Windmill Surgery

Updated 18 October 2017

Windmill Surgery is registered with the Care Quality Commission (CQC) as a partnership of three with a senior GP partner and two other GP partners. The practice was established in 1992 and is located in the outskirts of Coventry city centre having moved in 2006 from the original premises in Windmill Road to purpose built premises. The practice has good transport links for patients travelling by public transport and has parking facilities for staff and patients. The practice has a General Medical Services contract with NHS England to provide medical services.

The practice is situated within the Longford Primary Care Centre, a joint healthcare facility that houses two GP practices and community services. Since our inspection on 7 November 2016, a third practice located within the building has closed and Windmill Surgery gained an additional 1400 patients, meaning 6700 patients are now registered at the practice.

The practice team consists of three partners, two male, one female. The partners are supported by one regular locum GP (female). The nursing team consists of two specialist practice nurses. Clinical staff are supported by a full time practice manager, a business manager and five administration/reception staff. In addition to the GP partners, there are a total of nine staff employed either full or part time hours to meet the needs of patients.

The practice is open every week day between 8.45am and 6.30pm. Appointments are available from 9am to 12.30pm and from 2pm to 6.30pm each week day except for on a Thursday when the last appointment is 3pm with an on call service provided by the practice until 6.30pm. The practice offers e xtended hours each week day from 6.30pm to 9.30pm and on Saturday and Sunday mornings from 9am to 12 noon. The practice does not provide an out-of-hours service to its patients but has alternative arrangements for patients to be seen when the practice is closed. Patients are directed to the out of hours service via the NHS 111 service.

It provides Directed Enhanced Services, such as the childhood immunisations, asthma and diabetic reviews. Separately the practice provided a number of services that included joint injections and learning disability health checks.

Updated 18 October 2017

Letter from the Chief Inspector of General Practice

We previously carried out an announced comprehensive inspection at Windmill Surgery on 7 November 2016. Overall the practice was rated as good overall, with the effective domain rated as requires improvement. The full comprehensive report on the November 2016 inspection can be found by selecting the ‘all reports’ link for Windmill Surgery on our website at www.cqc.org.uk.

This inspection was a follow up focused inspection carried out on 5 September 2017 to confirm that the practice had carried out their plan to meet the legal requirements in relation to the breaches in regulations that we identified in our previous inspection on 7 November 2016. This report covers our findings in relation to those requirements and also additional improvements made since our last inspection.

Effective is now rated as Good and overall the practice rating remains good.

Our key findings were as follows:

• The practice had implemented an effective system to manage patients with long-term conditions ensuring that regular reviews were undertaken. We saw evidence that progress was regularly reviewed at clinical staff meetings.

• The practice obtained written consent from patients when administering joint injections and recorded this with the patient’s notes.

• A programme of internal audits to monitor safety and drive improvement within the practice had been introduced. They included implementation of clinical guidelines.

• Patients on repeat medications received regular reviews.

• The physical and mental health of all newly appointed staff had been considered to ensure they were suitable to carry out the requirements of the role. This included a medical checklist and appropriate changes to the Reasonable Adjustments Policy.

• The practice had improved the management of alerts such as those from the Medicines and Healthcare products Regulatory Agency (MHRA) by ensuring it was noted when action did not need to be taken.

• Infection prevention control audits were carried out in accordance with nationally recognised guidelines and completed every six months.

• The practice had reviewed the systems for information sharing to consider how it could be more accessible. The practice had changed the way it stored internal documents to ensure information was easily available for staff and had briefed staff accordingly.

Professor Steve Field CBE FRCP FFPH FRCGP

Chief Inspector of General Practice

Updated 18 October 2017

The provider had resolved the concerns identified at our inspection on 7 November 2016 regarding the lack of an effective procedure to manage and regularly review patients with long-term conditions. This applied to everyone within this population group. An appropriate procedure had now been introduced and the population group rating has been updated to reflect this.

Updated 16 January 2017

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

• 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 did not attend hospital appointments. The provider liaised with both health visitors and school nurses.
• Immunisation uptake rates for standard childhood immunisations were similar to the local clinical commissioning group (CCG) and national averages.
• Patients told us that 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 offered contraceptive services and signposted patients to a community sexual health clinic.
• The practice’s uptake for the cervical screening programme was 76%, which was comparable to the national average of 82%.

Updated 16 January 2017

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

• The practice offered personalised care to meet the needs of the older people in its population and provided a service to a care home that housed elderly patients in need of short term respite care.
• The practice offered GP and nurse home visits to older people who were housebound only. For example to perform heart monitoring and diabetic foot checks.
• Flexible appointments were available for older patients.
• All patients aged 75 and over were offered a health check including blood tests.
• Practice staff used their knowledge of different languages to assist elderly patients from a minority background (mainly South Asian) to come in for checks and be signposted to community services or activities such as day care.
• The practice had regular meetings with the Integrated Neighbourhood Team, a group of health and social care professionals over 60 years of age who helped with the care of the frail and elderly.

Updated 16 January 2017

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

• 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.
• The practice offered extended opening hours through membership of GP Alliance (a federation of local GP practices that provided extended hours appointments from three local hubs) and the appointment telephone line was easily accessible to patients who worked during the day.
• The practice was proactive in offering online services as well as a full range of health promotion and screening that reflected the needs for this age group.

Updated 16 January 2017

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

• The practice regularly worked with multi-disciplinary teams in the case management of people who experienced poor mental health, including those with dementia.
• The practice held a register of patients who experienced poor mental health. Clinical data for the year 2015/16 showed that 40% of patients on the practice register who experienced poor mental health had a comprehensive agreed care plan. This was significantly lower than the CCG average of 86% and national average of 89%.
• The practice had told patients experiencing poor mental health about how to access various support groups and voluntary organisations. For example, the Child and Adolescent Mental Health Team (CAMHS).
• The percentage of patients diagnosed with dementia, whose care had been reviewed in a face to face review in the preceding 12 months was 73%, which was below the CCG average of 81% and the national average of 84%. The exception reporting rate was nil compared to the CCG average of 6.3% and the national average of 6.8% meaning more patients had been seen.
• There were a number of examples of where the reception team supported patients with mental health problems. For example, one wheelchair repair, injections delivered to the surgery, patient with anxiety problems.

Updated 16 January 2017

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

• The practice held a register of 45 patients with a learning disability. All were invited for annual health checks and 22 checks had been carried out in the last 12 months. The practice engaged in awareness training with nurses from the Community Learning Disability Team.
• Staff had been trained 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.
• The practice regularly worked with multi-disciplinary teams in the case management of vulnerable people. It had told vulnerable patients about how to access various support groups and voluntary organisations. For example the Coventry Rape and Sexual Abuse –counselling and advocacy (CRASAC).
• Staff told us of a number of patients from the travelling community with literacy problems who were helped to make and reminded of appointments to avoid a deterioration in their health. We saw that 29 patients from a local travelling community official site were supported by visits, translating of hospital letters and chasing up hospital appointments by reception staff and supporting in general areas such as making payments when cash was not accepted.
• Flexible appointments were offered to patients with learning disabilities. This included home visits for those unable to attend the surgery.
• We saw evidence of the practice supporting victims of domestic violence by providing a hub for them to discuss their problems. For example providing the practice address to be used by vulnerable patients likely to be rehoused.
• Vulnerable patients were categorised into category one and category two. Category one patients had immediate access to a GP. A GP was informed of communication from category two patients to give advice on the most appropriate action.