Letter from the Chief Inspector of General Practice

We conducted a comprehensive announced inspection on 22nd June 2015.

Specifically, we found the practice to be good for providing safe, effective, caring, responsive and well-led services. It was also good for providing services for older people, people with long-term conditions, families, children and young people, working age people (including those recently retired and students), people living in vulnerable circumstances, and people experiencing poor mental health (including people with dementia).

Our key findings were as follows:

• Staff understood and fulfilled their responsibilities to raise concerns, and to report incidents and near misses. Information about safety was recorded, monitored, appropriately reviewed, addressed and shared with staff during meetings.
• Risks to patients and staff were assessed and managed. There were risk management plans which included areas such as premises, medicines handling and administration, infection control and safeguarding vulnerable adults and children.
• Patients’ needs were assessed and care was planned and delivered following best practice guidance.
• Staff had received training appropriate to their roles. Staff were supervised and supported and any further training needs had been identified and planned for.
• Patients said they were treated with compassion, dignity and respect and they were involved in their care and decisions about their treatment. They told us that access to appointments with GPs and nurses was good and that they were happy with the treatments that they received.
• Information about services and how to complain was readily available and easy to understand. Complaints were handled and responded to in line with relevant guidelines.
• The practice had good facilities and was well equipped to treat patients and meet their needs.
• There was a clear leadership structure and staff felt supported by management. The practice sought feedback from staff and patients, which it acted on.

However, there were areas of practice where the provider needed to make improvements.

The provider should

• Ensure infection control audits are fully completed and have a process in place to monitor and review incidents of infections.
• Ensure policies are robust and reviewed regularly.
• Ensure a written Legionella policy or risk assessment is completed.
• Ensure that staff guidance for administering vaccines and medicines is current and accessible.
• Ensure that clinical audit cycles are completed in order to demonstrate improved outcomes for patients.

Professor Steve Field (CBE FRCP FFPH FRCGP) 

Chief Inspector of General Practice

This practice is rated as Inadequate overall. At the previous inspection in August 2015 the

practice were rated as good overall.

The key questions at this inspection are rated as:

Are services safe? – Inadequate

Are services effective? – Requires Improvement

Are services caring? – Requires Improvement

Are services responsive? – Good

Are services well-led? – Inadequate

We carried out an announced comprehensive inspection at Westwood Clinic on 13 December 2018 as part of our inspection programme.

We based our judgement of the quality of care at this service 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.

We concluded that:

• Patients were able to access care and treatment in a timely way.
• Quality Outcomes Framework data was generally in line, or above, local and national averages. However, exception reporting data was higher than both the CCG and England averages in indicators such as mental health and diabetes.
• Complaints were dealt with appropriately; however verbal compalints were not recorded.
• In August 2018, the practice had identified staff were unclear about the reporting of significant events and introduced a new policy and guidance for staff. The practice was able to evidence an increase in the number of significant events reported, investigated and learning distributed which would have previously been missed.

However, we also found that:

• People were not adequately protected from avoidable harm.
• The leadership, governance and culture of the practice did not assure the delivery of high quality care.
• Some legal requirements were not met.

We rated the practice as inadequate for providing safe services because:

• The practice did not have an effective system in place to manage and monitor patients taking high-risk medicines.
• The practice did not have a fire risk assessment at the time of inspection.
• Recruitment checks were not always completed.
• The practice could not evidence all staff had received appropriate safety training. The practice provided a training matrix following the inspection which did not evidence staff had received all safety training relevant to their role.
• Equipment calibration was not always completed.

We rated the practice as requires improvement for providing effective services because:

• The practice’s exception reporting rate for diabetes and mental health indicators was higher than the CCG and England averages.
• The number of patients attending for cervical screening was lower than both the CCG and England averages. The practice were aware but had no actions in place to address this.
• The number of patients attending for bowel cancer screening was lower than both the CCG and England averages. The practice were aware but had no actions in place to address this.
• We were unable to ascertain how the practice reviewed the competency of staff involved in advanced clinical practice and the practice did not provide us with evidence that any staff received appraisals.

We rated the practice as requires improvement for providing caring services because:

• The practice were aware of lower than average GP Patient Survey data however the practice had no actions taking place or being planned for the future in order to address this.

We rated the practice as good for providing responsive services.

We rated the practice as inadequate for providing well led services because:

• Practice staff reported leaders were not visible and approachable, this was evident on the day of our inspection.
• Some staff we spoke with told us they felt unsupported and under-valued by the practice partners.
• Comprehensive assurance systems were not in place, for example, not all building risk assessments were not completed and a lack of management for patients on high risk medicines.
• The practice could not evidence that risks, issues and performance were managed.
• The practice did not always involve the public, staff and external partners to sustain high quality and sustainable care. For example, the practice did not act on negative patient survey data and there was no active patient participation group.
• We found the governance systems and the oversight of the management did not ensure that the practice had complete oversight of staff training and not all staff received annual appraisals.

The areas where the provider must make improvements are:

• Ensure that care and treatment is provided in a safe way to patients.
• 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 and improve the process for recording all complaints to ensure verbal complaints are included.

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

I am placing this service in special measures. Services placed in special measures will be inspected again within six months. If insufficient improvements have been made such that there remains a rating of inadequate for any population group, key question or overall, we will take action in line with our enforcement procedures to begin the process of preventing the provider from operating the service. This will lead to cancelling their registration or to varying the terms of their registration within six months if they do not improve.

Special measures will give people who use the service the reassurance that the care they get should improve.

Professor Steve Field CBE FRCP FFPH FRCGP

Chief Inspector of General Practice