Archived: Widbrook Medical Practice

Updated 29 December 2016

Widbrook Medical Practice is a GP practice located in the Wiltshire town of Trowbridge. It is one of the practices within the Wiltshire Clinical Commissioning Group and has approximately 5,700 patients. The practice building is purpose built with all patient services located on the ground floor which include; four consulting rooms, four treatments rooms, a self-check in appointment system and a toilet with access for people with disabilities.

The area the practice serves has relatively low numbers of people from different cultural backgrounds although the practice has recognised an increased number of Polish and Moroccan people registering at the practice. The practice has a slightly higher than average population between 40 and 60 years old. The general Index of Multiple Deprivation (IMD) population profile for the geographic area of the practice is in the third least deprivation decile (although it is important to remember that not everyone living in a deprived area is deprived and that not all deprived people live in deprived areas). Average male and female life expectancy for the area is 80 and 84 years, which is broadly in line with the national average of 79 and 83 years respectively.

The practice provides a number of services and clinics for its patients including: childhood immunisations, family planning, minor surgery and wound care, and a range of health lifestyle management and advice services including; smoking cessation, asthma management, diabetes management and travel health.

The practice has a total of three GPs. Two are full time (one male and one female) and one part-time (male). There are three part-time practice nurses, a practice manager, and a reception and administration team of team of nine.

The practice is open from 8.30am to 6.30pm Monday to Friday. Appointments with a GP are from 9am to 12.30pm and 3.15pm to 6.30pm Monday to Friday. Extended hours surgeries are offered from 6.30pm to 7.30pm on Tuesday and 7.30am to 8.00am on Thursdays. Appointments can be booked over the telephone, on line or in person at the surgery.

There are arrangements in place for services to be provided when the surgery is closed and these are displayed at the practice, on the website and in the practice information leaflet. The practice has opted out of providing out of hours services to their patients. The out of hours service is accessed by calling NHS 111 and is provided by Medvivo.

The practice has a General Medical services contract to deliver health care services. This contract acts as the basis for arrangements between NHS England and providers of general medical services in England.

The practice provides services from:

 Widbrook Surgery, 72 Wingfield Road, Trowbridge, Wiltshire, BA14 9EN. 

Updated 29 December 2016

Letter from the Chief Inspector of General Practice

We undertook a comprehensive inspection of Widbrook Medical Practice on 1 December 2015. At that time evidence showed the practice was not meeting regulations and was rated as inadequate. It was subsequently placed into special measures and the practice sent us an action plan setting out what they would do to meet the regulations.

We carried out a second comprehensive inspection at Widbrook Medical Practice on 11 October 2016. This comprehensive inspection was undertaken to check whether the practice had completed the actions they told us they would take to comply with regulations .

We have revised the practice’s overall rating based on our findings and they are now rated as requires improvement. We found the practice had made some improvement in some areas.  

Our key findings across all the areas we inspected were as follows:

• Staff understood their responsibilities to raise concerns, and to report incidents and near misses. However the recording of lessons learnt and actions taken following investigations of significant events and incidents were not always clear.
• Arrangements were in place to safeguard children and vulnerable adults from abuse. The safeguarding policies had been revised since our last visit.  
• Since our last inspection the practice had introduced new systems for sharing learning from audits and some had been discussed at staff meetings. However, in some cases these discussions were not recorded in the minutes of the meetings.
• The practice was comparable for its satisfaction scores on consultations with GPs and nurses. 36% of patients said they could get through easily to the practice by phone, this was an 7% improvement on what we found in December 2015.
• Patients told us that they found it difficult to get appointments when they needed them.
• Appointments could be booked up to two weeks in advance using the on-line system or ten days in advance by phone or in person. However, on the day of the inspection the practice told us there were no bookable appointments available.
• Since our last inspection, the practice had introduced a new system to review complaints and share any lessons were learnt. However, the system was not effective as complaints from patients were not always investigated or responded to appropriately and an apology was not always given.
• Some of the governance structures did not allow for the easy retrieval of information and some of the policies and procedures were not always followed.
• In the action plan they sent us the following our last inspection, the practice said they would carry out a number of actions and confirmed these actions had been completed. However, during this inspection the practice accepted that some had not been done, some could not be evidenced and we found some had not been completed adequately.

The areas where the provider must make improvement are:

• Ensure all medical equipment, including vaccine fridges and weighing scales are serviced and calibrated in line with manufacturer’s recommendations, and second thermometers used in the vaccine fridges meet the requirements set out in the guidance.
• Ensure emergency medicines are routinely checked and that they are in date and fit to use.
• Ensure external clinical waste bins are secure.
• Ensure their systems and processes are fit for purpose, and that they are able to access all necessary information when it is required.
• Ensure all staff have received infection control training appropriate for their role.
• Ensure policies and procedures are followed and that the practice has a good understanding of their management information.
• Ensure minutes of meetings adequately and clearly reflect what is discussed particularly in relation to lessons learnt and actions agreed.
• Ensure they keep all records up to date and store management information in a way that is easily accessible to all authorised staff.

The areas where the provider should make improvement are:

• Continue to improve how they use audit to improve services.
• Ensure that translation services are adequately advertised.
• Ensure infection control audits include an action plan to address any findings.
• Ensure staff protocols include information on the practices’ responsibilities towards staff.
• Review their process for identifying carers who may need additional support.
• Continue to review and take appropriate action on feedback from patients on the difficulties in booking an appointment.

This service will remain in special measures. Services placed in special measures will be inspected again within six months. If, after re-inspection, the service has failed to make sufficient improvement, and is still rated as 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 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.

Special measures will give patients 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

Updated 29 December 2016

The practice is rated as requires improvement for the care of patients with long-term conditions. The provider is rated as requires improvement for safe, effective, caring and responsive, and inadequate for well led. The concerns which led to these ratings apply to everyone using the practice, including this population group.

However, there were examples of good practice.

• Nursing staff had lead roles in chronic disease management and patients at risk of hospital admission were identified as a priority.
• Performance for diabetes related indicators was 99% compared to the national average of 89%. The exception reporting rate was 12% compared to the clinical commissioning group average of 14% and national average of 11%.%. (Exception reporting is the removal of patients from QOF calculations where, for example, the patients are unable to attend a review meeting or certain medicines cannot be prescribed because of side effects).
• Longer appointments and home visits were available when needed.
• All patients with long-term conditions had a named GP and a structured annual review to check their health and medicines needs were being met. For those patients with the most complex needs, the named GP worked with relevant health and care professionals to deliver a multidisciplinary package of care.
• 84% of patients with learning difficulties had received an annual health check in the last 12 months.

Updated 29 December 2016

The practice is rated as requires improvement for the care of families, children and young people. The provider is rated as requires improvement for safe, effective, caring and responsive, and inadequate for well led. The concerns which led to these ratings apply to everyone using the practice, including this population group.

However, there were examples of good practice.

• There were systems in place to identify and follow up children living in disadvantaged circumstances and who were at risk, for example, children and young people who had a high number of A&E attendances. Immunisation rates were relatively high for all standard childhood immunisations.
• The practice’s uptake for the cervical screening programme was 82%, which was comparable to the clinical commissioning group average of 85% and the national average of 82%.
• The premises were suitable for children and babies.
• We saw positive examples of joint working with midwives, health visitors and school nurses. 

Updated 29 December 2016

The practice is rated as requires improvement for the care of older people. The provider is rated as requires improvement for safe, effective, caring and responsive, and inadequate for well led. The concerns which led to these ratings apply to everyone using the practice, including this population group.

However, there were examples of good practice.

• The practice offered proactive, personalised care to meet the needs of the older patients in its population.
• The practice was responsive to the needs of older patients, and offered home visits and urgent appointments for those with enhanced needs.
• A GP undertook weekly visits to local nursing homes where the practice had large numbers of registered patients.
• The percentage of patients aged 75 or over with a fragility fracture on or after 1 April 2014, who were currently treated with an appropriate bone-sparing agent (in the period 04/2014 to 03/2015) was 100% compared to a national average of 93%. This was the same as we found on our inspection in December 2015.

Updated 29 December 2016

The practice is rated as Inadequate for the care of working age people (including those recently retired and students). The provider is rated as requires improvement for safe, effective, caring and responsive, and inadequate for well led. The concerns which led to these ratings apply to everyone using the practice, including this population group. .

However, there were examples of good practice.

• The needs of the working age population, those recently retired and students had been identified and the practice had adjusted the services it offered to ensure these were accessible, flexible and offered continuity of care.
• The practice was proactive in offering online services as well as a full range of health promotion and screening that reflects the needs for this age group.
• Routine appointments could be booked up to two weeks in advance using the on-line system or ten days in advance by phone or in person. On the day of our inspection there were no bookable routine appointments available for the next two weeks.
• Patients were able to receive travel vaccines available on the NHS as well as those only available privately.

Updated 29 December 2016

The practice is rated as requires improvement for the care of people experiencing poor mental health (including people with dementia). The provider is rated as requires improvement for safe, effective, caring and responsive, and inadequate for well led. The concerns which led to these ratings apply to everyone using the practice, including this population group..

However, there were examples of good practice.

• Performance for mental health related indicators was similar to the national average. For example, 91% of patients with a psychosis had their alcohol consumption recorded in the preceding 12 months compared to the clinical commissioning group average of 93% and national average of 90%.
• 84% of patients diagnosed with dementia who had their care reviewed in a face to face meeting in the last 12 months, which is the same as the national average of 84%.
• The practice regularly worked with multi-disciplinary teams in the case management of patients experiencing poor mental health, including those with dementia.
• The practice had told patients experiencing poor mental health about how to access various support groups and voluntary organisations. 

Updated 29 December 2016

The practice is rated as requires improvement for the care of people whose circumstances may make them vulnerable. The provider is rated as requires improvement for safe, effective, caring and responsive, and inadequate for well led. The concerns which led to these ratings apply to everyone using the practice, including this population group.

However, there were examples of good practice.

• The practice held a register of patients living in vulnerable circumstances including homeless people, travellers and those with a learning disability.
• The practice offered longer appointments for patients with a learning disability.
• The practice regularly worked with other health care professionals in the case management of vulnerable patients.
• The practice informed vulnerable patients about how to access various support groups and voluntary organisations.
• Staff knew how to recognise signs of abuse in vulnerable adults and children. Staff were aware of their responsibilities regarding information sharing, documentation of safeguarding concerns and how to contact relevant agencies in normal working hours and out of hours.