Westcotes GP Surgery

We carried out an announced focused inspection at Westcotes GP Surgery on 3 February 2020 as part of our inspection programme to confirm that the practice had carried out their plan to meet the legal requirements in relation to the warning notices served on the 15 November 2019. This report only covers our findings in relation to those requirements.

At the last inspection in October 2019 we rated the practice as inadequate for providing safe, effective and well-led services. The practice was rated good for providing caring and responsive services. Breaches of legal requirements were found and after our comprehensive inspection, we issued warning notices against the providers registration.

The full comprehensive report on the October 2019 inspection, can be found by selecting the ‘all reports’ link for Westcotes GP surgery on our website at www.cqc.org.uk .

At this inspection we followed up on breaches of regulations identified at a previous inspection on 14 and 15 October 2019.

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 found that:

• Staff were able to demonstrate access to significant events policies and logs. Staff demonstrated awareness of actions taken and learning following incidents.
• Patients received effective care and treatment that met their needs. In particular, clinical records showed actions had been taken to ensure blood results were added to patients notes and diagnoses were being coded.
• The practice held appropriate emergency medicines to enable staff to respond to a variety of medical emergencies.
• The practice demonstrated that staff were working within their level of competence and where required additional training and support was provided to enable staff to carry out their role safely and effectively.
• The provider took action to strengthen governance arrangements as well as processes for managing clinical risks, issues and performance.
• The practice acted on appropriate and accurate information. There was clear clinical oversight and coherent working within the practice.

There was evidence that action taken since our October 2019 inspection, had a positive impact on the providers ability to deliver safe and well-led services. Although some actions were ongoing, we found changes were effectively communicated, monitored and the provider had set a realistic timeframe to complete all identified actions. The provider proactively worked with key stakeholders and we saw engagement was ongoing. As a result, inspectors were satisfied actions taken by the provider achieved compliance with the relevant requirements set out in the warning notice issued on the 15 November 2019.

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

• Continue taking actions to address the issues identified during the Care Quality Commissions October 2019 comprehensive inspection.

The practice is due to be inspected again within six months of publication of the October 2019 comprehensive inspection report.

This service will remain in special measures. Services placed in special measures will be inspected again within six months. If insufficient improvements have been made such that there remains a rating of inadequate for any population group, key question or overall, we will take action in line with our enforcement procedures to begin the process of preventing the provider from operating the service. This will lead to cancelling their registration or to varying the terms of their registration within six months if they do not improve.

The service will be kept under review and if needed could be escalated to urgent enforcement action. Where necessary, another inspection will be conducted within a further six months, and if there is not enough improvement, we will move to close the service by adopting our proposal to remove this location or cancel the provider’s registration.

Special measures will give people who use the service the reassurance that the care they get should improve.

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 Westcotes GP Surgery on 14 and 15 October 2019 as part of our inspection programme.

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 inadequate overall.

We rated the practice as inadequate for providing safe services because:

• Safeguarding systems and processes did not provide assurance that people were kept safe and safeguarded from potential abuse.
• The practice did not have appropriate systems in place for the safe management of medicines.
• Staff were working outside their level of competence.
• The practice had processes to enable learning and make improvements when things went wrong following significant events and complaints. However, senior clinicians explained they were not routinely informed of incidents and did not have access to the practice incident log.

We rated the practice as inadequate for providing effective services because:

• There was limited monitoring of the outcomes of care and treatment.
• The practice was unable to show staff had the skills, knowledge and experience to carry out the additional roles they performed
• Some performance data was below local and national averages and the practice did not have a coherent approach to managing Quality Outcomes Framework (QOF) performance.
• Clinicians were unable to demonstrate that test results carried out in secondary care were being viewed prior to generating repeat prescriptions, and we saw examples of missed diagnoses of long-term conditions.

We rated the practice as inadequate for providing well-led services because:

• The partnership was a two GP partnership; with one partner being a sleeping partner for business continuity. However, the partners could not demonstrate they had the capacity or established leadership structure to deliver high quality, sustainable care.
• Whilst there was a clear vision, there was a lack of coherent working within the practice to demonstrate that the vision, values and strategy had a powerful influence on the behaviour of staff at all levels.
• There were areas where governance arrangements were ineffective.
• The practice did not have clear and effective processes for managing clinical risks, issues and performance.
• The practice did not always act on appropriate and accurate information.

These areas affected all population groups, so we rated all population groups as inadequate.

We rated the practice as good for providing caring and responsive services because:

• Staff dealt with patients with kindness and respect and involved them in decisions about their care.
• Patients who completed Care Quality Commission comment cards were positive and the practice carried out their own internal patient survey which also demonstrated positive patient satisfaction.
• The 2019 national GP patient survey showed patients felt they were able to access care and treatment in a timely way.
• During our inspection, patients we spoke with described staff as understanding.
• There was information in patient waiting areas to support people who wished to make a complaint. Complaints were responded to in a timely manner and actions taken in response

The areas where the provider must make improvements are:

• Ensure that care and treatment is provided in a safe way.
• Establish effective systems and processes to ensure good governance in accordance with the fundamental standards of care.

(Please see the specific details on action required at the end of this report).

The areas where the provider should make improvements are:

• Gain assurance that staff are up to date with their routine immunisations.
• Take action in regards’ to carrying out premises’ security risk assessment.
• Take action to improve the uptake of childhood immunisation as well as national screening programmes such as cervical screening.

I am placing this service in special measures. Services placed in special measures will be inspected again within six months. If insufficient improvements have been made such that there remains a rating of inadequate for any population group, key question or overall, we will take action in line with our enforcement procedures to begin the process of preventing the provider from operating the service. This will lead to cancelling their registration or to varying the terms of their registration within six months if they do not improve.

The service will be kept under review and if needed could be escalated to urgent enforcement action. Where necessary, another inspection will be conducted within a further six months, and if there is not enough improvement we will move to close the service by adopting our proposal to remove this location or cancel the provider’s registration.

Special measures will give people who use the service the reassurance that the care they get should improve.

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