Archived: Willenhall Primary Care Centre

Updated 12 January 2017

Willenhall Primary Care Centre is located in Willenhall, a suburb in the south-east of Coventry City in the West Midlands. The premises is shared with another GP practice with a very similar name.

There is direct access to the practice by public transport from surrounding areas. There are some limited parking facilities on site as well as public on street parking.

The practice currently has a list size of 3333 patients. The practice also has a branch surgery at 183 Green Lane, Finham, which is located 4 miles from the main site. We did not visit the branch site during our inspection.

The practice holds a Personal Medical Services (PMS) contract which is a locally agreed contract between NHS England and a GP to deliver care to the public. The practice provides additional GP services commissioned by NHS Coventry and Rugby Clinical Commissioning Group (CCG). A CCG is an organisation that brings together local GPs and experienced health professionals to take on commissioning responsibilities for local health services.

The practice is situated in an area with higher levels of deprivation. The practice has a higher than national average number of children and working aged adults in their 40s and 50s. It also has a higher than national average number of patients of retirement age.

A lower number of patients registered at the practice are unemployed (3.7%) compared with the local CCG (6.7%) and national averages (5.4%).

The practice is currently managed by two GPs (male and female). They are supported by two female practice nurses. There is currently no practice manager in post since the previous manager left in April 2016. A member of administrative staff has been assisting the GP partners in the day to day operation of the practice. The partners did not have existing plans to formally recruit to the vacant practice manager role. The practice also employs a team of reception, clerical and administrative staff.

The main site and branch of the practice is open on Mondays, Tuesdays, Wednesdays and Fridays from 9am to 6.30pm and on Thursdays from 9am to 2pm. The provider did not have an arrangement in place with out of hours services between 8am and 9am for patient telephone calls to be answered. This is during core business hours. We were told that the senior GP partner answered all calls during this time. A member of staff was assigned to answer calls on a Thursday afternoon from 2pm when the practice was closed. Appointments are available at the main site on Mondays from 8.30am to 11am and 4pm to 6pm, Tuesdays from 9.30am to 11.30am and 4pm to 6pm, Wednesdays from 9am to 11am and 4pm to 6pm, Thursdays from 8.30am to 10.30am and Fridays from 9.30am to 11.30am and 4pm to 6pm. Appointments at the branch site are available on Mondays from 9.30am to 11.30am and 4pm to 6pm, Tuesdays and Wednesdays from 11.20am to 1pm and Thursdays and Fridays from 9.30am to 11.30am.

The practice has started to offer extended hours services through the GP alliance it is affiliated with. Practice patients could therefore be seen at three other named practices each weekday evening from 6.50pm up until 9.10pm and both weekend mornings from 9am to 11.40am by pre-booking an appointment. Outside of this cover, out of hours service is provided by Coventry and Warwickshire Partnership Trust. Patients can also contact NHS 111.

As part of our inspection process we checked the service provider’s registration with the Care Quality Commission under the Health and Social Care Act 2008. We found that the provider’s registration did not reflect the current partnership arrangements in place. The registered partnership included a partner who had left the partnership in December 2013. We noted that a new partner had joined the partnership in January 2013 but the Care Quality Commission had not been notified of these changes. The Care Quality Commission (Registration) Regulations 2009 requires the registered person to give notice as soon as reasonably practicable; any change in the membership of the partnership.

Updated 12 January 2017

Letter from the Chief Inspector of General Practice

We carried out an announced comprehensive inspection at Willenhall Primary Care Centre on 22 September 2016. Overall the practice is rated as inadequate. (The practice is located in the same premises as another GP practice with a similar name.)

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

• Staff were did not have a clear understanding about reporting incidents, near misses and concerns and there was limited evidence of learning and communication with staff.
• Patients were at risk of harm because systems and processes were not sufficiently in place to keep them safe. These included recruitment procedures for locum doctors and the practice’s ability to respond to all medical emergencies.
• Staff assessed needs and delivered care in line with current evidence based guidance. There was some limited evidence of clinical audit which showed improved patient outcomes.
• Not all staff had the skills, knowledge and experience to deliver effective care and treatment. Induction training had not been completed for all staff employed, ongoing training requirements for staff were not being met and appraisals were overdue for completion.
• Patient feedback on CQC comment cards was positive about interactions with staff and patients said they were treated with compassion and dignity.
• Results from the National GP Patient Survey showed that patients were able to access the practice easily by phone and were able to see or speak to their preferred GP. Results also identified areas where care could be improved.
• The practice did not have a patient participation group (PPG) and had not obtained feedback from its patients to identify where improvements could be made in services delivered.
• The practice did not have a clear leadership structure, there was insufficient leadership capacity and there were limited formal governance arrangements.

The areas where the provider must make improvements are:

• Ensure there are structured processes for reporting, recording, acting on and monitoring significant events, incidents and near misses.

• Ensure recruitment processes include all necessary checks for locum staff working within the practice.

• Risk assess emergency medicines required within the practice and ensure all equipment held is fit for use in the event of an emergency.

• Ensure that all policies and processes used to govern activity are implemented and up to date. To include business continuity plans, infection control, incident reporting, complaints policy.

• Implement national guidance regarding the follow up of childrens’ missed hospital appointments and document recording of actions taken.

• Maintain records of all practice meetings including clinical, multidisciplinary, practice and significant events discussions to evidence the ongoing care and treatment of patients and improvement of service.

• Ensure all the learning and development needs of all staff are identified through a system of comprehensive induction, annual appraisals and meetings which are recorded and monitored. Ensure all staff are up to date with attending the provider’s mandatory training courses to include basic life support training, safeguarding training for non clinical staff, information governance and infection control.

• Ensure all staff are offered and provided with vaccinations relevant to their roles, including the hepatitis B vaccination, and that a register is maintained to reflect staff immunisation status.

• Implement processes for how the practice gathers feedback to ensure that patients and staff are involved with how the practice is run.

• Ensure their systems for identifying and responding to complaints are effective.

• Implement formal governance arrangements including systems for assessing and monitoring risks and the quality of the service provision.

• Review its arrangements to ensure compliance with contractual agreements. Patients must be able to speak with a GP when necessary between the core business hours of 8am to 9am.

The provider should have regard to:

• Review the system for managing alerts and notifications, including the recording of actions taken, to ensure patients are kept safe.

• Review the arrangements for storing medicines; to ensure vaccine fridges are calibrated monthly or to consider the use of a secondary thermometer.

• Review the frequency of their quality monitoring activity such as clinical audit to improve patient outcomes.

• Ensure that prescription pads are monitored by recording the sequential numbers on items held from point of delivery to point of dispatch to prescribing staff.

• Review its processes to ensure that carers are proactively identified and appropriate support offered.

I am placing this service 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 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

Updated 12 January 2017

The practice is rated as inadequate for safe and well-led. The issues identified as inadequate overall affected all the patients including this population group.

• Performance for eleven diabetes related indicators was 98% which was higher than the CCG average of 90% and national average of 90%.

• 97% of patients diagnosed with asthma, on the register, had an asthma review in the last twelve months. This was above the CCG average of 77% and national average of 75%. The practice exception reporting was 0.4% which was lower than the CCG average of 3.8% and national average of 7.9%.

• Longer appointments and home visits were available when needed.

• All these patients 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.

Updated 12 January 2017

The practice is rated as inadequate for safe and well-led. The issues identified as inadequate overall affected all the patients including this population group.

• Safeguarding systems required strengthening to ensure that vulnerable children were identified to all staff. For example, at the time of our inspection, there was no process in place to identify children who had missed hospital appointments.

• The practice told us they had been unable to hold formal meetings with attached health visiting staff, but recent recruitment within the health visiting team meant that more regular liaison meetings would be held in the near future.

• Immunisation rates for all standard childhood immunisations ranged from 88% to 100%. This was similar to CCG averages which ranged from 82% to 98%.

• Children and young people were treated in an age-appropriate way and were recognised as individuals, and we saw evidence to confirm this.

• Appointments were available outside of school hours and the premises were suitable for children and babies.

Updated 12 January 2017

The practice is rated as inadequate for safe and well-led. The issues identified as inadequate overall affected all the patients including this population group.

• The practice offered personalised care to meet the needs of the older people in its population. Care plans were implemented for those who were at risk of hospital admission and those close to the end of their life.

• The practice was responsive to the needs of older people, and offered home visits and urgent appointments for those with enhanced needs.

• We spoke with two care homes staff where practice patients were living. We received mixed feedback. Positive feedback included that practice GPs had supported care homes staff in the management of particular patients with complex needs, and were responsive in attending the home when required. Other feedback said responsiveness in GPs attending the practice could be improved and prescriptions were not always brought with them. This meant there could be delays in obtaining medicines for patients.

• National data showed the practice was performing above the local CCG and national averages for its achievement within stroke and transient ischaemic attack (TIA) related indicators. Data showed that 98% of patients with a history of stroke or TIA had received a blood pressure reading within the previous 12 months. The CCG average was 87% and national average was 88%.

Updated 12 January 2017

The practice is rated as inadequate for safe and well-led. The issues identified as inadequate overall affected all the patients including this population group.

• The age profile of patients at the practice included those of working age, students and the recently retired but the services available did not fully reflect the needs of this group. Whilst telephone consultations were offered to those who requested these,

• The practice offered screening that reflects the needs for this age group. Data showed that

• Health promotion advice was offered, and we found a range of information in one of the clinic rooms. There was more limited health promotion material available in the practice waiting area.

Updated 12 January 2017

The practice is rated as inadequate for safe and well-led. The issues identified as inadequate overall affected all the patients including this population group.

• 96% of patients diagnosed with dementia had their care reviewed in a face to face meeting in the last 12 months. This was above the CCG average of 81% and national average of 84%. The practice had not exception reported any patients. The CCG average was 6.3% and national average was 6.8%.
• Data showed that 98% of patients with a mental health condition had a documented care plan in place in the previous 12 months. This was above the CCG average of 85% and above the national average of 89%. The practice had not exception reported any patients. The CCG average was 10.4% and national average was 12.7%.

• The practice 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. For example, the practice referred patients who would benefit to a counselling service available on site. (Improving Access to Psychological Therapies, IAPT).

Updated 12 January 2017

The practice is rated as inadequate for safe and well-led. The issues identified as inadequate overall affected all the patients including this population group.

• The practice held a register of patients living in vulnerable circumstances including those with a learning disability. There were 66 patients on the learning disability register and 53 had received an annual health check.

• The practice offered longer appointments for patients with a learning disability.

• The practice 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. For example, those patients with drug or alcohol problems were referred to the Recovery Partnership, a service which provided advice, support and treatment for adults living within the practice area.
• The practice had identified 44 carers in total. This represented 1.3% of the practice list. Carers were offered an annual flu vaccination, a carers pack and provided with contact information for support organisations.