Westbrook Medical Centre

Updated 27 July 2016

We previously undertook a comprehensive inspection on 12 May 2016. We rated the service as requires improvement for providing safe services. We issued two Requirement Notices as a result of our findings and requested an action plan from the provider.

Westbrook Medical Centre is registered with the Care Quality Commission to provide primary care services. It provides GP services for approximately 10,500 patients living in Warrington. The practice is situated in a new modern purpose built health centre which houses other health care clinics such as podiatry, audiology and paediatric optometry. The practice has seven GPs (four male and three female), a practice management team, three practice nurses, and administration and reception staff. Westbrook Medical Centre holds a Primary Medical Services (PMS) contract with NHS England.

The practice is open during the week, between 8.30am and 6.00pm. Extended hours appointments are available in the mornings and one evening per week. They are closed one

afternoon per month for staff training and development. Patients can book appointments in person, via the telephone or online. The practice provides telephone consultations, pre bookable consultations, urgent consultations and home visits. The practice treats patients of all ages and provides a range of primary medical services.

The practice is part of Warrington Clinical Commissioning Group (CCG).The practice is situated in an affluent area. The practice population is made up of a slightly higher than national average working age population. Forty nine percent of the patient population has a long standing health condition, whilst 52% have health related problems in daily life. There is a slightly lower than national average number of unemployed patients.

The practice does not provide out of hours services. For out of hours medical care patients are advised to ring NHS 111 helpline. Out of hours GP services are provided locally by the local NHS Trust.

Updated 27 July 2016

Letter from the Chief Inspector of General Practice

We carried out an announced comprehensive inspection of this practice on 12 May 2015. A breach of legal requirements was found. The breach related to a lack of effective auditing systems in place to ensure assessment, monitoring and driving improvements in the quality and safety of care and treatment provided. We had also found there was not an effective risk management system or process in place to assess, monitor and mitigate risks relating to the health, safety and welfare of people using the service and others. This included general environmental and health and safety risk assessments. Following the comprehensive inspection, the practice wrote to us to say what they would do to meet legal requirements in relation to the breach.

We undertook this focused inspection visit to check that the provider had followed their plan and to confirm that they now met legal requirements. This report only covers our findings in relation to those requirements. You can read the report from our last comprehensive inspection, by selecting the 'all reports' link for Westbrook Medical centre on our website at www.cqc.org.uk

During this follow up inspection visit we found a number of practices had been put in place to address the previously identified shortfalls;

• Auditing systems had been improved to monitor effectiveness and drive improvements to the quality and safety of care and treatment provided.

• Additional health and safety related checks and risk assessments had been introduced to assess, monitor and mitigate risks relating to people’s health, safety and welfare.

• Staff had been supported through appraisal and on going training.

Professor Steve Field (CBE FRCP FFPH FRCGP) 

Chief Inspector of General Practice

Updated 25 June 2015

The practice is rated as good for the care of people with long-term conditions. The practice had a lower than national average number of patients with long standing health conditions (49.4% of its population). Patients with long term conditions were supported by a healthcare team that cared for them using good practice guidelines and were attentive to their changing needs. There was proactive intervention for patients with long term conditions. Patients had health reviews at regular intervals depending on their health needs and condition. For example 100% of patients with rheumatoid arthritis had received an annual review.

The practice maintained and monitored registers of patients with long term conditions for example cardiovascular disease, diabetes, chronic obstructive pulmonary disease and heart failure. These registers enabled the practice to monitor and review patients with long term conditions effectively. The Quality and Outcomes Framework (QOF) information indicated that patients with long term health conditions received care and treatment as expected and above the national average. For example, 100% of patients with asthma had received a review in the last 12 months, regular and clinical risk groups (at risk due to long term conditions) had good uptake rates for seasonal flu vaccinations.

Clinical staff (both GPs and practice nurses) managed chronic long term conditions and diseases. Patients at risk of hospital admission were identified, care plans developed and reviewed regularly. Longer appointments and home visits were available when needed. Patients had a named GP and a structured annual review to check that their health and medication needs were being met.

Updated 25 June 2015

The practice is rated as good for the care of families, children and young people. There were systems in place to identify and follow up children who were at risk, for example, the practice maintained a register of children who had a child protection plan. Immunisation uptake rates were above average for standard childhood immunisations. We received positive feedback regarding care and treatment at the practice for this group. Patients we spoke with told us they were confident with the care and treatment provided to their families. Appointments were available outside of school hours and the premises were suitable for children and babies including the provision of breast feeding and baby changing rooms. We saw good examples of joint working with midwives and health visitors. For example there were weekly baby clinics held on site and a ‘Bosom Buddies’ group which supported breastfeeding mothers. The practice responded to the needs of this group and children or young people were always given a same day appointment or urgent appointment as necessary.

Updated 25 June 2015

The practice is rated as good for the care of older people. Nationally reported data showed that outcomes for patients were good for conditions commonly found in older people. For example the Quality and Outcomes Framework (QOF) information indicated that last year 90% of patients aged 75 or over with a fragility fracture on or after 1 April 2012, who are currently treated with an appropriate bone sparing agent. This was higher than the national average. The practice offered proactive, personalised care to meet the needs of the older people in its population and had a range of enhanced services, for example, avoiding unplanned admissions, seasonal flu vaccinations and in dementia and end of life care. It was responsive to the needs of older people, and offered home visits to deliver care to those older patients who were not able to attend the surgery. It was proactive in providing weekly ward rounds for patients living in local care homes.

Updated 25 June 2015

The practice is rated as good for the care of working-age people (including those recently retired and students). 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 offered flexibility in appointments and a range of services such as health promotion and screening that reflected the needs for this age group. For example smoking cessation and travel advice. Routine health checks were available to patients aged over 45. Online booking, cancellation of appointments and ordering of repeat medications facilities were available. Extended hours appointments were available with appointments available from 7am most days and one day per week appointments were available until 7.30pm.

Updated 25 June 2015

The practice is rated as good for the care of people experiencing poor mental health (including people with dementia). For example 78% of those diagnosed with dementia had received a review of their care in the preceding 12 months. The practice regularly worked with multi-disciplinary teams in the case management of people experiencing poor mental health, including those with dementia.

One of the GPs led on dementia care. The practice worked closely with the mental health services in Warrington. The practice provided an onsite weekly counselling service to patients suffering with poor mental health and was able to signpost patients experiencing poor mental health to access various support groups and voluntary organisations including MIND. Patients with poor mental health were accommodated, where possible, with same day appointments with a preferred clinician.

Updated 25 June 2015

The practice is rated as good for the care of people whose circumstances may make them vulnerable. The practice held a register of patients living in vulnerable circumstances including children and adults at risk of abuse, patients with dementia, terminally ill and those with a learning disability. It had carried out annual health checks for people with a learning disability and it offered longer appointments and home visits for vulnerable patients.

The practice worked with multi-disciplinary teams in the case management of vulnerable people. It was able to signpost vulnerable patients and their carers to 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.