We undertook a comprehensive inspection of Woolton House Medical Centre on the 9 May 2018 under Section 60 of the Health and Social Care Act 2008 as part of our regulatory functions. The practice was rated as good overall and requires improvement for safety. The full comprehensive report following the inspection on May 2018 can be found by selecting the ‘all reports’ link for Woolton House Medical Centre on our website at www.cqc.org.uk.

We undertook an announced focused inspection of Woolton House Medical Centre carried out on 7 November 2018 to confirm that the practice had carried out their plan to meet the legal requirements in relation to the breaches in regulations that we identified in our previous inspection on 9 May 2018. This report covers our findings in relation to those requirements and additional improvements made since our last inspection.

.Our key findings were as follows:

• Safeguarding policies and procedures were up to date to ensure patients were protected from abuse and improper treatment.
• Maintenance arrangements had been reviewed. In areas where work was identified at our last inspection as requiring improvement, this had been completed. New systems were put into place to ensure that all checks, such as an electrical wiring, were monitored to ensure they do not go out of date.
• The practice had reviewed the access restrictions for disabled patients at the entrance to the practice.
• The systems in place for ensuring all nurses working at the practice were covered with appropriate medical indemnity insurance had improved.
• All staff with responsibility for specimen handling and storage had undergone specific training.
• The arrangements in place for Health Care Assistants (HCA) staff who were delivering vaccination programmes, was supported with a written patient specific directions (PSD) always.
• A new system was put in place for monitoring and reviewing policies and procedures.
• Information held about patient complaints was full and accurate to ensure a full and accurate audit trail of events was maintained.
• New arrangements were in place to ensure the safe storage of past medical records for patients.
• A staff training matrix was in place.
• At our previous inspection we found that past medical records were not stored safely. At this inspection we found that some new storage facilities had been purchased by the practice, however, the storage arrangements remained inadequate for the volume of patient’s records needing safe storage. Therefore, the records remained at risk of accidental loss, corruption, damage and destruction.

In addition, the provider should:

• Take action to ensure the storage of medical records for patients are protected against the risk of accidental loss, including corruption, damage or destruction.

Professor Steve Field CBE FRCP FFPH FRCGP

Chief Inspector of General Practice

Letter from the Chief Inspector of General Practice

This practice is rated as Good overall. (Previous inspection October 2014 – Good)

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? - Good

We carried out an announced comprehensive inspection at Woolton House Medical Centre 9 May 2018. 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 clear 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 had systems to safeguard children and vulnerable adults from abuse. However, we could not verify the level of safeguarding training for clinical staff and the children’s safeguarding policy had not been updated.

• The practice had arrangements to ensure that facilities and equipment were safe and in good working order. However, a planned preventative maintenance program was not in place.

• The practice routinely reviewed the effectiveness and appropriateness of the care provided. It 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 open access appointment system easy to use and reported that they were able to access care when they needed it.

• 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.

• Staff worked well together as a team, knew their patients well and all felt supported to carry out their roles.

• The provider was aware of the requirements of the duty of candour. Examples we reviewed showed the practice complied with these requirements.

• The practice had an active Patient Participation Group (PPG) who worked closely with staff to monitor and develop services.

• There was a strong focus on continuous learning and improvement at all levels of the organisation.

• Review the storage of medical records for patients to ensure they are protected against the risk of accidental loss, including corruption, damage or destruction.

We saw areas of outstanding practice:

• The practice continued to proactively identify patients aged over 75 years who were socially isolated and lonely. Patients were then referred to a local social event, supported by the practice and the local charity set up by the lead GP named Woolton Community Life.

The areas where the provider must make improvements are:

• Ensure patients are protected from abuse and improper treatment

The areas where the provider should make improvements are:

• Review the maintenance plans and arrangements at the practice and undertake repairs where building work has deteriorated. Systems should be put into place to ensure that all checks, such as an electrical wiring, are monitored to ensure they do not go out of date.

• Review the access restrictions for disabled patients at the entrance to the practice.

• Review the systems in place for ensuring all

• Review the training for staff with responsibility for specimen handling and storage.

• Review the arrangements in place for Health Care Assistants (HCA) staff who are delivering vaccination programmes, to ensure that they operate with a written patient specific directions (PSD) at all times.

• Review the system in place for monitoring and reviewing policies and procedures.

• Review the information held for all patient complaints to ensure a full and accurate audit trail of events is maintained.

• Review the arrangements for the storage of past medical records for patients.

• Review and develop a staff training matrix so that the practice can demonstrate how they are assured of all staff competence.

Professor Steve Field CBE FRCP FFPH FRCGPChief Inspector of General 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 Woolton House Medical Centre on 15 September 2015. Overall the practice is rated as good.

Specifically, we found the practice to be good for providing safe, well-led, effective, caring and responsive services. It was also good for providing services for all the population groups it serves.

Please note that when referring to information throughout this report, for example any reference to the Quality and Outcomes Framework data, this relates to the most recent information available to the CQC at that time.

Our key findings across all the areas we inspected were as follows:

• Systems were in place to ensure incidents and significant events were identified, investigated and reported. Staff understood and fulfilled their responsibilities to raise concerns and to report incidents. However, information about incidents and how they were reported required improvement.
• Patients’ needs were assessed and care was planned and delivered in line with best practice guidance. Staff received training appropriate for their roles and any further training needs had been identified and planned.
• Patients spoke positively about the practice and its staff. They said they were treated with compassion, dignity and respect and were involved in their care and decisions about their treatment.
• Information about services and how to complain was available, this was provided in different languages and was easy to understand for the local population.
• Patients said they found it easy to make an appointment with a named GP and that there was continuity of care. Urgent appointments were available on the same day.
• 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.

We saw several areas of outstanding practice including:

• The practice proactively identified patients aged over 75 years who were socially isolated and lonely. Patients were then referred to the practice health trainer for on-going support and contact. The practice developed with the trainer a monthly ‘afternoon tea party’ as a social event. This initially took place in the practice but because of its success, it now takes place in the local village hall. The practice provided information to show that over the previous 10 months over 135 patients had attended these events. Within this figure 50% of patients had been visited first in their own homes by the health trainer to encourage and support them in their own home initially.
• To further support socially isolated patients the lead GP also set up a local charity with support from local churches and community groups. The organisation named Woolton Community Life developed a community directory booklet which included all activities in and around the village for people to get involved with.

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

The provider should:

• Ensure recruitment procedures include the necessary employment checks for all staff. This must include a Disclosure and Barring Service (DBS) check for any staff with chaperoning responsibilities or a risk assessment supporting the decision not to undertake this check.
• Review the records made of serious events and incidents to ensure that risks have been appropriately identified and actions plans have been put into place to enable closer monitoring of safety risks to patients.

Professor Steve Field (CBE FRCP FFPH FRCGP) 

Chief Inspector of General Practice