This practice is rated as Good overall. (Previous inspection February 2017 – Good)

The key questions are rated as:

Are services safe? – Good

Are services effective? – Requires improvement

Are services caring? – Good

Are services responsive? – Good

Are services well-led? – Good

We carried out an announced comprehensive inspection at Windermere and Bowness Medical Practice on 22 November 2018. This inspection was planned and undertaken as part of our inspection programme and as part of a wider inspection of the provider (One Medicare Ltd). The provider had agreed to contribute to our Primary Care at Scale project.

At this inspection we found:

• The practice had systems to keep patients safe and safeguarded from abuse.
• The practice had 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 were actively advertising for salaried GPs as recently, established staff had left the practice. This had been a challenge for all the staff at the practice.
• The practice routinely reviewed the effectiveness and appropriateness of the care they provided. They ensured that care and treatment was delivered according to evidence- based guidelines.
• Staff involved and treated patients with compassion, kindness, dignity and respect.
• Results from the National GP Survey were above local and national scores. However, recent feedback from some patients reflected that they were unhappy with the staffing changes at the practice. The provider told us that established GP’s had chosen to leave the service to move on to the next stage of their careers.
• The practice organised and delivered services to meet patients’ needs. They took account of patient needs and preferences.
• Feedback from the National GP Survey regarding access was positive, however more recent feedback provided to us by some patients said that access was not as good as it had previously been.
• There was a focus on continuous learning and improvement at all levels of the organisation. The practice proactively used performance information to drive improvement.

The areas where the provider must make improvements as they are in breach of regulations are:

• 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 their duties.

See Requirement Notice Section at the end of this report for further details

The areas where the provider should make improvements are:

• Review and improve the frequency of fire drills.
• Assure themselves that patients know how to escalate complaints and concerns about services provided by the practice, should they be unhappy with the initial response from the practice.

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

Letter from the Chief Inspector of General Practice

We carried out an announced comprehensive inspection at Windermere and Bowness Medical Practice on 28th February 2017. 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 in place for reporting and recording significant events.
• Risks to patients were generally assessed and well managed.

• Staff assessed patients’ needs and delivered care in line with current evidence based guidance. Staff had been trained to provide them with the skills, knowledge and experience to deliver effective care and treatment.
• 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 a clear leadership structure and staff felt supported by the management team.
• The practice proactively 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.

We saw some areas of outstanding practice:

• The practice used non-traditional staff roles to meet the needs of their patients, such as a home visiting nurse practitioner. A physiotherapist was also employed as a musculoskeletal practitioner, and since this was implemented in 2013/14, referrals to orthopaedics had dropped from 188 a year to 114 in 2015/16. In the same period, the number of injections performed at the practice had risen from 88 to 322, reducing the need for patients to travel to hospital and increasing the capacity of secondary care. Patients we spoke to on the day of inspection valued these services highly. One Medicial Group were due to introduce these roles in their other practices.
• Chronic disease management at the practice was extended to include patients with rheumatoid arthritis. Patients were reviewed annually, and the care plans created in conjunction with them encouraged patients to write their aims and objectives to improve their wellbeing, and to identify any areas they wish to explore with the GP or nurse practitioner.
• The practice had developed strong working relationships with the wider healthcare team in their community. This had led to the implementation of joint clinics between the GPs and the health visitor, which allowed them to have closer contact with vulnerable families, as well as being able to offer immediate advice or treatment that might otherwise have required an appointment. The practice also held bi-monthly meetings with the community psychiatric nurse, which ensured that the practice was able to offer support and collaborative treatment to some of the most vulnerable patients.

There was an area of practice where the provider should make improvements:

• All staff members should complete the cleaning checklists provided for their areas of work.

Professor Steve Field (CBE FRCP FFPH FRCGP) 

Chief Inspector of General Practice