Woodhouse Hill Surgery

We carried out an announced comprehensive inspection at Woodhouse Hill Surgery on 30 April 2019 as part of our inspection programme and to follow up a practice in special measures. Woodhouse Hill Surgery was placed into special measures in May 2018 under the previous provider. We also carried out a focused inspection of the previous provider in October 2018 to assess compliance with Regulation 12, Safe care and treatment. The new provider completed their registration of the practice with CQC on 8 April 2019.

This was the first rated inspection for this recently registered provider as a partnership. One of the GPs in this new partnership was previously registered with CQC as an individual to carry out regulated activities at this service from this address. Where we refer to the previous inspection in this report and evidence table, we are referring the previously registered individual provider.

At the last comprehensive inspection, carried out in April & May 2018, we rated the practice as inadequate. The practice was placed in special measures because:

• The provider was not keeping an accurate record with respect to each patient. Not all patients were clinically coded correctly to support delivery of care and treatment.
• There was a significant backlog of patient records that required summarising.
• The practice did not have a system in place for carrying out a review of changes introduced following significant events.
• The provider did not have clear or effective systems in place for the planning and provision of staffing levels.
• National GP patient survey results with regards to access were lower than local and national averages.
• The recruitment process in place was not operating effectively. Some of the information required to be held to support the recruitment of staff was not available.

At this inspection, we found that the provider had satisfactorily addressed most of these areas.

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 as requires improvement for the provision of effective and responsive care and for all of the population groups.

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

• Outcomes for patients living with diabetes, hypertension and mental health conditions were lower than local and national averages. This includes on areas as measured by the Quality and Outcomes Framework (QOF).
• The uptake of two of the four childhood immunisations for children under two years of age was below WHO target levels of coverage.
• The uptake of breast and bowel cancer screening was below local and national averages.

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

• Patient satisfaction with access to the service was below local and national averages. The provider had taken some steps in an attempt to address this however; at the time of our inspection they could not demonstrate the impact of these changes had been fully assessed or improved satisfaction.

We found that:

• The practice had systems to keep people safe and safeguarded from abuse.
• There were safety systems and processes within the practice, to assess, monitor and manage risks, to keep patients safe.
• The practice had invested in new equipment and thermometers which were located in every consultation room. These included pulse oximeters, infra-red thermometers and digital ear thermometers.
• There had been a significant reduction in the backlog of patient clinical records that required summarising, to ensure all information was available to clinicians to support safe and effective care.
• The provider had made improvements in keeping accurate records with respect to each patient. We identified the clinical coding in the patient records we viewed was now accurate. (Coding is used to easily identify patient information, such as disease and past medical history, and support the running of reports/data collection within the practice).
• We were informed that the practice nurse no longer undertook breast examinations.
• Clinicians ensured that in the cases we viewed, care and treatment was delivered according to evidence based guidelines.
• The arrangements for leadership were now effective. We observed that there were now adequate numbers of clinical and non-clinical staff at the practice.
• An understanding of the performance of the practice was now maintained.
• Changes to the significant events and complaints system were updated to include all possible and on-going significant events and complaints.
• The practice had a system in place for carrying out a planned review of changes introduced following significant events to determine their effectiveness and to assure that changes had been embedded into the practice.
• The recruitment process had been reviewed and was now operating effectively.

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

• Continue to work to improve outcomes for patients living with diabetes, hypertension and mental health conditions. This includes on areas as measured by the Quality and Outcomes Framework (QOF), which showed patient outcomes in these areas were lower than the local and national averages.
• Continue to promote and work to increase the uptake of childhood immunisations for children under two years of age in order to achieve WHO target levels of coverage as a minimum.
• Continue to promote and work to increase the uptake of breast and bowel cancer screening programmes within their patient population.
• Continue to prioritise the summarising of patient records to avoid any backlog.
• Continue to improve the prescribing of antibiotics to ensure that all antibiotic prescriptions are supported with a clear rationale.
• Improve the identification of carers to enable this group of patients to access the care and support they need.
• Improve patient satisfaction with access to the service on areas that are below local and national averages.

I am taking this service out of special measures. This recognises the significant improvements made to the quality of care provided by the service. Details of our findings and the evidence supporting our ratings are set out in the evidence tables.

Dr Rosie Benneyworth BM BS BMed Sci MRCGP

Chief Inspector of Primary Medical Services and Integrated Care