The Care Quality Commission
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Archived: Westside Surgery

Overall: Requires improvement read more about inspection ratings

Sleaford Road Medical Centre, Boston West Business Park, Sleaford Road, Boston, Lincolnshire, PE21 8EG (01205) 362556

Provided and run by:
Westside Surgery

All Inspections

15 November 2017

During a routine inspection

Letter from the Chief Inspector of General Practice

This practice is rated as Requires Improvement overall. We previously carried out an announced comprehensive inspection on 30 November 2016; the practice was rated inadequate, with the safe, effective and well-led key questions rates as inadequate. The practice was rated as requires improvement in responsive and good in caring. We found three breaches of the legal requirements and as a result we issued a warning notice in relation to:

  • Regulation 12 of the Health and Social Care Act 2008 (Regulated Activities) Regulation 2014 – Safe Care and Treatment.
  • Regulation 17 of the Health and Social Care Act 2008 (Regulated Activities) Regulation 2014 – Good Governance.

In addition, we issued a requirement notice in relation to:

  • Regulation 19 of the Health and Social Care Act 2008 (Regulated Activities) Regulation 2014 – Fit and Proper Persons Employed.

Following that inspection, the practice was placed in special measures.

We carried out an announced comprehensive inspection at Westside Surgery on 15 November 2017 to monitor that the necessary improvements had been made.

The key questions are rated as:

Are services safe? – Good

Are services effective? – Good

Are services caring? – Requires Improvement

Are services responsive? – Requires Improvement

Are services well-led? - Good

As part of our inspection process, we also look at the quality of care for specific population groups. The practice overall rating was requires improvement and this related to patients in each of the population groups:

Older People – Requires Improvement

People with long-term conditions – Requires Improvement

Families, children and young people – Requires Improvement

Working age people (including those recently retired and students) – Requires Improvement

People whose circumstances may make them vulnerable – Requires Improvement

People experiencing poor mental health (including people with dementia) - Requires Improvement

At this inspection we found:

  • The practice had systems, processes and practices in place to protect people from potential abuse. Staff were aware of how to raise a safeguarding concern and had access to internal leads and contacts for external safeguarding agencies.
  • 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.
  • There were systems in place for identifying, assessing and mitigating risks to the health and safety of patients and staff.
  • 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.
  • The partners had reviewed and increased its workforce and employed additional clinicians with a varied skill mix to help meet the health and social needs of patients and the demand for access to appointments.
  • Staff had received essential training to enable them to carry out their duties safely.
  • We saw that staff involved and treated patients with compassion, kindness, dignity and respect. However, the national patient survey highlighted that patient satisfaction scores were below local and national averages when asked about their feedback on GP consultations.
  • Patient feedback on same day access to appointments was positive. However, some patients found it difficult to access the practice by telephone.
  • The practice had suitable facilities was well equipped and maintained to treat patients and meet their needs.
  • The practice worked proactively with the patient participation group (PPG) to meet the needs of their patients and had consulted with them and members of the community about a planned merger with a neighbouring GP practice based in the same building.
  • There was a focus on continuous learning and improvement at all levels of the organisation.

The areas where the provider should make improvements are:

  • Consider how exception reporting can be reduced or better recorded to increase assurance that treatment given away from the practice has been appropriate and effective.
  • Take steps to improve the uptake of health checks for those patients over 75 years.
  • Explore how the patient satisfaction scores in relation to consultations with a GP from the National Patient Survey can be improved.
  • Improve the complaints management by recording discussions held in practice meetings and updating the contact details on the practice website.
  • GPs to adopt all policies including those relating to administration.
  • Further follow good practice guidance and adopt control measures to make sure the risks to patients, staff and visitors are minimised.

I have taken this practice out of special measures. This recognises the significant improvements made to the quality of care provided by the service.

Professor Steve Field (CBE FRCP FFPH FRCGP) 

Chief Inspector of General Practice

30 November 2016

During a routine inspection

Letter from the Chief Inspector of General Practice

We carried out an announced comprehensive inspection at Westside Surgery on 30 November 2016. Overall, the practice is rated as inadequate.

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

  • Patients were at risk of harm because not all appropriate systems and processes were implemented in a way to keep them safe. For example, the processes in place to review patients prescribed high-risk medicines was inconsistent. Changes to a patient’s medicines received from other services were not checked by a GP for interactions and medicine reconciliation. Uncollected prescriptions, including prescriptions for controlled drugs, were not brought to the attention of the clinical staff.

  • Blank prescription forms and pads were securely stored; however, there was no system in in place to monitor their use.

  • There was no evidence to show what action had taken because of inappropriate items disposed of within sharps bins, as identified within sharps bin audits.

  • The practice did not obtain satisfactory information regarding any relevant physical or mental health conditions before staff commenced employment.

  • Reviews, searchesand audits linked to patient safety alerts were not completed.

  • Reviews in relation to patients prescribed high risk medicines were not always completed in accordance with best practice guidance.

  • The practice had high levels of exception reporting for several clinical conditions. An explanation was provided following the visit regarding some of the exception rates, however further work was to be carried out to review the process to exception report patients.

  • Nationally reported data showed that prevalence rates for several medical conditions were low compared to the local and national averages, the practice had recognised this and requested support from an external contractor to review patient records.

  • Not all clinical mail was reviewed by a clinician to ensure the appropriate action was taken to amend patients care and treatment.

  • The practice informed us they met with other providers of health and social care and a meeting schedule was in place, however there was no evidence to show the meetings took place.

  • Staff had annual appraisals and were supported to carry out training relevant to their role; however, there were gaps within the practices identified mandatory training.

  • Patients said they were treated with compassion, dignity and respect.

  • The practice identified if a patient was also a carer and written information was available to direct carers to the various avenues of support available to them.

  • There was no system in place to make contact with families who had suffered a bereavement.

  • The practice had reviewed the needs of its local population and secured improvements to services where these had been identified.

  • One GP was accredited to provide orthopaedic services under an Any Qualified Provider contract commissioned by the local clinical commissioning group.

  • Feedback from patients reported that it was difficult to pre-book appointments, although urgent appointments were usually available the same day. Patients also told us they had difficulty in accessing the practice by phone.

  • The practice had a clinical governance policy to support the delivery of quality care, however we found some aspects on the governance system was weak. Not all policies and procedures were adhered to, reviews, searches and audits linked to patient safety alerts were not completed, and reviews in relation to patients prescribed high risk medicines were not always completed in accordance with best practice guidance.

  • Regular practice meetings were held which discussed significant events, infection control, training and the community surgery service provided by the practice.

  • The practice sought feedback from staff or patients and had a patient participation group, which was practice led.

The areas where the provider must make improvements are:

  • Ensure systems and processes are in place to review patient safety alerts and ensure patients prescribed high-risk medicines are monitored appropriately.

  • Ensure uncollected prescriptions are brought to the attention of a GP and a process is in place to support this.

  • Ensure there are systems in place to monitor the use of prescription forms and pads.

  • Ensure recruitment arrangements include all necessary employment checks for all staff.

  • Ensure clinical mail is reviewed and new medicines are added to patient records by an appropriate clinician.

The areas where the provider should make improvement are:

  • Improve processes to review areas for improvement identified because of infection prevention and control audits.
  • Continue to review the process for exception reporting and the identification of patients to include in disease registers.
  • Record minutes of multidisciplinary meetings.
  • Continue to encourage staff to carry out and attend mandatory training.
  • Review what support is offered to families who have suffered a bereavement.
  • Continue to review patient satisfaction in relation to access to appointments and to the practice by phone.

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