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Archived: Widbrook Medical Practice

Overall: Requires improvement read more about inspection ratings

Widbrook Surgery, 72 Wingfield Road, Trowbridge, Wiltshire, BA14 9EN (01225) 757120

Provided and run by:
Widbrook Medical Practice

All Inspections

11 October 2016

During a routine inspection

Letter from the Chief Inspector of General Practice

We undertook a comprehensive inspection of Widbrook Medical Practice on 1 December 2015. At that time evidence showed the practice was not meeting regulations and was rated as inadequate. It was subsequently placed into special measures and the practice sent us an action plan setting out what they would do to meet the regulations.

We carried out a second comprehensive inspection at Widbrook Medical Practice on 11 October 2016. This comprehensive inspection was undertaken to check whether the practice had completed the actions they told us they would take to comply with regulations .

We have revised the practice’s overall rating based on our findings and they are now rated as requires improvement. We found the practice had made some improvement in some areas.  

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

  • Staff understood their responsibilities to raise concerns, and to report incidents and near misses. However the recording of lessons learnt and actions taken following investigations of significant events and incidents were not always clear.
  • Arrangements were in place to safeguard children and vulnerable adults from abuse. The safeguarding policies had been revised since our last visit.  
  • Since our last inspection the practice had introduced new systems for sharing learning from audits and some had been discussed at staff meetings. However, in some cases these discussions were not recorded in the minutes of the meetings.
  • The practice was comparable for its satisfaction scores on consultations with GPs and nurses. 36% of patients said they could get through easily to the practice by phone, this was an 7% improvement on what we found in December 2015.
  • Patients told us that they found it difficult to get appointments when they needed them.
  • Appointments could be booked up to two weeks in advance using the on-line system or ten days in advance by phone or in person. However, on the day of the inspection the practice told us there were no bookable appointments available.
  • Since our last inspection, the practice had introduced a new system to review complaints and share any lessons were learnt. However, the system was not effective as complaints from patients were not always investigated or responded to appropriately and an apology was not always given.
  • Some of the governance structures did not allow for the easy retrieval of information and some of the policies and procedures were not always followed.
  • In the action plan they sent us the following our last inspection, the practice said they would carry out a number of actions and confirmed these actions had been completed. However, during this inspection the practice accepted that some had not been done, some could not be evidenced and we found some had not been completed adequately.

The areas where the provider must make improvement are:

  • Ensure all medical equipment, including vaccine fridges and weighing scales are serviced and calibrated in line with manufacturer’s recommendations, and second thermometers used in the vaccine fridges meet the requirements set out in the guidance.
  • Ensure emergency medicines are routinely checked and that they are in date and fit to use.
  • Ensure external clinical waste bins are secure.
  • Ensure their systems and processes are fit for purpose, and that they are able to access all necessary information when it is required.
  • Ensure all staff have received infection control training appropriate for their role.
  • Ensure policies and procedures are followed and that the practice has a good understanding of their management information.
  • Ensure minutes of meetings adequately and clearly reflect what is discussed particularly in relation to lessons learnt and actions agreed.
  • Ensure they keep all records up to date and store management information in a way that is easily accessible to all authorised staff.

The areas where the provider should make improvement are:

  • Continue to improve how they use audit to improve services.
  • Ensure that translation services are adequately advertised.
  • Ensure infection control audits include an action plan to address any findings.
  • Ensure staff protocols include information on the practices’ responsibilities towards staff.
  • Review their process for identifying carers who may need additional support.
  • Continue to review and take appropriate action on feedback from patients on the difficulties in booking an appointment.

This service will remain in special measures. Services placed in special measures will be inspected again within six months. If, after re-inspection, the service has failed to make sufficient improvement, and is still rated as inadequate for any population group, key question or overall, we will take action in line with our enforcement procedures to begin the process of preventing the provider from operating the service. This will lead to cancelling their registration or varying the terms of their registration within six months if they do not improve.

The service will be kept under review and if needed could be escalated to urgent enforcement action. Where necessary, another inspection will be conducted within a further six months, and if there is not enough improvement we will move to close the service.

Special measures will give patients who use the service the reassurance that the care they get should improve.

​

Professor Steve Field (CBE FRCP FFPH FRCGP) 

Chief Inspector of General Practice

1 December 2015

During a routine inspection

Letter from the Chief Inspector of General Practice

We carried out an announced comprehensive inspection at Widbrook Medical Practice on 1 December 2015. Overall the practice is rated as inadequate.

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. However, there was no formal structure for sharing any learning within the practice.
  • Risks to patients were inconsistently assessed and managed. For example, recruitment checks were not recorded and some risks had not been assessed.
  • Data showed patient outcomes were average for the locality.
  • Although some audits had been carried out, we saw no evidence that audits were driving improvement in performance to improve patient outcomes.
  • The majority of patients said they were treated with compassion, dignity and respect.
  • We were told the appointment system and the telephone system made it very difficult for patients to get an appointment that was suitable for them. We observed a queue of patients outside the practice at 8.30am and were told this was a queue to make an appointment for later that day.
  • The practice had good facilities and was well equipped to treat patients and meet their needs.
  • The practice had a number of policies and procedures to govern activity, but some were overdue a review.

Importantly, the provider MUST:

  • Introduce consistent systems and procedures that ensure patients are protected from abuse. This should include provision of training for all staff that is both current and relevant to their role.
  • Implement an up to date safeguarding policy.
  • Implement a policy or procedure setting out how Significant Events will be managed.
  • Have systems and procedures in place to reduce the risk of cross infection. Such systems should be reviewed and updated at appropriate intervals.
  • Ensure the procedure for recruitment of staff (including locum GPs) includes undertaking all relevant checks to verify that staff are of good character and have the qualifications, competence, skills and experience which are necessary for them to discharge their role.
  • Ensure that staff receive the appropriate professional development, supervision, appraisals and training as is necessary to enable them to carry out their duties.
  • Ensure they have a Risk Assessment of the premises which is regularly reviewed at appropriate intervals.
  • Quality improvement activity needs to ensure that learning takes place to improve patient safety and quality, for example clinical audits.
  • Ensure all confidential information is kept in a secure manner and carry out a risk assessment to identify appropriate ways any risks can be mitigated or minimised.
  • Review and take appropriate action on feedback from patients on the difficulties in booking an appointment.
  • Review the storage and security of prescriptions and the storage of vaccines.
  • Ensure that all non-clinical staff who act as chaperones are appropriately trained, have the necessary DBS check or a risk assessment in place and know the procedure for raising concerns.

In addition the provider should:

  • Ensure that all policies and procedures are kept up to date and reviewed at appropriate intervals.
  • The practice should consider their immunisations and the impact of this on their patient population and consider how this can be improved.
  • Ensure the services they provide are appropriate to the people who use the service, meets their needs and reflects their personal preferences.

I am placing this practice in special measures. Practices placed in special measures will be inspected again within six months. If insufficient improvements have been made so a rating of inadequate remains for any population group, key question or overall, we will take action in line with our enforcement procedures to begin the process of preventing the provider from operating the service. This will lead to cancelling their registration or to varying the terms of their registration within six months if they do not improve.

The practice will be kept under review and if needed could be escalated to urgent enforcement action. Where necessary, another inspection will be conducted within a further six months, and if there is not enough improvement we will move to close the service.

Special measures will give people who use the practice the reassurance that the care they get should improve.

Professor Steve Field (CBE FRCP FFPH FRCGP) 

Chief Inspector of General Practice

3 January 2014

During an inspection looking at part of the service

We went back to Widbrook Medical Practice to check on improvements made following our inspection in August 2013. The GP practice sent us an action plan following our last visit telling us how and when they planned to make the required improvements. We were told the action plan would be completed by the end of November 2013.

We found the concerns around infection prevention and control had been mostly addressed. The patient toilets had been redecorated and were now clean. The consulting rooms and treatment rooms were clean and tidy, although the paintwork was still showing signs of wear and tear in places. The cleaning equipment included floor mops which were now clean and left outside of the buckets to dry. The carpet cleaning had yet to be carried out, but we were told this was booked with the contracted cleaning company.

We found the concerns around the security and safe destruction of paper-based patient records had been addressed. The old records no longer required had been securely disposed of. Confidential patient information on white boards had been removed. All paper-based confidential information was now handled securely and could not be seen by unauthorised people. The storage of other patient records was now secure and access by unauthorised people had been prevented.

29 August 2013

During a routine inspection

Most of the people we met at Widbrook Medical Practice were happy with their medical care. Some people were critical of the appointments system and the attitude of a small number of staff. The practice had taken steps to improve the appointments system and access to a GP and a new doctor was starting at the practice shortly.

We found the practice respected the dignity and independence of people they looked after. People were able to make decisions about their treatment. They were treated with consideration and respect. People were encouraged to express their views and given opportunities to be involved in how the practice was run.

Staff at the practice had been trained in recognising and reporting signs of abuse in vulnerable people. Staff who worked for the practice were employed safely and checks were made about them. The medical staff made sure people were referred safely into the care of other health and social care professionals.

What the practice was not doing well related to cleanliness and the prevention and control of infections, and the confidentiality and security of people's records. There were some concerns also around preventative maintenance of the premises.