The Wilberforce Surgery

Letter from the Chief Inspector of General Practice

We carried out an announced comprehensive inspection at The Wilberforce Surgery on 23 August 2017. The overall rating for the practice was requires improvement.

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

• There was an open and transparent approach to safety and a system in place for reporting and recording significant events. However, when things went wrong reviews and investigations into significant events were not thorough enough and lessons learned were not communicated widely enough to support improvement.
• The practice did not have clearly defined and embedded systems to minimise risks to patient safety, in relation to recall of patients on high risk medicines and the monitoring of vulnerable patients at the practice. For example, the system for completing a review of patient safeguarding cases was not fully implemented and required review and no safeguarding meetings had taken place and the review of vulnerable adults was infrequent.
• Staff were aware of current evidence based guidance. Staff had been trained to provide them with the skills and knowledge to deliver effective care and treatment.

• The practice had not completed infection control audits or adopted any action plans for review.

• The monitoring of the refrigerator temperature checks was not robust and there were gaps in the recording of the refrigerator temperatures.

• Patient Group Directions (PGDs) had been adopted by the practice to allow nurses to administer medicines in line with legislation. Not all PGDs were they readily available during the inspection.

• Results from the national GP patient survey showed patients were treated with compassion, dignity and respect and were involved in their care and decisions about their treatment.
• Patients we spoke with said they found it easy to make an appointment with the GP and there was continuity of care, with urgent appointments available the same day.

• The practice did not have adequate arrangements to respond to emergencies and major incidents. For example, there was no oxygen available at the time of our visit and arrangements for access to a defibrillator had not been established.

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

The areas where the provider must make improvements are:

• Ensure care and treatment is provided in a safe way to patients.

• Establish effective systems and processes to ensure good governance in accordance with the fundamental standards of care.

The areas where the provider should make improvements are:

• Although patient feedback is being sought in other ways, the practice should develop the patient participation group (PPG) to drive improvement through further suggestions from a patient perspective.

• Although the provider had a complaints process in place we did not see a transparent system for ensuring patients were aware of what to do in the event they need to make a complaint. For example, there was no information available for patients in the waiting area which explained what to do in the event of a complaint.

• Review the system that identifies patients who are also carers to help ensure that all patients on the practice list who are carers are offered relevant support if appropriate.

• Although team meetings take place on an ad-hoc basis the practice should develop a more regular review for staff to have

• The practice should arrange and hold multi-disciplinary meetings on a frequent basis including meetings with district nurses, social workers and health visitors to monitor vulnerable patients.

• The practice’s uptake for the cervical screening programme was 69%, which was worse than the local CCG average of 81% and the national average of 81%. The practice should review their process for the recall of patients.

Professor Steve Field (CBE FRCP FFPH FRCGP) 

Chief Inspector of General Practice