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West Pottergate Medical Practice Good

Inspection Summary

Overall summary & rating


Updated 9 December 2019

We carried out an inspection of this service due to the length of time since the last inspection.

Following our annual review of the information available to us, including information provided by the practice, we focused our inspection on the following key questions:

  • Are services effective?
  • Are services well-led?

Because of the assurance received from our review of information we carried forward the ratings for the following key questions:

  • Are services at this location safe?
  • Are services at this location caring?
  • Are services at this location responsive?

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 good overall and good for all population groups.

We found that:

  • Patients received effective care and treatment that met their needs.
  • The way the practice was led and managed promoted the delivery of high-quality, person-centred care.

We received 20 CQC Comments cards which were wholly positive about the service and showed that patients felt the practice was welcoming, caring and friendly and that staff were good at listening, professional and helpful.

Whilst we found no breaches of regulations, the provider should:

  • Review the provision of services for the cervical cancer screening programme to improve uptake rates in line with the national target of 80% uptake.
  • Continue in efforts to review and where appropriate reduce the rates of exception reporting for people experiencing poor mental health (including people with dementia).

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

Inspection areas



Updated 24 September 2015

The practice is rated as good for providing safe services. Staff understood and fulfilled their responsibilities to raise concerns, and to report incidents and near misses. When incidents occurred these were investigated to help minimise reoccurrences. Lessons were learned and communicated widely to support improvement. Information about safety was recorded, monitored, appropriately reviewed and addressed.

Risks to patients were assessed and well managed. Patients including children who were identified as being at risk were monitored and the practice worked with other agencies as appropriate to safeguard vulnerable adults and children. There were enough staff employed to keep patients safe.

Premises were clean and risks of infection were assessed and managed. Records we viewed showed that infection control audits had been carried out to test the effectiveness of the general cleaning and infection control procedures within the practice. These audits demonstrated that the practice had systems in place for identifying and managing risks of infection.

There were Health and Safety and Infection Prevention and Control policies in place. The practice had suitable equipment to diagnose and treat patients and medicines were stored and handled safely.





Updated 24 September 2015

The practice is rated as good for providing caring services. Data from patient surveys showed that patients rated the practice higher than others for several aspects of care, such as how GPs and nurses explained their care to them, involving them in making decisions and listening to them. Patients said they were treated with compassion, dignity and respect and that they were involved in decisions about their care and treatment.

Information to help patients understand the services available was accessible, available in different formats and languages and easy to understand. We also saw that staff treated patients with kindness and respect, and maintained confidentiality. We received positive remarks on the 48 comment cards about the care patients experienced at the practice, and the patients we spoke with during the inspection confirmed this.



Updated 24 September 2015

The practice is rated as good for providing responsive services. It reviewed the needs of its local population and engaged with the NHS England Area Team and the local Clinical Commissioning Group (CCG) to secure improvements to services where these were identified. CCGs are groups of general practices that work together to plan and design local health services in England.

There was a higher than average amount of patients at the practice in the working age group. The practice had an appointments system which met the needs of these patients by offering early morning appointments from 8.30am and also appointments later in the day until 6pm. They offered online booking for appointments for ease. Urgent appointments were available each week day.

The majority of patients said they could make an appointment with a named GP and that there was continuity of care. The practice considered the facilities and made adjustments to meet the needs of patients with mobility difficulties. The practice was well equipped to treat patients and meet their needs.

Information about how to complain was available and easy to understand and evidence showed that the practice responded quickly to issues raised.


Checks on specific services

People with long term conditions


Families, children and young people


Older people


Working age people (including those recently retired and students)


People experiencing poor mental health (including people with dementia)


People whose circumstances may make them vulnerable