Whitwell Health Centre

Letter from the Chief Inspector of General Practice

This practice is rated as good overall. At the previous Care Quality Commission (CQC) inspection in July 2016, the practice received a good overall rating. This inspection had been undertaken following a six month period when the practice had been placed in special measures, further to our initial inspection and overall inadequate rating in December 2015.

Our announced comprehensive inspection on 18 December 2017 was undertaken to ensure the improvements that had been achieved in July 2016 were being sustained.

The inspection of Whitwell Health Centre was carried out under Section 60 of the Health and Social Care Act 2008 as part of our regulatory functions. The inspection was planned to check whether the provider was meeting the legal requirements and regulations associated with the Health and Social Care Act 2008, to look at the overall quality of the service, and to provide a rating for the service under the Care Act 2014

The key questions are rated as:

Are services safe? – Requires Improvement

Are services effective? – Good

Are services caring? – Good

Are services responsive? – Good

Are services well-led? - Good

As part of our inspection process, we also look at the quality of care for specific population groups. The population groups are rated as:

Older People – Good

People with long-term conditions – Good

Families, children and young people – Good

Working age people (including those recently retired and students – Good

People whose circumstances may make them vulnerable – Good

People experiencing poor mental health (including people with dementia) - Good

At this inspection we found:

• Significant work had been undertaken by the practice to address the findings of our initial inspection in December 2015. A new practice manager helped to drive improvements and we saw notable progress had been achieved with regards to infection control management and the oversight of carers.
• The practice team worked in partnership with community based teams to deliver effective care for their patients. Regular meetings were held with health, social and voluntary care representatives to plan and review the care of the practice’s most vulnerable patients.
• The practice provided additional hours to compliment the Clinical Commissioning Group (CCG) funded care co-ordinator post in recognition of the benefits this role provided for patients.
• Plans for a new building at the branch site were progressing in recognition that the existing site did not allow for expansion or deliver services in an environment conducive to 21st century health care.
• The practice benchmarked their performance by reviewing monthly data provided by the CCG. We saw that the practice was not an outlier for any of the performance indicators being monitored by their CCG.
• The practice did not have a written strategy and had not developed clear succession planning arrangements for the future. However, they did engage in locality meetings which encompassed discussions on issues such as the NHS Five Year Forward View.
• We spoke with community based health, social and care home staff who provided us with positive feedback about their interactions with the practice team.
• Results from the latest national GP patient survey showed that the practice had mostly performed in line with local and national averages in the majority of the questions about patient experience. However, results relating to GP consultations were below average and we did not see any evidence that the practice were actively seeking to address this.
• Patients were mostly positive about access to GP appointments. Most said they found it easy to get through to the practice by telephone and were able to obtain a convenient appointment when they needed one. Results from the latest national GP survey demonstrated that 72% of patients were able to see or speak to their preferred GP (local average 60%; national average 56%).
• The practice had identified almost 3% of their patients as being carers. They had developed a carers support and network meeting which was held at the practice every two months.
• The practice encouraged and supported staff to report incidents. When incidents did happen, the practice learned from them and improved their processes.
• Continuous learning and improvement was encouraged at all levels within the practice. Staff training records showed that most essential training had been completed, and regular appraisals helped to encourage the development of the practice team.
• The practice provided some evidence of a quality improvement programme, but audits produced were basic and not followed through to effectively demonstrate their impact on patient care. There was no quality assurance of the clinical coding undertaken within the practice.
• The practice had a procedure to review alerts received from the Medicines and Healthcare products Regulatory Agency (MHRA). However, we found that some alerts had not been recorded on the log maintained by the practice, and the outcomes achieved were not clearly indicated or evidenced within patient records.

Importantly, the provider must make improvements to the following areas of practice:

• Ensure care and treatment is provided in a safe way to patients by reviewing all relevant patient safety alerts, including those issued from the MHRA. The practice should ensure that documented evidence was available to support timely and appropriate follow up actions were completed, and that all clinical staff were updated.

The areas where the provider should make improvements are:

• Continue to explore ways to improve patient experience with regards to GP consultations.
• Consider formal succession planning arrangements within the practice.
• Explore a more structured approach to the practice’s quality improvement programme.
• Review the approach to clinical audit and develop a formal in-house audit programme.
• Encourage staff to maintain individual training requirements in accordance with the practice schedule for mandatory and role specific training.
• Review the need for written protocols to support reception staff, for example in dealing with potential medical emergencies.

Professor Steve Field (CBE FRCP FFPH FRCGP) 

Chief Inspector of General Practice