Background to this inspection
Updated
26 November 2018
Botolph Bridge Surgery in Woodston, Peterborough holds an Alternative Provider Medical Services (APMS) contract and provides healthcare services primarily to patients living in Woodston and the surrounding area. The surgery is located in a fit for purpose building and serves a population of approximately 7,000 patients. The building is shared with other health services that serve the community.
The principal GP is the registered manager and is supported by a male salaried GP and locum GPs and two clinical pharmacists. The practice employs an advanced nurse practitioner, practice nurses, and a healthcare assistant (HCA). There are two practice managers, a consultant practice manager and a team of reception/administration/secretarial staff support the clinical team
Compared to the national average, the practice served an area where they had a higher number of patients aged 0 to 4 years old and 29 to 50 year olds and they had a lower number of older people. The deprivation score for the practice area was in line with the local CCG and national averages.
The practice offered extended hours appointments some evenings to 7pm and appointments were available each Saturday morning. The practice could book appointments at the GP Hub in Peterborough for patients that wished to be seen there. The GP Hub offered appointments in the evenings and at weekends. Appointment times varied. When the practice was closed, patients access the out of hours service provide by Herts Urgent Care via 111.
We previously inspected this practice on six other occasions. On 7 May 2015, we found that the practice required improvement for effective services but was good overall. On 10 June 2016 the practice was rated inadequate for safe, effective, and well led services and rated requires improvement for caring and responsive services. The practice was placed into special measures for six months. We conducted a focused inspection on the 19 August 2016 and we took urgent action to suspend 3Well Ltd Botolph Bridge from providing general medical services at 3Well Ltd Botolph Bridge for a period of three months. A further focused inspection was carried out on 14 November 2016, the suspension was lifted, and we imposed urgent conditions on the provider’s Care Quality Commission registration. A comprehensive inspection was undertaken on 13 February 2017, the practice was rated as requires improvement overall, with requires improvement for providing safe, effective and responsive services, inadequate for well led services and good for caring services. The practice was remained in special measures. We carried out a comprehensive inspection on 27 October 2017. This inspection was undertaken following a period of special measures. The practice was rated requires improvement overall and for providing effective, caring, responsive and well led services, good for providing safe services. The practice was removed from special measures.
Updated
26 November 2018
This practice is rated as Good overall.
This was the seventh inspection that we have carried out at 3Well Ltd – Botolph Bridge.
We carried out a comprehensive inspection of 3Well Ltd - Botolph Bridge on 7 May 2015. The practice was rated as good overall with ratings of good for providing safe, caring responsive and well led services, and requires improvement for effective services. As a result of the findings on the day of the inspection, the practice was issued with a requirement notice for regulation 17 (good governance).
We carried out a second comprehensive inspection on 10 June 2016. This inspection was in response to concerns raised by members of the public and to check if the practice had made the changes required from the inspection in May 2015. The practice was rated as inadequate overall and for providing safe, effective, and well led services, and requires improvement for providing responsive and caring services.
At our June 2016 inspection we found that some of the improvements needed as identified in the report of May 2015 had been made, however, some of these needed to be improved further. Patients were at risk of harm because systems and processes were not in place to keep them safe. The systems and processes in place to ensure good governance were ineffective and did not enable the provider to assess and monitor the quality of the services and identify, assess and mitigate against risks to people using services and others. As a result of the findings on the day of the inspection, the practice was issued with a warning notice for regulation 12 (safe care and treatment) and requirement notice for regulation 17 (governance and quality assurance). The practice was placed into special measures for six months.
We conducted a focused inspection on 19 August 2016 to ensure that the practice had made the required improvements detailed in the warning notice that had been issued on 8 August 2016.At this inspection we found that some of the improvements needed as identified in the report of June 2016 had been made, however, some of these needed to be improved further. We further identified a new issue relating to the safe prescribing and management of medicines and we were concerned that patients were at risk of harm. The systems and processes in place to ensure good governance were ineffective and did not enable the provider to assess and monitor the quality of the services and identify, assess and mitigate against risks for people using services and others. Following this inspection, we took urgent action to suspend 3Well Ltd Botolph Bridge from providing general medical services at 3Well Ltd Botolph Bridge.
We conducted a focused inspection on 14 November 2016 to check whether the provider had made sufficient improvements and to decide whether the suspension period should end. At this inspection we found that improvements had been made. We saw that a governance framework had been put in place and that medicines were authorised by GPs and nurses with a prescribing qualification. The practice had prioritised patients and had started a process of reviewing patients identified as ‘may be at risk’ from inappropriate reviews. We found that GPs and nurse practitioners managed pathology results and these had been managed in a timely way. The systems and processes in place to ensure good governance had improved but further improvements were needed to enable the provider to assess and monitor the quality of the services and identify, assess and mitigate against risks to people using services and others. Following this inspection, the suspension was lifted; however, we imposed urgent conditions on the registration of this provider. The ratings remained the same; inadequate overall and the special measures period continued.
We carried out a comprehensive inspection on 13 February 2017. This inspection was undertaken following a period of special measures. The practice was rated requires improvement overall and for providing safe, effective, and responsive services, inadequate for providing well-led services and good for providing caring services. The practice remained in special measures.
We carried out a comprehensive inspection on 27 October 2017. This inspection was undertaken following a period of special measures. The practice was rated requires improvement overall and for providing effective, caring, responsive and well led services, good for providing safe services. The practice was removed from special measures.
This inspection was undertaken to ensure the improvements had been sustained and that the practice had made further improvement to meet the regulations. This was an announced comprehensive inspection on 15 November 2018. Overall the practice is now rated as good.
The key questions at this inspection are rated as:
Are services safe? – Good
Are services effective? – Good
Are services caring? – Good
Are services responsive? – Good
Are services well-led? - Good
At this inspection we found:
- The practice had sustained improvements made and had made further improvements since our inspection in October 2017.
- The practice had successfully recruited staff including a salaried GP and an advance nurse practitioner and had retained practice nurses and clinical pharmacists.
- The practice performance in relation to the quality and outcome framework had improved. Their overall achievement was 96%, this was in line with the CCG and national average. The practice overall exception reporting was lower than the CCG and national average.
- The practice had monitored the results from the GP patient survey July 2018 and had undertaken their own survey using the same questions to show that improvement made since the GP data collection had been successful and improve patient satisfaction.
- Practice policies and procedures were easily accessible and staff we spoke with knew how to do this.
- 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 routinely reviewed the effectiveness and appropriateness of the care it 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.
- Generally, patients found the appointment system easy to use and reported that they were able to access care when they needed it.
- The practice had increased the number of patients using online services in the past 12 months from approximately 200 patients to approximately 1,200.
- There was a strong focus on continuous learning and improvement at all levels of the organisation. Feedback from staff was positive about the changes and the cohesive team work.
The areas where the provider should make improvements are:
- Continue to monitor GP patient survey data to ensure patient satisfaction is maintained and further improved.
- Continue to monitor and improve the practice performance in relation to the review of patients with diabetes.
Professor Steve Field CBE FRCP FFPH FRCGP
Chief Inspector of General Practice
Please refer to the detailed report and the evidence tables for further information.