Background to this inspection
Updated
8 March 2018
The practice surgery is located at Eastmoor Health Centre, Windhill Road, Wakefield, West Yorkshire WF1 4SD. The practice serves a patient population of around 2,650 people and is a member of NHS Wakefield Clinical Commissioning Group.
The surgery is located in purpose built premises and is readily accessible for those with a disability, for example the entrance door is wide enough to allow wheelchair access. There is limited parking available on site for patients, although there is on-street parking available nearby. An independent pharmacy is located close to the practice.
The practice age profile shows that 24% of its patients are aged under 18 years (compared to the CCG average of 20% and the England average of 21%), whilst it is below both the CCG and England averages for those over 65 years old (14% compared to the CCG average of 18% and England average of 17%). Average life expectancy for the practice population is 77 years for males and 79 years for females (CCG average is 78 years and 82 years and the England average is 79 years and 83 years respectively). The practice serves an area of higher than average deprivation and is ranked in the most deprived 10% of areas in the country. The practice population is primarily composed of White British patients, although there are significant numbers (16%) of patients from other ethnic backgrounds.
The practice provides services under the terms of the Personal Medical Services (PMS) contract. In addition the practice offers a range of enhanced local services including those in relation to:
-
Childhood vaccination and immunisation
-
Influenza and Pneumococcal immunisation
-
Rotavirus and Shingles immunisation
-
Dementia support
-
Minor surgery
-
Learning disability support
As well as these enhanced services the practice also offers additional services such as those supporting long term conditions management including diabetes and coronary heart disease.
Attached to the practice or with the ability to work closely with the practice is a team of community health professionals that includes health visitors, midwives, members of the district nursing team and health trainers.
The practice is operated by one principal GP (male). The clinical team within the practice composes one salaried GP (female), an agency practice nurse, and a phlebotomist/health care assistant (female). Clinical staff are supported by a practice manager, a team leader and an administration and reception team. The practice also uses the services of a pharmacist (male) on a locum basis when required.
The practice appointments include:
-
Pre-bookable appointments which can be made from four to 12 weeks in advance
-
On the day/urgent appointments
-
Telephone triage/consultations where patients could speak to a GP or advanced nurse practitioner. This service is delivered in conjunction with local network partners.
Appointments can be made in person, via telephone or online.
The practice is open between 8am and 6.30pm Monday to Friday. Extended hours appointments are offered on a Thursday evening from 6.30pm to 8pm.
The practice also participates in a local extended hours/out of hours telephone triage service, Trinity Care, which operates across the local network. Patients can call the service on weekdays 8am to 8pm and on weekends and bank holidays 9am to 3pm. Calls are triaged and an appointment made with a doctor should this be necessary. Patients were encouraged to ring this number during the week when no further appointments were available at the practice.
Out of hours care is provided by GP Care Wakefield and is accessed via the practice telephone number or patients can contact NHS 111.
The practice had previously been inspected in April 2017 and was rated as Inadequate overall with individual key question ratings of:
This last rating is clearly displayed in the practice and on the practice website.
Updated
8 March 2018
Letter from the Chief Inspector of General Practice
This practice is rated as Requires Improvement overall. At a previous inspection carried out on 12 and 20 April 2017 the practice was rated as Inadequate overall. A focused inspection carried out on 5 October 2017 did not assess ratings for the practice and was used to assess compliance against Warning Notices, which had previously been served on the practice in light of identified breaches of regulation. At that inspection, we found the provider had made the improvements required.
The key questions are rated as:
Are services safe? – Requires Improvement
Are services effective? – Requires Improvement
Are services caring? – Good
Are services responsive? – Good
Are services well-led? - Requires Improvement
As part of our inspection process, we also look at the quality of care for specific population groups. The population groups are rated as:
Older People – Requires Improvement
People with long-term conditions – Requires Improvement
Families, children and young people – Requires Improvement
Working age people (including those retired and students – Requires Improvement
People whose circumstances may make them vulnerable – Requires Improvement
People experiencing poor mental health (including people with dementia) - Requires Improvement
We carried out an announced comprehensive inspection at Eastmoor Health Centre on 17 January 2018. This was to check that the practice had taken sufficient action to address a number of significant shortfalls we had identified during our previous inspection of the practice on 12 and 20 April 2017. Following this inspection, the practice was rated as inadequate for providing safe, effective and well-led services; and requires improvement for providing caring and responsive services. Overall it was rated as inadequate. We also issued two warning notices and a requirement notice for breaches of regulations under the Health and Social Care Act 2008 and placed the practice into special measures. A subsequent focused inspection carried out on 5 October 2017 found that the two warning notices had been complied with. The requirement notice was considered complied with at this inspection.
At the time of this inspection the practice was in a transition period as the current provider was in the process of retiring from the practice. They were working closely with a potential new provider to ensure continuity of service for patients and staff at Eastmoor Health Centre.
At this inspection we found:
-
The practice had made some improvements since the last comprehensive inspection in April 2017. We saw that remedial actions which included those in relation to the management of patient safety and medicines alerts, infection prevention and control and quality improvement activity had been actioned and sustained.
-
However we saw that the significant event process was being applied inconsistently and that the management of medicines still required improvement. These were areas of work which had previously been highlighted to the practice and had improved at the focused inspection in October 2017.
-
The practice had systems to safeguard children and vulnerable adults from abuse. Policies were regularly reviewed and were accessible to all staff. They outlined clearly who to go to for further guidance.
-
Team meetings had not taken place for a period of three months and annual appraisals for six members of staff had not been completed.
-
The practice had a comprehensive, pre-planned programme of quality improvement activity.
-
The practice was generally below local and national averages for its satisfaction scores on consultations with GPs and nurses.
-
Some staff personnel records were incomplete and lacked detail with regard to induction received, checks on identity and verifying the full immunity status of staff.
-
The practice had recently formed a patient reference group and had developed relationships with local community and health groups, and were using these to improve patient engagement in areas such as bowel and breast cancer screening.
-
Whilst leadership and oversight within the practice had shown some improvement, we saw that this had not been fully sustained in all areas.
The areas where the provider must make improvements as they are in breach of regulations are:
-
Ensure care and treatment is provided in a safe way to patients.
-
Establish effective systems and processes to ensure good governance in accordance with the fundamental standards of care.
-
Review and improve the level and detail of information contained in staff personnel files to include information with regard to induction received, identity checks carried out and staff immunity status.
The areas where the provider should make improvements are:
-
Review and consider how best to improve satisfaction scores from the national GP patient survey.
-
Review staff capabilities to run checks on patients in receipt of high risk medication.
-
Review procedures with regard to cleaning schedules and the accuracy of cleaning records.
I am taking this service out of special measures. This recognises the significant improvements made to the quality of care provided by the service. These improvements now need to be sustained moving forwards, and improvements made in some other areas.
Professor Steve Field (CBE FRCP FFPH FRCGP)
Chief Inspector of General Practice