Letter from the Chief Inspector of General Practice

We carried out an announced comprehensive inspection at Wigmore Medical Centre on 27 May 2015. Overall the practice is rated as good.

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

Our key findings across all the areas we inspected 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 and addressed.
• Patients’ needs were assessed and care was planned and delivered following 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 about services and how to complain was available and easy to understand.
• Patients said they found it easy to make an appointment with a named GP and that 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 a clear leadership structure and staff felt supported by management. The practice proactively sought feedback from staff and patients, which it acted on.

Professor Steve Field (CBE FRCP FFPH FRCGP) 

Chief Inspector of General Practice

This practice is rated as Inadequate overall.

The key questions at this inspection are rated as:

Are services safe? – Inadequate

Are services effective? – Requires Improvement

Are services caring? – Good

Are services responsive? – Requires Improvement

Are services well-led? – Inadequate

We carried out an announced comprehensive inspection at Wigmore Medical Centre on 2, 3 and 8 April 2019 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:

• An effective system for reporting and recording significant events had been introduced in March 2019.
• The practice learned and made improvements when things went wrong.
• The practice’s systems, processes and practices did not always help to keep people safe.
• Risks to patients, staff and visitors were not always assessed, monitored and managed in an effective manner. For example, in relation to the arrangements for managing medicines as well as infection prevention and control.
• Staff had the information they needed to deliver safe care and treatment to patients.
• Published results showed the childhood immunisation uptake rates for the vaccines given were lower than the minimum target percentage of 90% in one other of the four indicators.
• Published QOF data from 2017 / 2018 showed that the practice’s exception reporting for some indicators was higher than local and national averages. However, unverified data demonstrated that the practice had taken action and exception reporting to date in the current period being measured had been greatly reduced.
• Staff had the skills, knowledge and experience to carry out their roles. However, not all staff were up to date with essential training.
• Staff involved and treated patients with compassion, kindness, dignity and respect.
• Patients were able to access care and treatment from the practice within an acceptable timescale for their needs.
• Where national GP patient survey results were below average the practice was taking action to address some of the findings and improve patient satisfaction.
• There were clear responsibilities, roles and systems of accountability to support good governance and management. However, governance arrangements were not always effective.
• The limited access for people with mobility issues and lack of an accessible patient toilet at the branch surgery had not been effectively managed in a timely manner.

The areas where the provider must make improvements are:

• Ensure care and treatment is provided in a safe way to patients.
• Ensure all premises and equipment used by the service provider is fit for use.
• Establish effective systems and processes to ensure good governance in accordance with the fundamental standards of care.
• Ensure persons employed in the provision of the regulated activity receive the appropriate support, training, professional development, supervision and appraisal necessary to enable them to carry out the duties.
• Ensure recruitment procedures are established and operated effectively to ensure only fit and proper persons are employed.

The areas where the provider should make improvements are:

• Continue to monitor and improve national GP patient survey patient satisfaction scores.
• Continue with plans to install a hearing loop at the branch surgery.
• Continue to identify patients who are also carers to help ensure they are offered appropriate support.

I am placing the service in special measures. Services placed in special measures will be inspected again in 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.

The service will be kept under review and if needed could be escalated to urgent enforcement action. Where necessary, another inspection will be conducted within a further six months, and if there is not enough improvement we will move to close the service by adopting our proposal to remove this location or cancel the provider’s registration.

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

Dr Rosie Benneyworth BM BS BMedSci MRCGP

Chief Inspector of Primary Medical Services and Integrated Care

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