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West Bridgford Medical Centre Good

Reports


Review carried out on 10 June 2021

During a monthly review of our data

We carried out a review of the data available to us about West Bridgford Medical Centre on 10 June 2021. We have not found evidence that we need to carry out an inspection or reassess our rating at this stage.

This could change at any time if we receive new information. We will continue to monitor data about this service.

If you have concerns about West Bridgford Medical Centre, you can give feedback on this service.

Review carried out on 6 February 2020

During an annual regulatory review

We reviewed the information available to us about West Bridgford Medical Centre on 6 February 2020. We did not find evidence of significant changes to the quality of service being provided since the last inspection. As a result, we decided not to inspect the surgery at this time. We will continue to monitor this information about this service throughout the year and may inspect the surgery when we see evidence of potential changes.

Inspection carried out on 6 June 2016

During an inspection looking at part of the service

Letter from the Chief Inspector of General Practice

We carried out an announced comprehensive inspection of West Bridgford Medical Centre on 15 September 2015. We found that some requirements were not in place or sufficiently robust, and supporting evidence was not always available. After the comprehensive inspection, the practice wrote to us to say what they would do to meet the legal requirements and ensure that effective procedures were followed.

We undertook this focused inspection of the practice on 6 June 2016, to check that improvements had been made to meet legal requirements following our comprehensive inspection. We spoke with the practice manager and reviewed documents to demonstrate that the provider had taken action to address the issues identified at the last inspection.

Overall the practice is rated as good. Our findings across the areas we inspected were as follows:

  • The practice had strengthened systems for assessing environmental and health and safety related risks. Monthly meetings were in place between the practice manager and site manager to discuss site related issues. The practice was developing its own risk assessments when practice-specific concerns were identified.

  • A designated infection control lead had been appointed. Infection control policies had been updated, and an infection control audit had been completed. Staff induction had been revised to include infection control awareness for all new staff.

  • All staff had now received an annual appraisal. Appraisals had been documented and included personal objectives and a review of any training requirements.

  • The appointment of a Practice Administrator had strengthened managerial capacity in the practice. The provider had reviewed succession planning arrangements for the future.

  • The practice had a governance framework which supported the delivery of good quality care.

Professor Steve Field (CBE FRCP FFPH FRCGP) 

Chief Inspector of General Practice

Inspection carried out on 15 September 2015

During a routine inspection

Letter from the Chief Inspector of General Practice

We carried out an announced comprehensive inspection at the West Bridgford Medical Centre on 15 September 2015. Overall the practice is rated as good.

Our key findings 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.
  • Some risks to patients were assessed and well managed. However, the practice needed to strengthen its own systems for assessing environmental and health and safety related risks.
  • Patients’ needs were assessed and care was planned and delivered following best practice guidance. Staff had received training appropriate to their roles and any further training needs had been identified and planned.
  • Patients told us they were treated with compassion, dignity and respect and involved in their care and decisions about their treatment.
  • The Patient Participation Group (PPG) made suggestions for improvements which the practice had responded to. For example, changes to the waiting area with regards seating, the use of notice boards and the television to improve patient experience.
  • Patients told us they could usually get an appointment when they needed one, with urgent appointments available the same day. Pre-bookable appointments were available for up to two months with the first available appointment less than a week in advance.
  • Patients said they found it easy to make an appointment with a named GP and that there was continuity of care.
  • The practice had good facilities, although it was using the site to full capacity and planned to work with the landlord regarding opportunities for expansion. It was well equipped to treat patients and meet their needs.
  • There was clear leadership and staff felt supported and valued by management.

We saw two areas of outstanding practice:

  • The practice employed a pharmacist who made a valuable contribution to the practice’s achievements. The pharmacist’s role had a clear impact in making sure patients were safe by reviewing the appropriateness and repeats of prescribed medicines. The pharmacist supported all practice staff and met with patients to explain medications where there had been difficulties in their understanding, as well as being a valuable link to the CCG. The pharmacist contributed to audit programmes and service developments such as a self-management plan for asthma patients.
  • The practice actively worked with The Carers Federation to identify carers and signpost them to relevant support. A Carers Federation representative attended the surgery weekly, and met regularly with the practice manager

However, the areas where the provider must make improvement are:

The provider must:

  • Ensure the systems they have in place to identify, assess and mitigate risk are effective particularly in relation to; systems and processes around infection control, including appointing a lead and undertaking infection control audits; practice specific risk assessments including health and safety, and assure themselves of the quality of assessments being managed by the landlord and ensuring appraisals are in place for all employees including the practice manager.

Professor Steve Field (CBE FRCP FFPH FRCGP) 

Chief Inspector of General Practice