Archived: Windermere and Bowness Medical Practice

We carried out an announced focused inspection at Windermere and Bowness Medical Practice on 17 January 2020. We had previously inspected the practice in November 2018 where the practice overall rating was good, with the key question of effective rated as requires improvement.

We issued the practice with a requirement notice for a breach of Regulation 18 of the Health and Social Care Act 2008 (Regulated Activities) Regulations 2014 (Staffing) following the previous inspection. The full comprehensive report following the inspection in November 2018 can be found on our website here: https://www.cqc.org.uk

We also carried out a scheduled annual review of the information available to us including information provided by the practice before this inspection. Our review indicated that there may have been a significant change to the quality of care provided since the last inspection.

We carried out our most recent inspection in order to ensure the practice had implemented appropriate improvements following our inspection in November 2018 and as a result of our subsequent annual review.

This inspection focused on the following key questions: well-led, effective and responsive.

Because of the assurance received from our review of information we carried forward the ratings for the following key questions: safe and caring.

This inspection identified improvements in the effectiveness of the service and that good ratings for other key questions had been sustained.

We based our judgement of the quality of care at 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 rated this practice as good overall and good for all population groups.

We found that:

• The practice provided care in a way that kept patients safe and protected them from avoidable harm.
• Patients received effective care and treatment that met their needs.
• Areas of clinical staff support, training, professional development, supervision and appraisal had been addressed and comprehensive procedures put in place.
• The practice organised and delivered services to meet patients’ needs. Patients could access care and treatment in a timely way.
• The way the practice was led and managed promoted the delivery of high-quality, person-centre care.

We saw the following outstanding practice:

• The practice musculoskeletal (MSK) clinician had recognised the need to support patients who had had a fall and lost confidence in mobilising. They developed a monthly “Bounce Back” clinic to offer care and support for all local patients. The service had recently been nominated for a primary care innovation award.

Whilst we found no breaches of regulations, the provider should:

• Improve the practice clinical audit programme to ensure two-cycle audits are carried out.
• Improve records of all clinical staff training.
• Implement a formal policy and procedure for the management of communications coming into the practice including a GP audit of items removed, not seen by a clinician.

Details of our findings and the evidence supporting our ratings are set out in the evidence tables.

Dr Rosie Benneyworth BM BS BMedSci MRCGP

Chief Inspector of Primary Medical Services and Integrated Care

This practice is rated as Good overall. (Previous inspection February 2017 – Good)

The key questions are rated as:

Are services safe? – Good

Are services effective? – Requires improvement

Are services caring? – Good

Are services responsive? – Good

Are services well-led? – Good

We carried out an announced comprehensive inspection at Windermere and Bowness Medical Practice on 22 November 2018. This inspection was planned and undertaken as part of our inspection programme and as part of a wider inspection of the provider (One Medicare Ltd). The provider had agreed to contribute to our Primary Care at Scale project.

At this inspection we found:

• The practice had systems to keep patients safe and safeguarded from abuse.
• 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.
• The practice were actively advertising for salaried GPs as recently, established staff had left the practice. This had been a challenge for all the staff at the practice.
• The practice routinely reviewed the effectiveness and appropriateness of the care they provided. They ensured that care and treatment was delivered according to evidence- based guidelines.
• Staff involved and treated patients with compassion, kindness, dignity and respect.
• Results from the National GP Survey were above local and national scores. However, recent feedback from some patients reflected that they were unhappy with the staffing changes at the practice. The provider told us that established GP’s had chosen to leave the service to move on to the next stage of their careers.
• The practice organised and delivered services to meet patients’ needs. They took account of patient needs and preferences.
• Feedback from the National GP Survey regarding access was positive, however more recent feedback provided to us by some patients said that access was not as good as it had previously been.
• There was a focus on continuous learning and improvement at all levels of the organisation. The practice proactively used performance information to drive improvement.

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

• Ensure persons employed in the provision of the regulated activity receive the appropriate support, training, professional development, supervision and appraisal necessary to enable them to carry out their duties.

See Requirement Notice Section at the end of this report for further details

The areas where the provider should make improvements are:

• Review and improve the frequency of fire drills.
• Assure themselves that patients know how to escalate complaints and concerns about services provided by the practice, should they be unhappy with the initial response from the practice.

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