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Archived: Wokingham Medical Centre Good

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Reports


Inspection carried out on 11 December 2018

During an inspection to make sure that the improvements required had been made

We carried out an announced focused inspection at Wokingham Medical Centre on 11 December 2018.

This inspection was undertaken because when we last inspected the practice in July 2018 we found the practice was not dealing with complaints in a timely and comprehensive manner. Consequently, the practice was found in breach of regulation. This led to the practice being rated as requires improvement for provision of responsive services whilst rated good overall.

We based our judgement of the responsiveness of 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 now rated this practice as good for providing responsive services because improvements had been made in accordance with the action plan the practice sent us following the July 2018 inspection. The practice remains rated good overall and good for all population groups.

We found that:

  • The practice had improved their response to complaints to meet their complaints policy and procedure.
  • Complaints were dealt with in a timely way and the practice identified and shared learning from complaints.
  • The practice encouraged patient feedback and was developing a working relationship with a recently formed patient participation group.

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

Inspection carried out on 10 July 2018

During an inspection to make sure that the improvements required had been made

We carried out an announced focused inspection at Wokingham Medical Centre on 10 July 2018. This inspection was carried out because we found the practice did not respond consistently to patient feedback when we conducted a comprehensive inspection on 1 November 2017. At that time, the practice had not breached regulations and we found the practice good for provision of safe, effective, caring and well led services and was rated good overall.

At this inspection we found:

  • The practice had carried out a survey of 270 patients and devised an action plan to respond to the feedback received.
  • Patients gave a mixed response to the appointment system particularly in regard to accessing the practice via telephone. The practice was aware of this feedback and had made adjustments to the incoming telephone lines. The practice also provided evidence of recruiting additional staff whose duties would include answering incoming telephone calls.
  • An additional locum GP had been appointed to commence in August 2018.
  • The complaints process was not operated consistently. Some complainants were not receiving a timely acknowledgement or a response to their complaint.

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

  • Ensure there is an effective system for identifying, receiving, recording, handling and responding to complaints by patients and other persons in relation to the carrying on of the regulated activity.

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

Inspection carried out on 1 November 2017

During a routine inspection

Letter from the Chief Inspector of General Practice

This practice is rated as Good overall. (Previous inspection 26 January 2016 – Good)

The key questions are rated as:

Are services safe? – Good

Are services effective? – Good

Are services caring? – Good

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 population groups are rated as:

Older People – Good

People with long-term conditions – Good

Families, children and young people – Good

Working age people (including those recently retired and students – Good

People whose circumstances may make them vulnerable – Good

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

We carried out an announced comprehensive at Wokingham Medical Centre on 1 November 2017 as part of our inspection programme. As this was a comprehensive inspection we looked at all key questions and reviewed the care delivered to all population groups.

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 routinely reviewed the effectiveness and appropriateness of the care it provided. It ensured that care and treatment was delivered according to evidence- based guidelines and had a strong focus on use of research and audit in reaching clinical decisions.
  • There was a focus on continuous learning and improvement at all levels of the organisation.
  • The practice had responded to feedback from patients. A significant change in the appointment system had been undertaken having assessed patient feedback from the national GP patient survey. However, it was too early to evaluate the effect the change would have on patient feedback on access and caring.
  • Complaints were responded to in a timely manner but information for patients on how to complain was not readily available within the practice.
  • There was an active patient participation group (PPG) but the PPG sought to take a more active role in bringing patient feedback to the attention of the practice.

We saw one area of outstanding practice:

  • The practice undertook research projects. One such project included 32 of their registered patients diagnosed with diabetes. The patients underwent a change in their diet monitored by a GP and all lost weight resulting in an improvement in their health. Over 20 of the patients were able to stop taking medicines, and the others reduced their dose of medicines used, to control their diabetes.

The areas where the provider should make improvements are:

  • Providing patients with information on how to make a complaint which is both visible and accessible within the practice premises.
  • Establish effective and sustainable systems and processes to ensure actions to respond to patient feedback are monitored.
  • Consider their response to the patient participation group. For example, in provision of seating for patients that found it difficult to use low seats.

Professor Steve Field (CBE FRCP FFPH FRCGP) 

Chief Inspector of General Practice

Inspection carried out on 26 January 2016

During an inspection to make sure that the improvements required had been made

Letter from the Chief Inspector of General Practice

Our previous inspection in May 2015 found breaches of regulations relating to the safe and responsive delivery of services.

We found the practice required improvement for the provision of safe and responsive services, and was rated good for providing effective, caring and well-led services. Consequently we rated all population groups as requiring improvement.

This inspection was undertaken to check the practice was meeting regulations that were in breach from the last inspection. For this reason we have only rated the location for the key questions to which these relate. This report should be read in conjunction with the full inspection report of 9 July 2015.

We found the practice had made improvements since our last inspection. At our inspection on the 26 January 2016 we found the practice was meeting the regulations that had previously been breached.

Specifically we found:

  • The practice had a revised cold chain policy to ensure the safe storage of vaccines. For example, medicine fridge temperatures were monitored daily and records maintained.
  • The practice had developed a protocol for medicine reviews in accordance with national guidance. The practice had shown significant improvements since our previous visit in May 2015, and medicine reviews had been increased from 18% to 57%. The practice was continuing to improve this and planned to achieve 80% target by July 2017.
  • A comprehensive audit programme had been implemented to drive continuous improvement and better patient outcomes.
  • Improvements had been made to the appointment booking system. For example, additional appointments had been introduced during weekdays and the practice was offering additional extended hours during weekdays (two mornings and one evening) and every second Saturday from 8am to 12pm.
  • The practice had revised protocol for a GP call back system. For example, patients were offered to request a time range for a call back to accommodate their commitments such as work.
  • Most of the patients we spoke with on the day informed us they were satisfied with appointment booking system and were able to get appointments when they needed them.

We have amended the rating for this practice to reflect these changes. The practice is now rated good for the provision of safe and responsive services. Consequently we have amended the rating of all population groups as good.

Professor Steve Field (CBE FRCP FFPH FRCGP) 

Chief Inspector of General Practice

Inspection carried out on 6 May 2015

During a routine inspection

Letter from the Chief Inspector of General Practice

We carried out an announced comprehensive inspection at Wokingham Medical Centre on 6 May and 10 June 2015. We re-visited the practice on 10 June due to concerns with medicine review data sent to us after the initial inspection visit. This was to identify if there were significant concerns to patient welfare and safety. Overall the practice is rated as requires improvement.

We inspected this practice in September 2014 and found concerns regarding governance and monitoring of the quality of the service. We issued a requirement notice. Specifically the practice was not ensuring communication between staff was always taking place when significant concerns were identified. Staff training was not being monitored properly. Changes to protocols and practice were not always made in response to events or concerns identified. During this inspection we checked to see if improvements in these areas had been made. Improvements had been made to the process of checking test results and responding to incidents and concerns. Communication between staff had improved and training was being identified and monitored. However, we found some concerns regarding the monitoring of patients medicines and the storage of vaccines. Patients reported the appointment system sometimes caused problems for them in accessing appointments.

At this inspection we found the practice to be good for providing effective and caring services and for being well-led. The practice requires improvement in the safe and responsive domains. It also requires improvement for all of the six population groups we assessed.

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

  • The practice partnership had moved to one single location in 2014.
  • A purpose built practice was opened in 2014. The new building provided an accessible and modern practice with a broad range of facilities to meet patients’ needs.
  • Staff understood and fulfilled their responsibilities to raise concerns, and to report incidents and near misses.
  • Significant events and complaints were fully investigated and led to changes in protocol and practice.
  • Communication channels and regular meetings were available to all staff which enabled them to be involved the running of the practice.
  • Risks to patients were assessed and well managed including infection control, premises maintenance, equipment checks and emergency procedures.
  • Medicines were checked and monitored to ensure they were safe but vaccines were sometimes stored at a temperature slightly above the maximum indicated by national guidance.
  • Medicine reviews did not always take place within required timeframes to ensure ongoing treatment was appropriate.
  • Patients’ needs were assessed and care was planned and delivered following best practice guidance.
  • There was a system for following up test results and a buddy system to ensure urgent results were checked if GPs were absent.
  • Staff training was identified, monitored and undertaken to ensure staff could fulfil their roles safely and effectively.
  • Patient feedback showed they were treated with compassion, dignity and respect and they were involved in their care and decisions about their treatment.
  • Information about services and how to complain was available and easy to understand.
  • Survey data and feedback we received showed some patient dissatisfaction with the ability to see or speak with GPs, mainly associated with the appointment booking system. Some patients believed this impacted on their care.
  • The GP call back system operated by the practice made it difficult for patients who had commitments such as work to speak with a GP as call back times were unpredictable and patients said they were not given a specific all back time-slot.
  • The practice had modern facilities and was well equipped to treat patients and meet their needs.
  • There had a clear leadership structure and staff felt supported by management. The practice proactively sought feedback from staff and patients, which it acted on.

We found one area of outstanding practice:

The practice employed a nurse who worked in the local community, providing long term condition reviews, immunisations and other care to patients who found it difficult to travel to the surgery. This made accessing care and treatment much easier for patients who had limited mobility and long term health conditions.

There were areas of practice where the provider must make improvements.

  • Ensure patients receive medicine reviews in line with the timeframes identified by the practice and in line with national guidance.
  • Review the guidance used to monitor the storage of vaccines.
  • Review the appointment system to ensure it meets the needs of all patient groups.

Additionally the provider should :

  • Improve communication with the independent pharmacy located on site regarding prescriptions to avoid significant inconvenience to patients.
  • Develop a programme of clinical audit which ensures changes to patient care are embedded where they are needed.

Professor Steve Field (CBE FRCP FFPH FRCGP) 

Chief Inspector of General Practice

Inspection carried out on 23 September 2014

During an inspection in response to concerns

We inspected Wokingham Medical Practice due to concerns we received from patients and local Healthwatch. We spoke with the registered manager, who was also a GP partner, two practice managers and two members of nursing staff. We spoke with five patients. We were assisted by a GP specialist adviser.

The practice responded to patient feedback and reports from external organisations. This included feedback about the appointment system. All the patients we spoke with told us making appointments was not difficult at the practice.

Staff told us communication at the practice was good. The practice had regular meetings for all staff to attend and staff we spoke with were aware of how important information should be communicated. Three members of clinical staff were not aware of a major concern from a significant event (incidents which could affect the safety or effectiveness of the service) or the action plan prepared as a result of the event.

The practice identified significant events and investigated them. Complaints were dealt with by clinical or non-clinical leads as appropriate and responded to. The practice identified clinical audits in response to areas of concern or individual GP interests. Not all audit outcomes were shared with or available to clinical staff.

The practice did undertake a full hygiene and infection control audit.

Inspection carried out on 26 June 2014

During an inspection in response to concerns

This inspection was carried out in response to concerns raised with us about repeat prescriptions. We announced this inspection two days before we visited to ensure that the people we needed to see would be available. During this inspection we looked at the process for repeat prescriptions and talked to staff who carried out this task. We also spoke with other staff members and looked at the arrangements for medicines handling at the practice. We did not talk to people using the service during this inspection.

We found that the practice had safe arrangements for the management of medicines and prescriptions.