Archived: Willenhall Primary Care Centre

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