The Willow Tree Surgery

We carried out an announced comprehensive inspection at The Willow Tree Surgery on 13 November 2018. The overall rating for the practice was requires improvement. The practice was rated good for providing safe, responsive and well-led care. We rated the practice as requires improvement for providing effective and cartng services. We rated all the population groups as good except for the families, children and young people group and the long-term conditions group which we rated as requires improvement as childhood immunisations uptake rates were below the 90% target and overall clinical exception was above local and national averages for many long-term conditions.

This inspection was an announced focused inspection carried out on 6 September 2019 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 13 November 2018. This report covers our findings in relation to those requirements and additional areas for improvement since our last inspection.

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 for effective and caring services and all population groups except Families, children and young people which is requires improvement as some childhood immunisation rates are below eighty percent.

We found that:

• The practice provided care in a way that kept patients safe and protected them from avoidable harm.
• Patients received effective care and treatment that met their needs. Ninety one percent of patients felt their needs were met during their last general practice appointment.
• Since our last inspection the practice had made changes to their processes and although some childhood immunisations remained marginally below England rates, the practices had made some improvements and their uptake rates were comparable to other practices in the CCG area.
• The practice had reviewed their exception reporting and found that historically exception reporting had been incorrect. Unverified data from the practice showed exception reporting for long-term conditions had significantly reduced.
• Staff dealt with patients with kindness and respect and involved them in decisions about their care. We found the practice had made some changes to clinical staff and how they were supported which was reflected in the improved GP survey results.
• The practice organised and delivered services to meet patients’ needs. Patients could access care and treatment in a timely way.
• The way the practice was led and managed promoted the delivery of high-quality, person-centre care.

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

•Continue to implement processes to improve childhood immunisation uptake.

•Continue to review patients feedback to continue to improve their overall feedback.

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

We carried out an announced comprehensive inspection at The Willow Tree Surgery on 19 December 2017. The overall rating for the practice was good. The practice was rated as requires improvement for providing effective services as performance in relation to mental health care, the management of chronic conditions, childhood immunisations, and cervical cancer screening was below local and national averages. The full comprehensive report on the December 2017 inspection can be found by selecting the ‘all reports’ link for The Willow Tree Surgery on our website at www.cqc.org.uk.

After our inspection in December 2017 the practice wrote to us with an action plan outlining how they would make the necessary improvements to comply with the Requirement Notice served.

This inspection was an announced comprehensive inspection carried out on 13 November 2018 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 19 December 2017. This report covers our findings in relation to those requirements and additional areas for improvement since our last inspection.

Our judgement of the quality of care at this service is based 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.

This practice is now rated as requires improvement overall.

The key questions at this inspection are rated as:

Are services safe? – Good

Are services effective? – Requires improvement

Are services caring? – Requires improvement

Are services responsive? – Good

Are services well-led? - Good

At this inspection we found:

• The practice had clear systems to manage risk so that safety incidents were less likely to happen. When incidents did happen, the practice learned from them and improved their processes.
• Since our last inspection the practice had implemented safety systems to improve the monitoring of uncollected prescriptions and the documenting of significant events.
• The practice routinely reviewed the effectiveness and appropriateness of the care it provided. It ensured that care and treatment was delivered according to evidence-based guidelines.
• Whilst performance in relation to mental health care and the management of some chronic conditions had improved, there had not been sufficient improvement in childhood immunisation uptake rates or exception reporting for many long-term conditions.
• Feedback from patients we spoke with and CQC comment cards stated staff involved and treated patients with compassion, kindness, dignity and respect. However, results from the national GP patient survey were mixed, with patients rating some questions about the way staff treated people as below local and national averages.
• Feedback from patients we spoke with and CQC comment cards showed patients found the appointment system easy to use and reported that they could access care when they needed it. Some patients reported difficulties accessing the GP of their choice.
• There was a focus on continuous learning and improvement at all levels of the organisation.

The areas where the provider must make improvements are:

• Establish effective systems and processes to ensure good governance in accordance with the fundamental standards of care.

The areas where the provider should make improvements are:

• Continue to review and improve uptake rates for cervical cancer screening.
• Take action to restart the patient participation group.

Professor Steve Field CBE FRCP FFPH FRCGP
Chief Inspector of General Practice

Please refer to the evidence tables for further information.