve Field (CBE FRCP FFPH FRCGP) 

Chief Inspector of General Practice

This practice is rated as Good overall. (A previous inspection undertaken on 7 December 2017 had rated the practice as requires improvement overall.)

The key questions at this inspection are rated as:

Are services safe? – Good

Are services effective? – Good

Are services caring? – Good

Are services responsive? – Good

Are services well-led? – Good

As part of our inspection programme, we carried out an announced comprehensive inspection at Westgate Surgery on 28 June 2018.

At this inspection we found:

• The practice had addressed all issues and areas of concern, which had been identified at the previous inspection.
• There was effective management and clinical leadership at a local level, which was supported at an organisational level.
• There were improvements in the identification, reporting and recording of incidents. We saw evidence of shared learning from events, both at a local level and across the organisation as a whole; this also included a “lessons learned” bulletin which was shared with staff.
• There was a clear process for dealing with complaints. On a daily basis, patients had access to a manager in the practice should they need to make a complaint.
• There were comprehensive processes in place relating to the central administration call handling team. Regular meetings were held with the team to enable any issues to be addressed in a timely manner.
• There was a clear and detailed programme of audit in place, which evidenced quality improvement relating to service delivery and patient care. These were shared at a local and organisational level.
• There was regular staff engagement through the use of appraisals, daily ‘huddles’, staff meetings and the “what matters to you” questionnaire.
• There was evidence of good patient engagement through the use of the patient participation group, practice patient survey and the NHS Friends and Family Test.
• There was evidence of a cohesive team with a strong focus on continuous learning and improvement at all levels of the organisation. Staff informed us of the improvements and positive changes that had occurred since the previous inspection.
• The practice was engaged with innovative schemes to support quality patient care and service delivery.

We saw an area of outstanding practice:

• The practice had significantly increased their patient and local community engagement to support patient care. They had facilitated an ‘open afternoon’ to listen to and understand patients’ concerns; set up a regular carers’ café and a bereavement café; attended a local event to perform health checks and provide training in basic life support. The practice offered weekly exercise classes and were currently in the process of developing an area behind the premises into a community garden.

Professor Steve Field CBE FRCP FFPH FRCGPChief Inspector of General Practice

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