Archived: West End Surgery

Updated 13 August 2015

West End Surgery provides primary medical services to 5,204 patients. The practice area includes Beeston and Chillwell in Nottingham.

The staff team includes 13 administrative staff, a practice manager, a healthcare assistant (HCA) and four GPs (two salaried and two partners). All staff are female except for one GP.

The practice holds a General Medical Services (GMS) contract to deliver essential primary care services. The practice opted out of providing out-of-hours services to their own patients. This is covered by NEMS provider.

Updated 13 August 2015

Letter from the Chief Inspector of General Practice

We carried out an announced comprehensive inspection at West End Surgery on 25 March 2015. Overall the practice is rated as requires improvement.

Specifically, we found the practice to require improvement for providing safe, effective and well-led services. It was good for providing a caring, and responsive service. It also required improvement for providing services for all six of the population groups we inspected, based on the findings in the overall domains.

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 not always assessed or well managed, specifically those relating to recruitment checks and infection prevention and control.
• Data showed patient outcomes were average for the locality. Although some audits had been carried out, we saw limited evidence that audits were driving improvement in performance to improve patient outcomes.
• Patients said they were treated with compassion, dignity and respect.
• Information about services and how to complain was available and easy to understand.
• Urgent appointments were usually available on the day they were requested. However patients said that they sometimes had to wait a long time for non-urgent appointments.
• The practice had not proactively sought feedback from staff or patients.

The areas where the provider must make improvements are:

• Ensure recruitment arrangements are robust and ensure that all employment checks are carried out before staffs starts working at the practice.
• Ensure risk assessments in place to protect patients and staff from risk of harm. Specifically in respect of infection prevention and control. Additionally infection control audits should be carried out and their findings acted on.
• Ensure there are formal governance and management arrangements in place and staff are aware how these operate. For example policies, procedures and guidance to carry out their role and that feedback from staff and patients is responded to.

In addition the provider should:

• Consider how to improve the availability of non-urgent appointments.
• Keep records of equipment checks for defibrillator and emergency medicines

Professor Steve Field (CBE FRCP FFPH FRCGP) 

Chief Inspector of General Practice

Updated 13 August 2015

The provider was rated as good for caring and responsive overall and this includes for this population group. The provider was rated as requires improvement for safe, effective and well-led. The concerns which led to these ratings apply to everyone using the practice, including this population group.

High turnover of staff meant there was a lack of continuity in lead roles in chronic disease management. As a consequence there was variability in terms of the practice performance on QOF for different long term conditions. However patients at risk of unplanned hospital admission were identified as a priority and regular multi-disciplinary team meetings were held to discuss patients with complex needs. Longer appointments and home visits were available when needed. All these patients were invited for an annual review to check that their health needs were being met A pharmacist carried out a review of patients medications.

Updated 13 August 2015

The provider was rated as good for caring and responsive overall and this includes for this population group. The provider was rated as requires improvement for safe, effective and well-led. The concerns which led to these ratings apply to everyone using the practice, including this population group.

There were systems in place to identify and follow up children living in disadvantaged circumstances and who were at risk. For example, children on the 'at risk' register, those who had high A&E attendances and those who had accessed the mental health crisis team. Immunisation rates for the standard childhood immunisations were below the local and national averages for some age groups. For example MMR, Infant Meningococcal Vaccine and Infant Hib. Patients told us that children and young people were treated in an age-appropriate way and we saw evidence to confirm this. Appointments were available outside of school hours.

Updated 13 August 2015

The provider was rated as good for caring and responsive overall and this includes for this population group. The provider was rated as requires improvement for safe, effective and well-led. The concerns which led to these ratings apply to everyone using the practice, including this population group.

Care and treatment of older people reflected current evidence-based practice, however nationally reported data showed that outcomes for patients for some conditions commonly found in older people were mixed. For example, QOF results in respect of Rheumatoid arthritis, cancer and dementia were all significantly below the CCG average . Longer appointments and home visits were available for older people when needed, along with a dedicated telephone line for patients with more complex needs.

Updated 13 August 2015

The provider was rated as good for caring and responsive overall and this includes for this population group. The provider was rated as requires improvement for safe, effective and well-led. The concerns which led to these ratings apply to everyone using the practice, including this population group.

The needs of the working age population, including those recently retired and students had been identified and the practice had put in some measures to meet their needs. For example extended opening hours on Wednesdays, online appointment booking and prescription requests. 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. Including health checks for those aged 40 – 75 and minor surgery clinics.

Updated 13 August 2015

The provider was rated as good for caring and responsive overall and this includes for this population group. The provider was rated as requires improvement for safe, effective and well-led. The concerns which led to these ratings apply to everyone using the practice, including this population group.

We saw evidence which showed the practice was performing below local and national averages (being 17.5% and 15.3% points below respectively) for carrying out health checks for patients experiencing poor mental health.

The practice regularly worked with multi-disciplinary teams in the case management of people experiencing poor mental health, including those with dementia. It carried out advance care planning for patients with dementia as well offering screening for memory problems and onward referral. However, evidence we saw showed the practice was performing significantly below local and national averages for completing health checks and blood tests for patients with dementia, being 16.5 and 13.2% points below respectively.

The practice had told patients experiencing poor mental health about how to access various support groups and voluntary organisations including MIND and SANE, (mental health support charities which aim to provide advice and support to empower anyone experiencing mental health problems). It had a system in place to follow up patients who had attended accident and emergency (A&E) where they may have been experiencing poor mental health. Staff had received training on how to care for people with mental health needs and dementia.

Updated 13 August 2015

The provider was rated as good for caring and responsive overall and this includes for this population group. The provider was rated as requires improvement for safe, effective and well-led. The concerns which led to these ratings apply to everyone using the practice, including this population group.

The practice held a register of patients living vulnerable circumstances including homeless people and those with a learning disability. Evidence showed that of the 18 patients with learning disabilities, only two on the register had received a health check or been followed up. Regular health checks are essential to ensure there are no changes to the health of patients with learning disabilities.

The practice 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. 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.