Archived: Westgate

Updated 23 January 2017

Westgate Surgery is situated on the first floor of Boots at the Queensgate Shopping Centre, Peterborough. The practice was opened in 2009 and the patient list size has grown from 5,400 to 12,500 patients over the past seven years. It holds a General Medical Services contract with Cambridgeshire and Peterborough Clinical Commissioning Group.

According to information taken from Public Health England, the practice population has a larger percentage of working age adults, teenagers and children in comparison to the national average for practices in England. It has a relatively small proportion of patients over the age of 65. The practice is in a central area with a high level of deprivation. It has a high percentage of patients from a variety of ethnic minority groups.

The practice clinical team consists of one male GP partner, one female GP partner, three practice nurses and a healthcare assistant. Locum GPs and a locum advanced nurse practitioner are regularly used to provide further clinical appointments. They are supported by a practice manager and teams of reception, secretarial, administration and cleaning staff. There are members of staff employed who are fluent in a variety of different languages.

Westgate Surgery is open from Monday to Friday. It offers appointments from 8.30am to 6pm daily. Extended hours appointments are available between 7.10am and 8am on Mondays and 6.30pm and 7.30pm on Thursdays. In addition to this, patients registered at the surgery are able to access evening and weekend appointments at another local surgery as part of the Prime Minister’s Challenge Fund. Out of hours care is provided via the NHS 111 service.

Updated 23 January 2017

Letter from the Chief Inspector of General Practice

We carried out an announced comprehensive inspection at Westgate Surgery on 16 November 2016. Overall the practice is rated as good.

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

• Staff understood and fulfilled their responsibilities to raise concerns, and to report incidents and near misses. Information about safety was recorded, monitored, appropriately reviewed and addressed.
• 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.
• Patients said they were treated with compassion, dignity and respect and they were involved in their care and decisions about their 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.
• Patients said they found it easy to make an appointment with a named GP and there was continuity of care, with urgent appointments available the same day.
• The practice had good facilities and was well equipped to treat patients and meet their needs.
• 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 and complied with the requirements of the duty of candour.

The areas where the provider should make improvements are:

• Ensure that patient feedback continues to be monitored to identify further areas for improvement.
• Continue to improve cervical screening uptake.

Professor Steve Field (CBE FRCP FFPH FRCGP) 

Chief Inspector of General Practice

Updated 23 January 2017

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

• Nursing staff had lead roles in chronic disease management and patients at risk of hospital admission were identified as a priority.
• The practice used the information collected for the Quality and Outcomes Framework (QOF) to monitor outcomes for patients (QOF is a system intended to improve the quality of general practice and reward good practice). Data from 2015/2016 showed that performance for diabetes related indicators was 85%, which was below the local average of 91% and the national average of 90%. Exception reporting rates for all diabetes related indicators were in line with local and national averages (exception reporting is the removal of patients from QOF calculations where, for example, the patients are unable to attend a review meeting or certain medicines cannot be prescribed because of side effects).

• Longer appointments and home visits were available when needed.
• Patients with complex needs had a named GP and a structured annual review to check their health and medicines needs were being met. There was a robust recall system in place to ensure that patients were invited and attended annual reviews.
• 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.

Updated 23 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 had a high number of A&E attendances.
• Immunisation rates were high for all standard childhood immunisations.
• Patients told us that children and young people were treated in an age-appropriate way and were recognised as individuals.
• The percentage of women aged 25-64 whose notes recorded that a cervical screening test had been performed in the preceding five years was 63%, which was below the local and national average of 82%. We discussed this with the practice who were aware of the low uptake and had trialled different methods to increase uptake, such as holding late night and weekend clinics specifically for cervical screening tests. However, we were told that these had not been successful and that it had been difficult to engage with the patient population.
• Appointments were available outside of school hours and the premises were suitable for children and babies.
• The practice offered a full range of contraception services and chlamydia screening.
• We saw positive examples of joint working with midwives, health visitors and school nurses.

Updated 23 January 2017

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

• The practice was responsive to the needs of older people, and offered home visits and urgent appointments for those with enhanced needs. All home visits were triaged by a clinician to prioritise visits and ensure appropriate and timely intervention.
• The practice contacted all patients after their discharge from hospital to address any concerns and assess if the patient needed GP involvement at that time.
• The practice worked closely with local admissions avoidance services, such as the Joint Emergency Team.
• A second duty doctor was on call each day specifically to address the needs of older patients.
• Nationally reported data showed that outcomes for patients for conditions commonly found in older people, including rheumatoid arthritis and heart failure, were above local and national averages.

Updated 23 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 where possible.
• 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. The practice offered the Web GP E-Consult service, which gave patients 24 hour access a GP by email with a response by 6pm the following working day.
• Extended hours appointments were available between 7.10am and 8am on Mondays and 6.30pm and 7.30pm on Thursdays.
• Practice staff carried out NHS health checks for patients between the ages of 40 and 74 years. The practice was able to refer patients to a health trainer to encourage lifestyle changes.
• The practice offered many NHS services in house, reducing the need for outpatient referral and therefore improving patient convenience.

Updated 23 January 2017

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

• 86% of patients diagnosed with dementia had received a face to face care review in the last 12 months, which was in line with the local and national averages of 87%.
• 80% of patients experiencing poor mental health had a comprehensive care plan, which was below the local average of 90% and the national average of 89%.
• 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.
• A counselling service was available in house.
• 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.

Updated 23 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 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. 22 out of 31 patients on the learning disability register had received an annual health check in the past eight months.
• The practice regularly worked with other health care professionals in the case management of vulnerable patients, and held regular multidisciplinary team meetings.
• The practice informed vulnerable patients about how to access various support groups and voluntary organisations.
• The practice was engaged with the local carers support group, which provided guidance, support and respite for carers. Written information was available to direct carers to the various avenues of support available to them.
• 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.