3W Health

Updated 22 November 2016

Letter from the Chief Inspector of General Practice

In April 2016 we found concerns related to the management of medical emergencies and supporting processes during a comprehensive inspection of Wing Surgery – Stewkley Road in Wing (a village between Aylesbury and Leighton Buzzard on the Buckinghamshire/Bedfordshire boarder). Following the inspection the provider sent us an action plan detailing how they would improve the areas of concern. On previous inspection in April 2016, we found one breach of the regulations relating to the safe delivery of services.

We carried out a follow up inspection of Wing Surgery – Stewkley Road on 3 November 2016 to ensure these changes had been implemented and that the service was meeting the requirements of the regulations.

The ratings for the practice have been updated to reflect our findings following the improvements made since our last inspection and the practice was now meeting the regulations that had previously been breached.

Specifically the practice was:

• Operating safe systems in relation to the management of medical emergencies and supporting processes. This included appropriate arrangements in place for handling, using, storing and dispensing medicines.

• The practice (specifically the dispensary within the practice) was now managing repeat prescriptions in a safe and effective way. Furthermore, processes supporting prescription security within the practice had been strengthened and prescriptions were now securely stored and systems implemented to monitor their use.
• Reviewing all the patient feedback received. This included a review of all complaints and compliments and ensuring any relevant learning was implemented. The practice had also updated leaflets and information on the website to ensure patients were aware of how they can raise verbal comments and complaints.

Wing Surgery – Stewkley Road had taken full heed of the findings of the inspection undertaken in April 2016 and is now rated good for the provision of safe, effective, caring, responsive and well led services.

Professor Steve Field CBE FRCP FFPH FRCGP

Chief Inspector of General Practice

Updated 27 May 2016

The practice is rated as good for the care of people with long-term conditions.

• Nursing staff had lead roles in chronic disease management and patients at risk of hospital admission were identified as a priority.
• The most recent published results were 96% of the total number of points available compared to the CCG average of 97% and national average of 95%.
• Performance for diabetes related indicators was 91% compared to the national average of 89% and regional average of 93%.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.
• The process for repeat prescriptions did not ensure a GP reviewed prescriptions before they were produced by the dispensary.

Updated 27 May 2016

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 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.
• Patients told us that children and young people were treated in an age-appropriate way and were recognised as individuals, and we saw evidence to confirm this.
• We saw positive examples of joint working with midwives, health visitors and school nurses.
• Joint working with external organisations took place in the management of children at risk of abuse, although the practice rarely attended these meetings.

Updated 27 May 2016

The practice is rated as good for the care of older people.

• The practice offered proactive, personalised care to meet the needs of the older people in its population.
• The practice was responsive to the needs of older people, and offered home visits and urgent appointments for those with enhanced needs.
• The premises were accessible for patients with limited mobility and poor hearing. Appointments were available on the ground floor.
• Patients over 75 had a named GP.

Updated 27 May 2016

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.
• Patients feedback on the appointment system was very positive overall.
• 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.
• Travel vaccinations were available.

Updated 27 May 2016

The practice is rated as good for the care of people experiencing poor mental health (including people with dementia).

• Performance for mental health related indicators was 92% compared to the national average 92% and regional average of 97%.
• 93% of patients eligible for a care plan had one agreed and updated on their records.
• The practice regularly worked with multi-disciplinary teams in the case management of patients experiencing poor mental health, including those with dementia.
• The practice carried out advance care planning for patients with dementia.
• The practice had told patients experiencing poor mental health about how to access various support groups and voluntary organisations.

Updated 27 May 2016

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 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.
• Joint working with external organisations took place in the management of patients at risk of abuse or harm, although the practice rarely attended these meetings.