We carried out an announced follow up inspection at Woodlands Medical Practice on 5 March 2019 as part of our inspection programme.

At the last inspection in May 2018 we rated the practice as requires improvement for providing safe and well led services because:

• Governance arrangements to monitor and review the service provided were not fully established.
• Evidence that action in response to patient safety alerts was not available and some risk assessments were not in place.
• Systems to assess, monitor and improve the quality and safety of services provided at the practice were not established.

At this inspection, we found that the provider had satisfactorily addressed these areas.

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 have rated this practice as good overall and good for all population groups.

We found that:

• The practice had implemented its action plan in response to the findings from last inspection in May 2018.
• Processes and systems to support good governance and management were now established, clearly set out, understood and effective.
• Action had been taken to identify and support patients who were also carers, staff had re-introduced the patient information newsletter, updated the practice website and had recorded a business development plan.
• Appropriate policies, procedures and activities to ensure safety were established and monitored to ensure effectiveness.
• The practice had established systems to minimise risks to patient safety and the practice routinely reviewed the effectiveness and appropriateness of the care it provided. It ensured care and treatment was delivered according to evidence based guidelines.
• Staff involved and treated patients with compassion, kindness, dignity and respect.
• The practice was responsive to needs of its patients including vulnerable patients. They promoted access to a range of health and wellbeing services including Be Well and Age UK.
• There was a focus on continuous learning and improvement at all levels of the organisation.

Whilst we found no breaches of regulations, the provider should:

• Maintain records of the immunisation status of clinicians and ensure recruitment records consistently include evidence of identification and information confirming GPs are on the performers list.
• Improve the practice’s final written response to the complainant to ensure details of the Parliamentary and Health Service Ombudsman's (PHSO) are included.
• Continue to implement the practice improvement plan to ensure clinical protocols are available and staff training records are maintained up to date.

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

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

This practice is rated as requires improvement. This practice is registered with a new provider.

The key questions are rated as:

Are services safe? – Requires Improvement

Are services effective? – Good

Are services caring? – Good

Are services responsive? – Good

Are services well-led? - Requires Improvement

We carried out an announced comprehensive inspection at Woodlands Medical Practice on 10 May 2018. The GP provider for this service took over running this practice on 1 April 2017 and was registered with the CQC in September 2017.

This inspection was carried out 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:

• The practice had a long standing experienced staff team committed to providing a quality service to patients. However the staff team acknowledged the recent changes at the practice had been challenging and they did not always feel involved in the changes that had been made.
• The practice had not reviewed the impact of changes made to the quality of service provided.
• Patients we spoke with were positive about the practice and the service they received. 19 out of 26 comment cards also referred positively to the service. However six comment cards and other comments made on NHS Choices referred to concerns including lack of access to appointment.
• The practice did not have systems in place to respond to patient safety alerts potentially putting patients at risk.
• The practice did review and respond to other safety incidents such as complaints and significant incidents. The practice learned from them and improved their processes.
• Governance arrangements to monitor and review the service provided were not fully established.
• Staff involved and treated patients with compassion, kindness, dignity and respect. The practice provided examples where patients with disabilities were supported to attend GP appointments and contribute to the patient participation group.
• Patient access to routine appointments in the early evening was limited and this potentially impacted on working patients.
• The GP provider was committed to developing and improving the service, however current systems of communication to share these improvements with staff and patients were not effective.

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.

The areas where the provider should make improvements are:

• Continue to identify and support patients who are also carers.
• Consider the re-introduction of the patient newsletter to improve communication.
• Consider a business development plan and strategy, with action plans to support the practice in meeting future challenges and priorities.
• Consider updating of the practice website

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