The Care Quality Commission
  • Doctor
  • GP practice

Archived: The Wharf Family Practice

Overall: Good read more about inspection ratings

145a Pleck Road, Walsall, West Midlands, WS2 9ES (01922) 605850

Provided and run by:
Phoenix Primary Care Limited

All Inspections

26 October 2017

During an inspection looking at part of the service

Letter from the Chief Inspector of General Practice

We previously carried out an announced comprehensive inspection at The Wharf Family Practice on 30 August 2016. The overall rating for the practice was good with requires improvement for providing effective services. We found one breach of legal requirement and as a result we issued a requirement notice in relation to:

  • Regulation 17 of the Health and Social Care Act 2008 (Regulated Activities) Regulation 2014 – Good Governance

The full comprehensive report on the August 2016 inspection can be found by selecting the ‘all reports’ link for The Wharf Family Practice on our website at www.cqc.org.uk.

This inspection was an announced focused inspection carried out on 26 October 2017 to confirm that the practice had carried out their plan to meet the legal requirements in relation to the breaches in regulations that we identified in our previous inspection on 30 August 2016. This report covers our findings in relation to those requirements and also additional improvements made since our last inspection.

The effective domain is now rated as good and overall the practice remains rated as good.

Our key findings were as follows:

  • The practice had improved the governance procedures in place to ensure patients with long term conditions were effectively managed. Action had been taken to address errors in the reporting system.
  • The GPs and named senior nurses were responsible for completing the coding on the electronic patient record and were able to clearly describe the rationale for exception reporting.
  • Staff had a clear understanding of the recall system for patients with long term conditions.
  • The practice had improved their clinical exception rate from for exception reporting 21% to 14%.
  • The practice manager had altered some of the standard letters sent to patients inviting them for a review to be more informative about the risks associated with the condition.
  • The practice was taking positive action to address areas where results below the expectation.

Professor Steve Field (CBE FRCP FFPH FRCGP) 

Chief Inspector of General Practice

30 August 2016

During a routine inspection

Letter from the Chief Inspector of General Practice

We carried out an announced comprehensive inspection at Wharf Family Practice on 30 August 2016. Overall the practice is rated as good.

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

  • There was an open and transparent approach to safety and an effective system in place for reporting and recording significant events. Risks to patients were assessed and well managed.
  • Staff assessed patients’ needs and delivered care in line with current evidence based guidance.
  • 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 as a result of complaints and concerns.
  • The practice had good facilities and was well equipped to treat patients and meet their needs.
  • The practice governance processes were not effective enough to ensure patients with long term conditions were being well managed. For example, the practice QOF exception reporting for many long term conditions were significantly higher than local and national averages. Staff members with lead clinical roles for some of the long term conditions were unaware of this. Following the inspection the practice told us that some of these high exception reporting were identified as administration errors and the policy had been re-visited and training had been offered to the relevant staff members.
  • Information in the practice leaflet and website in regards to opening hours did not align and needed updating. However, following the inspection the practice had contacted the website provider and action was taken to update the information on the website.
  • The practice was part of a corporate provider which had merged with another corporate provider and as a result a new structure of the provider was taking shape. There was a practice specific development plan outlining areas for improvement
  • There was evidence that the practice sought feedback from patients which it acted on.

The areas where the provider must make improvement are:

  • The practice must review its system to assess, monitor and improve the quality and safety of the services by means of the effective governance processes to ensure all patients with long term conditions are being well managed.

Professor Steve Field (CBE FRCP FFPH FRCGP) 

Chief Inspector of General Practice

5 March 2014

During a routine inspection

The visit to the practice was announced. This was to ensure we had the opportunity to speak to the GP and staff working at the practice. We visited the surgery to establish that the needs of patients using the service were being met. During the inspection process we spoke with nine patients, five staff members, a GP and the registered manager.

All of the nine patients we spoke with were complimentary about the service provided by the staff at Wharf Family Practice. They told us that they received care, treatment and support that met their needs. One patient said: The staff here are all helpful and polite'. We were also told: The doctor listens to me, I never feel rushed'.

We saw that there were processes in place to support people with the management of long term conditions, for example diabetes and asthma. Health information was available to patients in the waiting area.

A recruitment process was in place to ensure that pre-employment checks, for example references, were completed before the employment commenced. The recruitment process also ensured that staff had the necessary qualifications, skills and experience for their role

There was a patient participation group (PPGs) working with the staff and management team at the practice. The PPG supported the practice to continue to improve the service provided to patients. Patients were also invited to comment on the quality of the service via a patients' satisfaction survey, the complaints procedure and a comments book.