Archived: Westcotes GP Surgery

Updated 23 November 2016

The provider holds two separate contracts with NHS England to provide services for two separate patient lists, Westcotes GP Surgery 1 and Westcotes GP Surgery 2, both provided from one location ‘Westcotes GP Surgery’. Westcotes GP Surgery provides primary medical services to a combined patient list of approximately 2,608 patients in Leicester City. (Throughout this report, some areas of performance related data and national patient survey results refers to both Westcotes GP Surgery 1 and 2).

Westcotes GP Surgery is registered with the Care Quality Commission to provide the regulated activities of; the treatment of disease, disorder and injury; diagnostic and screening procedures; maternity and midwifery services and surgical procedures.

The practice has a General Medical Services (GMS) contract. The GMS contract is the contract between general practices and NHS England for delivering care services to local communities.

At the time of our inspection the practice employed a practice manager, assistant practice manager, a phlebotomist, eight reception and administration staff, 2 practice nurses and one domestic.

The surgery is open from 8am until 6.30pm Monday to Friday. The practice provides extended opening hours until 7.30pm on a Wednesday. The practice is part of a pilot scheme within Leicester City which  offers patients an evening and weekend appointment with either a GP or advanced nurse practitioner at one of four healthcare hub centres. Appointments are available from 6.30pm until 10pm Monday to Friday and from 9am until 10pm on weekends and bank holidays. Appointments are available by walk in, telephone booking or direct referral from NHS 111.

The practice is a training practice and delivers training to Foundation Year 2 Doctors (FY2). An FY2 is a fully qualified Doctor who is registered with the General Medical Council (GMC) who is training to become a GP.

The practice has an active patient participation group (PPG) which has been in place for four years who meet on a bi-monthly basis.

The practice has a higher population of patients between the ages of 25-44 years of age and also 45-59 years of age. 56.1% of the patient population have a long standing health condition which is higher than the clinical commissioning group (CCG) average of 51.7%.

The practice offers on-line services for patients including ordering repeat prescriptions, booking routine appointments and access to patient summary care record.

The practice lies within the NHS Leicester City Clinical Commissioning Group (CCG). A CCG is an organisation that brings together local GPs and experienced health professionals to take on commissioning responsibilities for local health services.

The practice is a member of a Federation called ‘Millennium’ within Leicester City CCG. A Federation is a group of GP practices that work collaboratively with a shared mission and vision to share best practice and provide a greater range of services for patients. The Federation has been successful in the provision of a clinical pharmacist working within the ten GP practices. The lead GP is the Deputy Chair of this Federation.

It is an active member of the local Primary Care Research Network Centre, England (PCRNCE) which is funded by the Department of health to undertake research to improve health care.

Updated 23 November 2016

Letter from the Chief Inspector of General Practice

We carried out an announced comprehensive inspection at Westcotes GP Surgery on 21 June 2016. Overall the practice is rated as requires improvement.

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

• There was an open and transparent approach to safety and an effective system in place for reporting and recording significant events.

• Risks to patients were assessed and well managed.

• Staff assessed patients’ needs and delivered care in line with current evidence based guidance. Staff had been trained to provide them with the skills, knowledge and experience to deliver effective care and treatment.

• 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 proactively sought feedback from staff and patients, which it acted on.

• The practice ensured all staff received regular appraisals. All members of staff received regular reviews of their performance which included a report and a rating.

• Data showed patient outcomes were low compared to the national average. The practice had employed two practice nurses to improve the range of services offered to patients.

• Patients said they did not always find it easy to make an appointment with a named GP or that there was continuity of care, with urgent appointments available the same day.

The areas where the provider must make improvements are:

• Address the issues highlighted in the national GP patient survey in order to improve patient satisfaction, including those in relation to appointment access and consultations with GPs and nurses.

• Ensure there is an effective system in place to manage and monitor processes to improve outcomes for patients.

The areas where the provider should make improvement are:

• Review process and methods for identification of carers and the system for recording this. To enable support and advice to be offered to those that require it.

Professor Steve Field (CBE FRCP FFPH FRCGP) 

Chief Inspector of General Practice

Updated 23 November 2016

The provider was rated as requires improvement for providing a caring, effective, responsive and well led service, good for being safe. The issues identified as requiring improvement overall affected all patients including this population group. There were, however, examples of good practice.

• Nursing 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.

• The practice participated in an admissions avoidance scheme and delivered personalised care plans and regular reviews for patients with a long term condition with a view to deliver more personalised care and to reduce emergency or unplanned hospital admissions.

• The practice allocated a ‘tracker’ who were non-clinical members of staff, to patients identified as vulnerable and at risk of unplanned admission to hospital. Their role was to contact patients on a monthly basis to ensure they had a point of contact in the practice and ensured patients’ needs were met. The tracker would also give patients advice on local support groups and organisations that may be helpful to them to ensure their social needs were met.

• All these patients had a named GP and a structured annual review to check their health and medicines needs were being met. For those patients with the most complex needs, the named GP worked with relevant health and care professionals to deliver a multidisciplinary package of care.

• The practice held bi-monthly Gold Standard Framework (GSF) meetings to review and discuss the needs of all palliative patients.

• There was a GP lead for patients who were at end of life.

• The practice held weekly meetings with district nursing teams.

• Performance for diabetes related indicators was 52% which was lower than the CCG average of 85% and the national average of 89%. (This included an exception reporting rate of 11.7% which was comparable to the national average of 11%). (Westcotes GP Surgery 1).

• Performance for diabetes related indicators was 76% which was lower than the CCG average of 85% and the national average of 89%. (Westcotes GP Surgery 2).

Updated 23 November 2016

The provider was rated as requires improvement for providing a caring, effective, responsive and well led service, good for being safe. The issues identified as requiring improvement overall affected all patients including this population group. There were, however, examples of good practice.

• 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

• Patients told us that children and young people were treated in an age-appropriate way and were recognised as individuals, and we saw evidence to confirm this.

• Appointments were available outside of school hours and the premises were suitable for children and babies.

• We saw positive examples of joint working with midwives, health visitors and school nurses.

• The lead GP had attended Gillick Competence and Fraser Guidelines training.

• The practice liaised with health visiting teams on a weekly basis.

• Midwifery led clinics were held in the practice on a two weekly basis.

• The practice reviewed children whose appointment had not been attended and where there had been no notification of cancellation. Any concerns relating to these children were discussed with health visiting teams on a weekly basis.

• Immunisation rates for the standard childhood immunisations were mixed. For example, childhood immunisation rates for the vaccinations given to under two year olds ranged from 82% to 88% and five year olds from 73% to 80% during 2014-15.  However, rates for some of the vaccinations given had improved with some higher than local and national averages.

• The practice’s uptake for the cervical screening programme was 82%, which was better than the CCG average of 69% and the national average of 74%. (Westcotes GP Surgery 1).

• The practice’s uptake for the cervical screening programme was 72%, which was better than the CCG average of 69% and the national average of 74%. (Westcotes GP Surgery 2).

Updated 23 November 2016

The provider was rated as requires improvement for providing a caring, effective, responsive and well led service, good for being safe. The issues identified as requiring improvement overall affected all patients including this population group. There were, however, examples of good practice.

• The practice offered proactive, personalised care to meet the needs of the older people in its population.

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

• The practice participated in a care navigation scheme which provided a wide range of support to older people through home visits from a care navigator to help them remain healthy and to help patients carry on living in their own homes.

• Patients received personalised care plans from a named GP to support continuity of care.

• The premises were accessible to patients with mobility difficulties.

Updated 23 November 2016

The provider was rated as requires improvement for providing a caring, effective, responsive and well led service, good for being safe. The issues identified as requiring improvement overall affected all patients including this population group. There were, however, examples of good practice.

• 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, flexible and offered continuity of care. For example, extended hours appointments were available and online services such as ordering repeat prescriptions and appointment booking for the convenience of patients who worked or had other commitments during the day.

• 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.

• An automated arrival machine was available to give patients the opportunity to arrive themselves for their appointment rather than speak to a receptionist.

Updated 23 November 2016

The provider was rated as requires improvement for providing a caring, effective, responsive and well led service, good for being safe. The issues identified as requiring improvement overall affected all patients including this population group. There were, however, examples of good practice.

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

• The practice carried out advance care planning for patients with dementia.

• The practice had told patients experiencing poor mental health about how to access various support groups and voluntary organisations.

• The practice had a system in place to follow up patients who had attended accident and emergency where they may have been experiencing poor mental health.

• Staff had a good understanding of how to support patients with mental health needs and dementia.

• All clinical staff had attended Mental Capacity Act (MCA) training.

• Performance for mental health related indicators was 92% which was higher than the CCG average of 90% and the national average of 93%. (This included an exception reporting rate of 19% which was higher than the national average of 11%). (Westcotes GP Surgery 1).

• Performance for mental health related indicators was 71% which was lower than the CCG average of 90% and the national average of 93%. (Westcotes GP Surgery 2).

Updated 23 November 2016

The provider was rated as requires improvement for providing a caring, effective, responsive and well led service, good for being safe. The issues identified as requiring improvement overall affected all patients including this population group. There were, however, examples of good practice.

• The practice held a register of patients living in vulnerable circumstances including homeless people, travellers and those with a learning disability.

• The practice offered longer appointments for patients with a learning disability.

• The practice regularly worked with other health care professionals in the case management of vulnerable patients.

• The practice informed vulnerable patients about how to access various support groups and voluntary organisations.

• 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.