Archived: West End Surgery

Updated 8 December 2016

West End Surgery provides primary medical services to approximately 4080 patients through a general medical services contract (GMS). Services are provided to patients from a practice in Beeston, Nottingham. The level of deprivation within the practice population is above the national average.

The medical team is undergoing change due to a partnership being developed between the current single handed GP and a care provider. At the time of inspection the clinical team comprised of three GPs (one female and two male), which had reduced the need for locums. In addition there was a practice nurse and a healthcare assistant. Supporting the clinical team was a practice manager, and administration and reception staff and the partnered care provider assisting in back office support.

The practice is open between the hours of 8am and 6:30pm. GP appointments are available from 8:50am to 11.30am every morning and from 3.30pm to 6pm every afternoon. Extended hours surgeries are offered on Thursday and Friday mornings from 7am.

The practice has opted out of providing out-of-hours services to its own patients. This service is provided by Nottingham Emergency Medical Services (NEMS).

Updated 8 December 2016

Letter from the Chief Inspector of General Practice

We carried out an announced comprehensive inspection on 6 September 2016 to check improvements had been made since our initial inspection; overall the practice is rated as requires improvement.

We initially carried out an announced comprehensive inspection at West End Surgery on 11 January 2016. The practice was rated inadequate for providing safe, effective, responsive and well-led services and requires improvement for providing caring services. The overall rating for the practice was inadequate and it was placed in special measures for a period of six months.

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

• There was an open and transparent approach to safety within the practice. Effective systems were in place to report, record and learn from significant events.

• Risks to patients were assessed and well managed.

• Staff assessed patients’ needs and delivered care in line with current evidence based guidance.

• Training was provided for staff which equipped them with the skills, knowledge and experience to deliver effective care and treatment.

• Patients said they were treated with compassion, dignity and respect and they were involved in their care and decisions about their treatment.

• Patients told us they were generally able to get an appointment with a GP when they needed one, with urgent appointments available on the same day, and that continuity had improved with the appointment of two additional GPs and less dependence on locums.

• Information about services and how to complain was available and easy to understand. Improvements were made to the quality of care as a result of complaints and concerns.

• There was a clear leadership structure and staff felt supported by management. The practice sought feedback from staff and patients, which it acted on.

• The practice had forged links with neighbouring practices, previously rated as outstanding in at least one domain, to share ideas and create a forum for discussion with the intention of improving services provided to patients.

However there was one area the practice must still make improvements:

• Ensure all clinical staff have undergone appropriate background checks.

At this inspection we found the provider had increased their capacity, both in terms of management and clinical staff, to ensure changes were being made towards making and sustaining improvements in quality. I am therefore taking this service out of special measures. This recognises the improvements being made to the quality of care provided by this service.

Professor Steve Field (CBE FRCP FFPH FRCGP) 

Chief Inspector of General Practice

Updated 8 December 2016

The practice is rated as requires improvement for the care of people with long-term conditions. The practice is rated as requires improvement for all domains. The concerns that led to these ratings apply to everybody using this practice including this population group.

• Clinical staff had lead roles in chronic disease management and patients at risk of hospital admission were identified as a priority.

• Longer appointments and home visits were available when needed.

• All these patients had a named GP and were offered a structured annual review to check their health and medicines needs were being met.

• For patients with the most complex needs, practice staff worked with relevant health and care professionals to deliver a multidisciplinary package of care.

• The practice was actively communicating with patients with long term conditions to ensure they were aware of their eligibility for a yearly flu vaccination.

Updated 8 December 2016

The practice is rated as requires improvement for the care of families, children and young people. The practice is rated as requires improvement for all domains. The concerns that led to these ratings apply to everybody using this practice including this population group.

• Systems were in place to identify children at risk. The practice had a dedicated child safeguarding lead and deputy lead who oversaw children’s safeguarding referrals, and staff were aware of who these were.

• There were systems in place to identify and follow up children living in disadvantaged circumstances and who were at risk, for example, children and young people who had a high number of A&E attendances. The GP lead for safeguarding liaised with other health and care professionals to discuss children at risk.

• The whooping cough vaccine was offered to all women who were 28 weeks pregnant and over.

• The practice offered contraception services including coil fitting and implants.

• Patients told us that children and young people were treated in an age-appropriate way and were recognised as individuals.

• Urgent appointments were available on a daily basis to accommodate children who were unwell and seen within four hours of initial contact.

Updated 8 December 2016

The practice is rated as requires improvement for the care of older people. The practice is rated as requires improvement for all domains. The concerns that led to these ratings apply to everybody using this practice including this population group.

• The practice offered proactive, personalised care to meet the needs of the older people in its population. Monthly multidisciplinary meetings were held to review frail patients and those at risk of hospital admission to plan and deliver care appropriate to their needs.

• The practice was responsive to the needs of older people, and offered home visits and urgent appointments for those with enhanced needs.

• To aid communication with patients, details of support workers and carers were recorded on the patient’s record.

• Care and nursing homes were visited regularly and by the same GP to enhance continuity of care. A direct telephone number to the practice was available for these homes to aid in communication and ensure advice was given in a timely manner.

Updated 8 December 2016

The practice is rated as requires improvement for the care of working-age people (including those recently retired and students). The practice is rated as requires improvement for all domains. The concerns that led to these ratings apply to everybody using this practice including this population group.

• The needs of the working age population, those recently retired and students had been identified and the practice had adjusted the services it offered to ensure these were accessible and flexible.

• Extended hours services were offered two mornings per week to facilitate access for working patients.

• The practice was proactive in offering online services as well as a full range of health promotion and screening that reflects the needs for this age group.

• Each GP had a task list which reception could log medication enquiries or medical certificate requests to be completed on behalf of patients.

Updated 8 December 2016

The practice is rated as requires improvement for the care of people experiencing poor mental health (including people with dementia). The practice is rated as requires improvement for all domains. The concerns that led to these ratings apply to everybody using this practice including this population group.

• The practice regularly worked with multi-disciplinary teams in the case management of patients experiencing poor mental health, including those with dementia.

• Patients with a diagnosis of dementia were offered double appointments to ensure care was delivered in an appropriate manner.

• The practice had told patients experiencing poor mental health about how to access various support groups and voluntary organisations and contact information for self-referral to the mental health service was available through reception.

• The practice was taking part in the dementia enhanced service, and those with a diagnosis of dementia were being reviewed to ensure correct diagnosis and correct care is maintained.

Updated 8 December 2016

The practice is rated as requires improvement for the care of people whose circumstances may make them vulnerable. The practice is rated as requires improvement for all domains. The concerns that led to these ratings apply to everybody using this practice including this population group.

• The practice held a register of patients living in vulnerable circumstances including those with a learning disability and those at risk of a fall.

• The practice offered longer appointments for patients with a learning disability and for those who required it.

• The practice regularly worked with other health care professionals in the case management of vulnerable patients. Monthly multidisciplinary meetings were hosted by the practice.

• Patients who were registered blind and those who were hard of hearing had alert on their patients’ home screen to allow staff to be aware they might need additional assistance getting to their consultation.

• Staff knew how to recognise signs of abuse in vulnerable adults and children. Staff were aware of their responsibilities regarding information sharing, documentation of safeguarding concerns and how to contact relevant agencies in normal working hours and out of hours was in each clinical room.

• The practice had identified 38 patients as carers which was equivalent to 1% of the practice list. The practice had information displayed in the waiting area and on the practice website to inform carers about the support that was available to them and to encourage them to identify themselves to practice staff.