Archived: Woodhouse Hill Surgery

We carried out an announced comprehensive inspection at Woodhouse Hill Surgery on 4 April 2018 and 10 May 2018. The overall rating for the practice was inadequate and as a result the service was placed in special measures. The full comprehensive report on the inspection can be found by selecting the ‘all reports’ link for Woodhouse Hill Surgery on our website at .

This inspection was an announced focused inspection carried out on 16 October 2018 to confirm that the practice had responded to the warning notice dated 14 June 2018 and met the legal requirements in relation to the breach of Regulation 12 (1), Safe Care and Treatment, identified at our previous inspection on 4 April 2018 & 10 May 2018. The practice was required to be compliant with the concerns documented in the warning notice by 2 October 2018.

This report covers our findings in relation to those requirements.

Our key findings were as follows:

• The provider had made improvements in keeping accurate records with respect to each patient. There were now only 134 (638 at our last inspection) patient records that required summarising. This meant that for most patients, accurate and up to date information was available which reduced the number of patients at risk.
• The practice had systems to manage risk so that safety incidents were less likely to happen. 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 themselves that changes had been embedded into practice.
• The practice reviewed the effectiveness and appropriateness of the care it provided. The sample of patients whose records we viewed were clinically coded correctly to support delivery of care and treatment.
• Clinicians ensured that in all the cases we viewed, care and treatment was delivered according to evidence based guidelines.

The area where the provider should make improvements are:

• Continue to prioritise patient records that still need to be summarised in order to clear the remaining backlog.
• Continue to review and improve the prescribing of antibiotics to ensure that all antibiotic prescriptions are supported with a clear rationale.

Professor Steve Field CBE FRCP FFPH FRCGP

Chief Inspector of General Practice

This practice is rated as Inadequate overall.

The previous inspection, carried out on 12 December 2016 rated the practice as good overall, but requires

improvement for the key question of well-led.

The key questions are rated as:

Are services safe? – Inadequate

Are services effective? – Requires Improvement

Are services caring? – Good

Are services responsive? – Requires Improvement

Are services well-led? - Inadequate

We carried out an announced comprehensive inspection at Woodhouse Hill Surgery on 4 April 2018 as part of our inspection programme. We also visited the practice unannounced on 10 May 2018 as part of the same

inspection due to some information of concern we received.

At this inspection we found:

• The provider was not keeping an accurate record with respect to each patient. There was a significant

backlog of patient records that required summarising. This meant that accurate and up to date information

was not always available which could put patients at risk.

• The practice had some systems to manage risk so that safety incidents were less likely to happen. However

the practice did not have a system in place for carrying out a planned review of changes introduced following

significant events, to determine their effectiveness and to assure themselves that changes had been

embedded into practice.

• The practice had some governance arrangements in place. However, there were areas where these were

not effective. For example, the provider did not have clear or effective systems in place for the planning and

provision of staffing levels.

• The practice reviewed the effectiveness and appropriateness of the care it provided. However not

all patients were clinically coded correctly to support delivery of care and treatment.

• Clinicians ensured that in most cases, care and treatment was delivered according to evidence based

guidelines.

• Staff involved and treated patients with compassion, kindness, dignity and respect.

• Patients found the appointment system easy to use and the ones we spoke with reported that they were

able to access care when they needed it. However, national GP patient survey results with regards to

access were lower than local and national averages.

The areas where the provider must make improvements are:

• Care and treatment must be provided in a safe way for service users.

• 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:

• The provider should review and act upon the results of patient satisfaction surveys, and ensure that they can

meet the needs of their patient population in the future. In particular, patient satisfaction with access to

the service was consistently below local and national average satisfaction rates.

• 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.

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.

Professor Steve Field (CBE FRCP FFPH FRCGP)

Chief Inspector of General Practice