Background to this inspection
Updated
28 October 2020
Wellington Practice is co-located with other healthcare services, within Aldershot Centre for Health, a purpose-built healthcare facility in Aldershot, Surrey. It provides GP services for approximately 3,880 patients and is part of North East Hampshire and Farnham Clinical Commissioning Group (CCG). The practice is also a member of the federation of all the CCG practices and in July 2019, formed a primary care network (PCN) with four Aldershot locality practices.
There are two GP partners, providing 16 sessions per week between them. A long-term locum GP also offers four sessions per week. The nursing team consists of one practice nurse (who works four days per week) and a healthcare assistant who works five days per week. The practice has an arrangement for a specialist diabetes nurse to attend on a locum basis (who provides between four and eight sessions per month, depending on patients needs). When required, the practice also facilitates a locum specialist respiratory nurse. There is a clinical pharmacist who holds regular clinics at the practice. (The pharmacist is employed by the local PCN and works across the five PCN GP sites).
Day to day coordination of the service is managed by a practice manager, a reception team leader and five receptionists, a medical secretary, an administrator and a business support administrator.
The practice provides services from: Wellington Practice, Aldershot Centre for Health, Hospital Hill, Aldershot, Hampshire, GU11 1AY.
Wellington Practice is registered with the Care Quality Commission to provide the following regulated activities: diagnostic and screening procedures, family planning, maternity and midwifery services, surgical procedures and treatment of disease, disorder or injury.
According to national statistics, there is a slightly lower than average percentage of older patients and slightly higher percentage of working age individuals. Aldershot has areas of deprivation, with the most deprived areas of the town in the top 30% most deprived areas of the country. There is a high prevalence of armed service personnel registered at the practice. There is a 30% proportion of Nepalese patients, many of whom are older patients. The practice told us many of these patients have come to the UK with existing health conditions that may not have been well managed in the past and this impacts on the practice’s ability to manage their ongoing health needs. However, the practice has a lower prevalence of patients with a long-standing health condition at 42% compared to the national average of 53%. The practice cares for approximately 130 patients who reside in three local nursing homes.
The practice is open between 8am and 6.30pm Monday to Friday. Extended hours appointments are available on a pre-bookable basis on Tuesday evenings between 6.30pm and 7.30pm and from 10am to 12.30pm on alternate Saturdays.
The practice does not offer out of hours treatment for their patients instead referring patients to the NHS 111 service.
Wellington Practice has been inspected before, including under the previous provider called “The Wellington Practice”. You can view the previous reports by selecting the “all reports” link for Wellington Practice on the CQC website.
Updated
28 October 2020
We previously carried out an announced focused inspection at Wellington Practice on 28 October 2018 as part of our inspection programme. We rated the practice as Good overall, however we found a breach of regulations and rated Effective and all the population groups as Requires Improvement. You can read the full report by selecting the ‘all reports’ link for Wellington Practice on our website at .
We were due to follow up on the breach of regulation in October 2019, but this was delayed due to changes with the practice registration with the Care Quality Commission. Our inspection was then further delayed by the restrictions put in place in relation to the COVID-19 pandemic.
We were mindful of the impact of the Covid-19 pandemic on our regulatory function. This meant we took account of the exceptional circumstances arising as a result of the COVID-19 pandemic when considering what type of inspection was necessary and proportionate, this was therefore a desk-based review. On 11 September 2020, we carried out the desk-based review to confirm that the practice had carried out its plan to meet the legal requirements in relation to the breach of regulations that we identified at our previous inspection in October 2018.
At this desk-based review we found that the practice had met those requirements and we have amended the rating for this practice accordingly. The practice is now rated Good for the provision of Effective services and Good for all population groups, except for Working age people (including those recently retired and students), who remain as Requires Improvement. We previously rated the practice as Good for providing Safe, Caring, Responsive and Well led services.
We based our judgement of the quality of care at this service on a combination of:
- what we found when we reviewed the information sent to us by the provider
- information from our ongoing monitoring of data about services and
- information from the provider.
We have rated Effective as Good because:
- The practice had reviewed their recall and review processes for quality outcomes. We saw a reduction in the practice’s exception reporting rates, which demonstrated more patients were receiving appropriate care.
- There was an improvement in the uptake of childhood immunisations, with unverified data showing the practice had achieved the minimum 90% target for all the sub indicators.
- Cervical screening recall processes had been reviewed and eligible patients were contacted when they did not attend for screening. The practice’s overall uptake had improved but it was still below the national target of 80%.
Although not part of the practice’s previous regulatory breach, the practice demonstrated it had also made improvements since our last inspection which included:
- The practice no longer had spirometer testing equipment onsite (since the last inspection). This was in part due to the availability of trained staff to undertake the testing and partly due to restrictions on aerosol generating procedures during the COVID-19 pandemic. We were told by the practice that a replacement spirometer would be purchased once a clinician had completed an additional specialist qualification in the management of respiratory conditions and could safely undertake spirometry testing.
- The practice had reviewed its arrangements regarding the location of the oxygen cylinders. They told us all staff were aware of the location of the cylinders, so they could be accessed quickly in an emergency. The practice was working with the building management team to determine if safety notices were required (signage which indicates to emergency services where medical oxygen is stored).
- The practice had reviewed and updated its policy regarding the provision of carers support in July 2020. The policy included ways in which patients who were also carers were identified. Clinicians and staff were reminded that they could identify a carer during a consultation or through reviewing documents such as discharge letters. The practice had also contacted all patients through their text messaging system to identify if they were a carer, so that appropriate support could be offered.
We were told the practice held a carer’s register and added alerts to patient’s clinical records, which enabled clinical staff to check their wellbeing during consultations or promoted other communications with those particular patients.
We were shown evidence that the carer’s register had increased from 27 (in October 2018) to 73, which now represented 2% of the practice population.
Whilst we found no breaches of regulations, the provider should:
- Continue to review and improve uptake rates for cervical screening and childhood immunisations.
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