Archived: Westfield Medical Centre

Letter from the Chief Inspector of General Practice

We carried out an announced comprehensive inspection at Westfield Medical Centre on 23 August 2017. Overall the practice is rated as requires improvement.

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

• There was a system in place for reporting and recording significant events. However, we did not see evidence that these were routinely discussed at monthly clinical meetings, and we were told these were not routinely shared with non-clinical staff.

• The practice had a number of systems to minimise risks to patient safety but these were not always effective. For example, the practice had access to a defibrillator which was located in the same building. The practice did not have oversight of this and could not assure themselves that should it be required in an emergency, it would be in good working order. The practice did not keep medications which could be used to treat severe pain or sickness and did not have a risk assessment in place to support this decision.
• 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.
• Patients we spoke with on the day agreed with the results from the national GP patient survey which showed patients were treated with compassion, dignity and respect and were involved in their care and decisions about their treatment.
• Risks to patients were assessed and well managed, with the exception of those relating to recruitment checks. The practice could not provide references to show satisfactory evidence of conduct in previous employment for two members of staff.
• Patient satisfaction regarding consultations with nursing staff was particularly high. For example, 100% of patients stated that they had confidence and trust in the last nurse they saw or spoke to.
• Information about services and how to complain was available. Improvements were made to the quality of care as a result of complaints and concerns.
• The practice had good facilities and was well equipped to treat patients and meet their needs.
• We did not see evidence that quality improvement activity was driving improvements to patient outcomes.
• There was a clear leadership structure and staff felt supported by management. The practice had a patient participation group which met regularly.
• The provider was aware of the requirements of the duty of candour. Examples we reviewed showed the practice complied with these requirements.
• Regular clinical meetings were held and documented. However, minutes were not taken at the nurse meetings and a documented record of what was discussed was not available.

Professor Steve Field (CBE FRCP FFPH FRCGP) 

Chief Inspector of General Practice

The areas where the provider must make improvements are:

• The provider must establish effective systems and processes to ensure good governance in accordance with the fundamental standards of care.

In addition the provider should:

• Review the practice of not documenting appraisals for non-clinical staff and be able to evidence the discussions, development and training needs of the staff.
• Improve the documentation of all clinical meetings to ensure that all staff are aware of the discussions which have taken place and to enable the ongoing review of issues, concerns and events.
• Assure themselves that the level of safeguarding training for all staff including GPs is appropriate.
• Improve the identification of carers and maintain a register to enable this group of patients to access the care and support they require.
• Review their system for discussing significant events and complaints and be able to assure themselves that these are reviewed at regular intervals and shared with the staff team.