Letter from the Chief Inspector of General Practice

We carried out an announced comprehensive inspection at Westgate Surgery on 26 July 2016. The overall rating for the practice was good but the practice was rated as requires improvement for providing safe services. The full comprehensive report on the July 2016 inspection can be found by selecting the ‘all reports’ link for Westgate Surgery on our website at www.cqc.org.uk.

This inspection was a desk-based review carried out on 7 February 2017 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. This report covers our findings in relation to those requirements and also additional improvements made since our last inspection.

Overall the practice is now rated as good.

Our key findings were as follows:

• Systems and processes had been implemented to ensure that the storage of vaccines was managed in line with national guidance.
• Blank prescription forms were securely stored and there were systems in place to monitor their use.
• A system had been implemented to help ensure that staff record that they have undertaken the routine cleaning of medical equipment.
• The practice had increased the number of patients identified as carers from 66 to 97, which is 1% of the practice list.
• A system had been implemented for monitoring staff training to help ensure that all members of staff were up to date with training.

Professor Steve Field (CBE FRCP FFPH FRCGP) 

Chief Inspector of General Practice

We carried out an announced comprehensive inspection at Westgate Surgery on 26 July 2016. Overall the practice is rated as good.

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

• There was an open and transparent approach to safety and an effective system for reporting and recording significant events.
• The practice had a range of systems and processes to manage and assess risks to patients. However, in some areas, for example, medicines management and infection prevention control, systems and processes were not sufficiently effective to help ensure patient safety.
• Blank prescription pads were securely stored. However, blank prescription forms were not always stored securely and the practice was unable to demonstrate that they had a system track the prescription forms through the practice.
• Vaccines were not managed in line with national guidance.
• There was wide a range of clinical audits that reflected the needs of the practice’s patient population. Findings were used to improve patient outcomes and the quality of services delivered.
• Data showed patient outcomes were at or above average compared to the national average.
• Staff assessed patients’ needs and delivered care in line with current evidence based guidance. Staff we spoke with demonstrated they had the skills, knowledge and experience to deliver effective care and treatment. However, we reviewed six staff personnel files and found there were some gaps in training for both clinical and non-clinical staff. For example, infection prevention control.
• Patients said they were treated with compassion, dignity and respect and they were involved in their care and decisions about their treatment.
• Information about services and how to complain was available and easy to understand. Improvements were made to the quality of care as a result of complaints and concerns.
• Patients said they found it easy to make an appointment with a named GP and there was continuity of care, with urgent appointments available the same day.
• The practice had good facilities and was well equipped to treat patients and meet their needs. There was access to extended services such as dermatoscopy (examination of skin lesions), ultrasound, audiology, counselling and physiotherapy services on site so that patients could access care closer to home.
• There was a clear leadership structure and staff felt supported by management. The practice sought feedback from staff and patients, which it acted on.
• The provider was aware of and complied with the requirements of the duty of candour.
• The practice was collaborating with other local practices to share resources and learning.
• The practice’s vision centred on the doctor/ patient relationship and all patients were designated a named GP. If a patient wished to change their designated GP they were required to write to the practice manager.

We saw one area of outstanding practice:

• The practice had recognised their patient population consisted of more elderly patients than the national average and in response had focused on developing care and treatment programmes for this population group.The practice was leading an over 75’s frailty team in conjunction with the local clinical commissioning group (CCG) and nearby GP Practices. The scheme facilitated nurse led home visits and had access to two beds in a local care home in order to provide an alternative to patients being admitted into hospital. Care homes were provided with a welcome pack to give to their new residents. These packs included the direct telephone numbers of key members of staff in the practice and registration documents which were tailored to patients living in care homes to help ensure they were registered quickly and efficiently.

The areas where the provider must make improvements are:

• Review procedures to ensure the safe storage of vaccines.
• Ensure a system is in place to track blank prescription forms and pads, and monitor their use

The areas where the provider should make improvements are:

• Review the system for monitoring staff training to help ensure that all members of staff are up to date with training. For example, Mental Capacity Act, infection prevention control and information governance.
• Review how the cleaning of medical equipment is recorded.
• Continue to identify patients who are also carers and build on the current carers register to help ensure that all patients on the practice list who are carers are offered relevant support if required.

Professor Steve Field CBE FRCP FFPH FRCGP

Chief Inspector of General Practice