Wayside Medical Practice

We carried out an announced comprehensive inspection at Wayside Medical Practice on 14 January 2020. This was to follow up on breaches of regulation found at our previous inspection 4 December 2018. The details of these can be found by selecting the ‘all reports’ link for Wayside Medical Practice on our website at www.cqc.org.uk.

We based our judgement of the quality of care at this service on a combination of:

• what we found when we inspected
• information from our ongoing monitoring of data about services and
• information from the provider, patients, the public and other organisations.

We have rated this practice as requires improvement overall and requires improvement for all population groups.

We rated the practice as requires improvement for providing safe services because:

• There were gaps in the systems and processes to keep people safe and safeguarded from abuse.
• There were gaps in arrangements to assess, monitor and manage risks.
• There were areas of medicines management that were not sufficient.
• The recording and dissemination of learning from significant events was not sufficient.

We rated the practice as requires improvement for providing effective services because:

• There was not a comprehensive programme of quality improvement activity.
• There was low uptake of childhood immunisations.
• Some performance results were significantly below national and the CCG average.
• There were gaps in staff training.

We rated the practice as inadequate for providing well-led services because:

• Leaders did not demonstrate that they had a credible strategy to develop sustainable care.
• There had not been sufficient improvement since our last inspection to address concerns.
• Systems and processes were not operating as leaders intended.
• Identification, management and mitigation of risk was not sufficient.

We rated the practice as good for providing caring and responsive services because:

• Staff dealt with patients with kindness and respect and involved them in decisions about their care.
• Feedback received from patients regarding their care and treatment and access to the service was very positive.
• The practice organised and delivered services to meet patients’ needs. Patients could access care and treatment in a timely way.

The areas where the provider must make improvements are:

• Ensure care and treatment is provided in a safe way to patients.
• Establish effective systems and processes to ensure good governance in accordance with the fundamental standards of care
• Ensure persons employed in the provision of the regulated activity receive the appropriate support, training, professional development, supervision and appraisal necessary to enable them to carry out their duties

(Please see the specific details on action required at the end of this report).

The areas where the provider should make improvements are:

• Review and improve how the provider seeks and acts on feedback from patients to continually evaluate and improve the service.
• Review and improve how significant events are recorded and the learning identified and shared.
• Review and monitor that all information is recorded correctly in patient group directions.
• Review and improve the information given to patients wanting to complain.

Details of our findings and the evidence supporting our ratings are set out in the evidence tables.

Dr Rosie Benneyworth BM BS BMedSci MRCGP

Chief Inspector of Primary Medical Services and Integrated Care

T his practice is rated as Requires improvement overall (There has been no previous inspection under this legal entity)

The key questions at this inspection are rated as:

Are services safe? – Requires improvement

Are services effective? – Good

Are services caring? – Good

Are services responsive? – Good

Are services well-led? – Requires improvement

We carried out an announced comprehensive inspection at Wayside Medical Practice on 4 December 2018. We carried out this inspection under Section 60 of the Health and Social Care Act 2008 as part of our inspection programme. 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.

At this inspection we found:

• We received positive feedback from patients who said they were treated with compassion, dignity and respect. They commented that they were involved in their care and decisions about their treatment.
• There were processes to identify, understand, monitor and address current and future risks including risks to patient safety. However, some of these processes were not implemented effectively. For example; recruitment processes and ongoing monitoring of clinical registration, completion of risk assessments and subsequent actions, medicines management including oversight of high risk and controlled drugs to ensure safe prescribing.
• Staff had the skills, knowledge and experience to deliver effective care and treatment.
• Patients found the appointment system easy to use and reported that they were mostly able to access care when they needed it.
• The practice accommodated additional services within the practice building such as community midwives, speech and language therapists and chiropody.
• Governance arrangements were not always clear or well documented. For example, evidence of shared learning from significant events, a programme of quality improvement activity and a documented business plan.
• 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. All staff spoke positively about working at the practice.

The areas where the provider must make improvements are:

• Ensure care and treatment is provided in a safe way to patients.
• Ensure recruitment procedures are established and operated effectively to ensure only fit and proper persons are employed.
• Establish effective systems and processes to ensure good governance in accordance with the fundamental standards of care.

The areas where the provider should make improvements are:

• Review the clinical tools used to identify older patients who were living with moderate or severe frailty.
• Review patient care plans to consider using templates as per best practice guidelines.
• Review and strengthen the processes for documenting staff training records to ensure they are accurate and up to date.
• Review the systems and processes used to record the monitoring of patients’ health, in relation to the use of medicines including high risk medicines.
• Review and strengthen the documentation available to patients wishing to make a complaint to ensure they are relevant and specific to the practice.

We saw one area of outstanding practice:

• The practice had a number of additional services available for registered patients experiencing poor mental health. These included a psychologist, and a wellbeing advisor who were based at the practice and could be booked for an appointment directly. The practice also supported a medium secure psychiatric hospital for young males aged between 18 and 65 years detained under the Mental Health Act 1983. The lead GP provided the service to 52 patients with a weekly ward round and had undertaken enhanced specialist training to support the role. We heard that the hospital had plans to expand with an increase of 28 beds and the GP planned to continue their support. We noted that the indicators for this population group were in line with or above local and England averages, with little or no exception reporting.

Professor Steve Field CBE FRCP FFPH FRCGP
Chief Inspector of General Practice

Details of our findings and the evidence supporting our ratings are set out in the evidence tables.