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The Wellington Health Centre Good

Inspection Summary


Overall summary & rating

Good

Updated 24 October 2017

Letter from the Chief Inspector of General Practice


We carried out an announced comprehensive inspection at The Wellington Medical Centre on 2 December 2014. The overall rating for the practice was good, however the rating for providing safe services was requires improvement. The full comprehensive report on the December 2014 inspection can be found by selecting the ‘all reports’ link for The Wellington Medical Centre on our website at www.cqc.org.uk.

This inspection was undertaken to check the provider had taken the action we said they must and should take and was an announced comprehensive inspection on 17 August 2017. Overall the practice is still rated as good and the rating for providing safe services has improved from requires improvement to good.

Our key findings were as follows:

  • There was an open and transparent approach to safety and a system in place for reporting and recording significant events.
  • The practice now had clearly defined and embedded systems to minimise risks to patient safety. It had taken the action we said it must and should take at our December 2014 inspection in relation to medicines management. However, we identified some shortcomings in the arrangements checking ancillary emergency equipment and prescription security.
  • 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 taken the action we said it must take at our December 2014 inspection to ensure staff training records were fully completed.
  • 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.
  • 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 majority of patients we spoke with said they found it easy to make an appointment with a named GP but some said there was not always continuity of care. Urgent appointments were available the same day.
  • The practice had adequate facilities and equipment to treat patients and meet their needs. However, there was no emergency pull cord in the disabled toilet.
  • 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 provider was aware of the requirements of the duty of candour. Examples we reviewed showed the practice complied with these requirements.

However, there were also areas of practice where the provider needs to make improvements.

The provider should:

  • Ensure prescriptions left in printers are appropriately secured.
  • Ensure recorded checks of emergency equipment include ancillary emergency equipment such as oxygen masks, suction pumps and pulse oximeters.
  • Carry out checks of emergency exit routes to ensure they remain accessible and install an emergency pull cord in the patients’ toilet.
  • Continue with efforts to improve uptake of childhood immunisations in relation to national targets.
  • Review the system for the identification of carers to ensure all carers have been identified and provided with support.


Professor Steve Field (CBE FRCP FFPH FRCGP) 

Chief Inspector of General Practice

Inspection areas

Safe

Good

Updated 24 October 2017

The practice is rated as good for providing safe services.

  • From the sample of documented examples we reviewed, we found there was an effective system for reporting and recording significant events; lessons were shared to make sure action was taken to improve safety in the practice. When things went wrong patients were informed as soon as practicable, received reasonable support, truthful information, and a written apology. They were told about any actions to improve processes to prevent the same thing happening again.
  • The practice had clearly defined and embedded systems, processes and practices to minimise risks to patient safety.
  • There were appropriate arrangements in place for the management of medicines, although prescription security needed strengthening to mitigate potential risks.
  • Staff demonstrated that they understood their responsibilities and all had received training on safeguarding children and vulnerable adults relevant to their role.
  • The practice had adequate arrangements to respond to emergencies and major incidents, although more rigorous checking of ancillary emergency equipment was needed. In addition, the emergency exit via the practice garden needed to be kept clear.

Effective

Good

Updated 24 October 2017

The practice is rated as good for providing effective services.

  • Data from the Quality and Outcomes Framework showed the majority of patient outcomes were at or above average compared to the national average.
  • Staff were aware of current evidence based guidance.
  • Clinical audits demonstrated quality improvement.
  • Staff had the skills and knowledge to deliver effective care and treatment.
  • There was evidence of appraisals and personal development plans for all staff.
  • Staff worked with other health care professionals to understand and meet the range and complexity of patients’ needs.
  • End of life care was coordinated with other services involved.

Caring

Good

Updated 24 October 2017

The practice is rated as good for providing caring services.

  • Data from the national GP patient survey showed patients rated the practice higher than others for several aspects of care.
  • Survey information we reviewed showed that patients said they were treated with compassion, dignity and respect and they were involved in decisions about their care and treatment.
  • The practice had a system in place to identify and support carers. However, less than one percent of the practice list had been identified as carers and offered support.
  • Information for patients about the services available was accessible.
  • We saw staff treated patients with kindness and respect, and maintained patient and information confidentiality.

Responsive

Good

Updated 24 October 2017

The practice is rated as good for providing responsive services.

  • The practice understood its population profile and had used this understanding to meet the needs of its population. For example, the practice provided a selection of appointments times and styles to cater for working people and students including a recently introduced walk-in service on three days in the week.
  • The practice took account of the needs and preferences of patients with life-limiting conditions, including patients with a condition other than cancer and patients living with dementia.
  • The majority of patients we spoke with said they found it easy to make an appointment with a named GP but some said there was not always continuity of care. Urgent appointments were available the same day.
  • The practice had adequate facilities and equipment to treat patients and meet their needs. However, there was no emergency pull cord in the disabled toilet.
  • Information about how to complain was available and evidence from eight examples reviewed showed the practice responded quickly to issues raised. Learning from complaints was shared with staff and other stakeholders.

Well-led

Good

Updated 24 October 2017

The practice is rated as good for being well-led.

  • The practice had a clear vision and strategy to deliver high quality care and promote good outcomes for patients. Staff were clear about the vision and their responsibilities in relation to it.
  • There was a clear leadership structure and staff felt supported by management. The practice had policies and procedures to govern activity and held regular governance meetings.
  • An overarching governance framework supported the delivery of the strategy and good quality care. This included arrangements to monitor and improve quality and identify risk.
  • Staff had received inductions, annual performance reviews and attended staff meetings and training opportunities.
  • The provider was aware of the requirements of the duty of candour. In seven examples we reviewed we saw evidence the practice complied with these requirements.
  • The partners encouraged a culture of openness and honesty. The practice had systems for being aware of notifiable safety incidents and sharing the information with staff and ensuring appropriate action was taken.
  • The practice proactively sought feedback from staff and patients and we saw examples where feedback had been acted on. The practice engaged with the patient participation group.
  • There was a focus on continuous learning and improvement at all levels. Staff training was a priority and was built into staff rotas.
  • GPs who were skilled in specialist areas used their expertise to offer additional services to patients.
Checks on specific services

People with long term conditions

Good

Updated 24 October 2017

The practice is rated as good for the care of people with long-term conditions.

  • Nursing staff had lead roles in long-term disease management and patients at risk of hospital admission were identified as a priority.
  • QOF performance for diabetes related indicators was similar to CCG and national averages: 86% compared to 80% and 90% respectively. The needs of new diabetic patients were reviewed and referred to appropriate education programme, a dietician and eye screening.
  • The practice followed up on patients with long-term conditions discharged from hospital and ensured that their care plans were updated to reflect any additional needs.
  • There were emergency processes for patients with long-term conditions who experienced a sudden deterioration in health.
  • All these patients had a named GP and there was a computerised system to recall patients for a structured annual review to check their health and medicines needs were being met. Reviews were also conducted opportunistically during consultations.
  • 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.

Families, children and young people

Good

Updated 24 October 2017

The practice is rated as good for the care of families, children and young people.

  • From the sample of documented examples we reviewed we found there were systems 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 accident and emergency (A&E) attendances.
  • The practice was involved in a scheme to provide a general paediatric opinion on un-complicated cases of childhood illness on a rotating basis. Meetings were held monthly in conjunction with neighbouring practices.
  • Immunisation uptake rates for the standard childhood immunisations were below national targets based on the latest published data. The practice recognised improving immunisation performance was a challenge and followed up with families in an attempt to increase uptake.
  • Children and young people were treated in an age-appropriate way and were recognised as individuals.
  • Appointments were available outside of school hours and the premises were suitable for children and babies.
  • The practice worked with midwives, health visitors and school nurses to support this population group. For example, in the provision of ante-natal, post-natal and child health surveillance clinics.
  • The practice had emergency processes for acutely ill children and young people.

Older people

Good

Updated 24 October 2017

The practice is rated as good for the care of older people.

  • Staff were able to recognise the signs of abuse in older patients and knew how to escalate any concerns.
  • The practice offered proactive, personalised care to meet the needs of the older patients in its population.
  • The practice was responsive to the needs of older patients, and offered home visits and urgent appointments for those with enhanced needs.
  • The practice identified at an early stage older patients who may need palliative care as they were approaching the end of life. It involved older patients in planning and making decisions about their care, including their end of life care.
  • The practice followed up on older patients discharged from hospital and ensured that their care plans were updated to reflect any extra needs.
  • Where older patients had complex needs, the practice shared summary care records with local care services.
  • The practice offered respite care for carers and the practice’s patient participation group had a support group for elderly patients who could provide support at home if needed.
  • Older patients were provided with health promotional advice and support to help them to maintain their health and independence for as long as possible.

Working age people (including those recently retired and students)

Good

Updated 24 October 2017

The practice is rated as good for the care of working age people (including those recently retired and students).

  • The needs of these populations 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, the practice provided a selection of appointments times and styles to cater for working people and students including a recently introduced walk-in service on three days in the week.
  • There was an on-site care navigator who facilitated access to health promotion services such as exercise on prescription.
  • The practice offered well person checks to discuss lifestyle and advise patients on ways to minimise health risk factors.
  • An on-site counsellor provided support to patients in this group for mental health problems.
  • 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.

People experiencing poor mental health (including people with dementia)

Good

Updated 24 October 2017

The practice is rated as good for the care of people experiencing poor mental health (including people with dementia).

  • The practice carried out advance care planning for patients living with dementia.
  • 94% of patients diagnosed with dementia had their care reviewed in a face to face meeting in the last 12 months, which was higher than the national average.
  • The practice specifically considered the physical health needs of patients with poor mental health and dementia.
  • The practice had a system for monitoring repeat prescribing for patients receiving medicines for mental health needs.
  • Performance for mental health related indicators was just higher than the CCG but lower than the national averages: 86% compared to 85% and 93% respectively.
  • The practice regularly worked with multi-disciplinary teams in the case management of patients experiencing poor mental health, including those living with dementia.
  • The practice held six monthly mental health reviews on patients with serious and complex mental health problems attended by a consultant adult psychiatrist and a psychogeriatrician (a psychiatrist concerned with behavioural and emotional disorders among the elderly) where patients on the practice mental health register were discussed.
  • The practice hosted a weekly session where a healthcare professional from the local Community Mental Health Team (CMHT) saw referred patients to advise on treatment, signpost or refer on to secondary care where appropriate.
  • Patients at risk of dementia were identified and offered an assessment.
  • The practice had information available for patients experiencing poor mental health about how they could access various support groups and voluntary organisations.
  • The practice had a system to follow up patients who had attended accident and emergency where they may have been experiencing poor mental health.
  • Staff interviewed had a good understanding of how to support patients with mental health needs and dementia.

People whose circumstances may make them vulnerable

Good

Updated 24 October 2017

The practice is rated as good for the care of people whose circumstances may make them vulnerable.

  • The practice held a register of patients living in vulnerable circumstances and those with a learning disability. The practice regularly discussed cases of concern at weekly practice meetings and reviewed the vulnerable patient list annually.
  • End of life care was delivered in a coordinated way which took into account the needs of those whose circumstances may make them vulnerable.
  • 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 had information available for vulnerable patients about how to access various support groups and voluntary organisations.
  • Staff interviewed knew how to recognise signs of abuse in children, young people and adults whose circumstances may make them vulnerable. They 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.