We carried out an announced comprehensive inspection at Windmill Health Centre on 2 October 2018. The overall rating for the practice was inadequate and the service was placed into special measures. The full comprehensive report for the October 2018 can be found by selecting the ‘all reports’ link for Windmill Health Centre on our website at .

This inspection was an announced focused inspection carried out on 11 February 2019 to confirm that the practice had responded to the warning notices dated 19 October 2018 and met the legal requirements in relation to breaches of Regulation 12(1), Safe Care and Treatment and Regulation 17(1), Good governance identified in our previous inspection on 2 October 2018. The provider was required to be compliant with the matters documented in the warning notices relating to Regulation 12 by 28 December 2018 and those relating to Regulation 17 by 22 January 2019.

This report covers our findings in relation to those requirements.

Our key findings were as follows:

• The provider had made the required improvements in most areas identified during the previous inspection. However, the provider had not sufficiently acted on the findings of the most recent Infection Control and Prevention (IPC) audit and we found that the practice premises were poorly maintained. We saw that the condition of the building had deteriorated since our last inspection.
• Resuscitation guidelines stored with emergency medical equipment had been updated and reflected the most current guidance.
• The recommendations of the 2016 legionella risk assessment had been acted upon with relevant staff trained and evidence seen of recommended water checks being made on a regular basis.
• Staff with responsibility for IPC across the practice had received relevant update training and the IPC policy had been reviewed.
• Significant event recording and the provider’s approach to learning from these events had been reviewed. We saw that they were documented, discussed and acted upon by the senior management team.
• Verbal complaints were recorded and we saw that all complainants were advised in writing of their right to refer complaints to the Parliamentary and Health Service Ombudsman if they were not satisfied with the provider’s response.
• A staff training matrix had been developed and we saw that mandatory training requirements had been established by the provider and were being implemented across the staff team.
• We saw that oversight of prescription stationary security had been reviewed and was now safely managed. The provider also told us that patient group directions (PGDs) had been reviewed and systems were now in place to ensure they were correctly authorised.
• Newly appointed staff were given an induction plan and their progress was documented. All relevant staff had received an appraisal in the last 12 months.
• Clinical and staff meetings were appropriately documented.
• Policies relating to staff occupational health and lone working had been implemented.

The area where the provider should make improvements are:

• Continue to ensure that the backlog of summarising records is addressed and cleared by 31st March 2019.

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

• The provider must ensure all premises and equipment used by the service provider is fit for use and maintain appropriate standards of hygiene for premises and equipment.

We are taking further action in line with our enforcement processes. The service will be kept under review and if needed could be escalated to urgent enforcement action.

Professor Steve Field CBE FRCP FFPH FRCGP

Chief Inspector of General Practice

This practice is rated as inadequate overall. (Previous rating January 2016 – Good)

The key questions are rated as:

Are services safe? – Inadequate

Are services effective? – Requires Improvement

Are services caring? – Good

Are services responsive? – Good

Are services well-led? - Inadequate

We carried out an announced comprehensive inspection at Windmill Health Centre on 2 October 2018 as part of our inspection programme.

At this inspection we found:

• The practice had some systems to manage risk so that safety incidents and significant events were less likely to happen. However, when incidents or significant events did happen, the practice did not have a consistent, effective process in place to review learning or implement improvements.
• The provider did not maintain oversight of staff training and could not be assured that all staff had undertaken safeguarding training relevant to their role. Not all relevant staff had a DBS check on file, including a GP. However, the GP had undertaken a DBS check in the past, in order to join the performers list.
• The system to manage infection prevention and control (IPC) was not effective.
• Prescription stationery was not monitored by the provider in line with national guidance for audit and security purposes.
• Patient Group Directions (PGDs) were not correctly authorised.
• The practice ensured that care and treatment was delivered according to evidence- based guidelines.
• Staff involved and treated patients with compassion, kindness, dignity and respect.
• Patients found the appointment system easy to use and reported that they were able to access care when they needed it. However, some patients told us it was sometimes difficult to access a convenient routine appointment with their preferred clinician.

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

• Ensure 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.
• Ensure that staff recruitment processes are safe and effective.

The areas where the provider should make improvements are:

• Continue to address and improve the uptake of childhood immunisations across the patient population.

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.

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 the reassurance that the care they get should improve.

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

Letter from the Chief Inspector of General Practice

We inspected this practice on the 7 October 2014 as part of our new comprehensive inspection programme. This provider had not been inspected before and that was why we included them.

We found that the practice had made provision to ensure care for people was safe, caring, responsive, effective and well lead and we have rated the practice as good overall.

Our key findings were as follows:

Patients were satisfied with the approaches adopted by staff and said they were caring and helpful. They felt the clinicians were professional, empathetic and compassionate. We had a number of comments from patients who told us that the GPs took their time to listen to them.

• The practice offers flexible appointment times and is open for early morning appointments from 7 am two days per week and one late evening until 8.30 pm. The practice also offers telephone consultations and an online appointment and prescription service. Patients told us that the online system for booking appointments is straightforward and appointments are available to book one week ahead. They also said that an appointment can usually be made with a GP of their choice and they can get an appointment the same day if necessary.
• The practice has a clear vision to deliver high quality care and promote good outcomes for patients. We found that the visons and values are embedded within the culture of the practice and are being achieved. There are good governance and risk management measures in place. We found that the provider listens to patient comments and takes action to improve their service.
• We looked at how well services are provided for specific groups of people and what good care looks like for them. We found that the practice actively monitors patients. We saw that they make arrangements for older patients and patients who have long term health conditions to be regularly reviewed and to attend the practice for routine checks. We found that appointments provide flexibility for patients who are working.

We saw some areas of outstanding practice including:

• The practice held a weekly multi-disciplinary meeting with attendance from the GPs, community matron, district nurse and health visitor. Information relating to risk factors for the patients’ health and welfare was shared and action plans to minimise risk were agreed. To ensure that records were up to date, the discussions and actions required were recorded directly onto patient records during the meeting.
• The practice had identified patients they considered to be at high risk of deterioration or admission to hospital due to the complexities of their health needs. Individual plans of care had been developed for these patients. The care plans were provided to patients to assist them to identify the signs and symptoms and when additional medical support may be required. The care plans contained the actions to take to ensure a timely response to their needs and relevant contact details for support. These patients’ needs and effectiveness of the care plans were also discussed at the weekly multi-disciplinary meeting. We saw that there was effort on all parts of the team to ensure that all that could be done for the patients was done. It was acknowledged that patients may have contact with several GPs and other multidisciplinary staff and the discussions between all the parties were recorded in the notes to ensure a seamless service. The multi-disciplinary, timely and open nature of the meetings together with accessibility of the information meant that the care was both caring and effective.

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

• The provider should improve infection control prevention and control by ensuring the cleanliness of the building is maintained and policies and procedures in relation to sharps boxes are implemented consistently.

The risks of cross contamination had not been considered during hand washing in consulting rooms that do not have taps which meet relevant guidance.

Professor Steve Field (CBE FRCP FFPH FRCGP) 

Chief Inspector of General Practice