Archived: Wilnecote Surgery Also known as Wilnecote and Dosthill Surgeries

Updated 2 February 2017

Wilnecote Surgery is situated in Tamworth, Staffordshire. Although it is a branch surgery of Dosthill Surgery in Cadogan Road, Dosthill, we found that the provider is incorrectly registered with CQC. They had registered their two sites as separate locations when they operate as a main location with a branch surgery with the same patient list, and with the governance arrangements managed from Dosthill Surgery. An application to correct the registration had been submitted to the CQC.

The patient population totals 7,800 patients of all ages registered at the practice. The practice is owned by a partnership of two GPs. The staff team comprises the two full time male GP partners, a long term female locum GP (the practice also uses other locum GPs when required).

The practice clinical team includes four practice nurses, two mental health nurses on a self-employed basis and a health care assistant, working various part time hours across both of the providers’ surgery locations.

Updated 2 February 2017

Letter from the Chief Inspector of General Practice

We carried out an unannounced inspection on Wilnecote Surgery on 17 March 2015. The inspection was to follow up warning notices we issued after an inspection on 28 September 2015 when the practice was rated as inadequate and placed into special measures.

At our inspection on 28 September 2015, we found the provider to be in breach of the Health and Social Care Act 2008 (Regulated Activities) Regulations 2014. We issued warning notices in respect of the following breaches of regulations:

Regulation 12: Safe care and treatment

Regulation 17: Good governance

Our follow up inspection on 17 March 2016 was to look at the areas we identified in the warning notices to determine if the required improvements had been made. During the inspection we saw other areas of serious concern.

Our key findings were as follows:

• Patients’ blood test results were not being actioned in a timely manner. Evidence was seen that 1,314 blood results had not been reviewed, 904 of which were highlighted by the system as abnormal.
• We reviewed thirteen of the unactioned blood results that were more than one month old. Eight of the 13 patients were at risk of avoidable harm. For example, one patient was at risk of a stroke.
• Patients on repeat prescription were not managed effectively. For example, a patient on a controlled drug had not had their medication reviewed since 9 July 2014.
• A review of patient letters found that the processing of correspondence was up to date. However we found a deleted email that had not been not been actioned or attached to the patient record.
• Patients on high risk medication had been identified and recalled for retest appointments when needed. However medication had been stopped by the practice for two patients with no reasons recorded, no notification to the patient, and no notification to the consultant who had initialised the medication. Evidence sent after the inspection confirmed that one of the patient's had had their medication stopped by a hospital consultant.
• Staff files contained appropriate checks. For example, proof of professional qualifications, two forms of personal identification.
• Relevant staff training had been completed or planned.
• Health and safety improvements had been made following our inspection in September. For example, risk assessments completed included use of visual display units, slips and trips and lone working.

Following the inspection, we wrote to the provider requiring them to take immediate steps to clear the backlog of blood test results, and to put in place a series of measures to ensure patient safety. We reviewed the provider’s response and decided that they had taken sufficient action to maintain patient safety.

As this inspection only focussed on the two warning notices previously issued, the practice’s original rating of Inadequate remains. This will be reviewed at a further comprehensive inspection within two months, when we will also check that the improvements made after this inspection have been maintained.

Professor Steve Field (CBE FRCP FFPH FRCGP) 

Chief Inspector of General Practice

Updated 10 December 2015

The practice is rated as inadequate for the care of people with long-term conditions. There were aspects of the practice which were inadequate and these related to all population groups. Nursing staff had lead roles in chronic disease management. Home visits were available for people with long-term conditions when needed, but the majority of these were carried out by the Home Visiting Service which the provider contracts and funds. Although patients were offered an annual review, the nationally reported data showed that outcomes for patients with long term conditions were below the national average. For example: The percentage of patients with diabetes who had a specific blood pressure reading in the previous 12 month period was 43.67% which was lower than the national average of 78.53%.

Updated 10 December 2015

The practice is rated as inadequate for the care of families, children and young people. There were aspects of the practice which were inadequate and these related to all population groups. Although the electronic patient record identified patients who were living in disadvantaged circumstances and who were at risk, a system wasn’t in place to follow up patients in this group. The practice did engage with health visitors and midwives, but this was on an ad hoc basis rather than regular meetings. Immunisation rates for the standard childhood immunisations were comparable with the Clinical Commissioning Group averages. Appointments were available outside of school hours and the premises were suitable for children and babies.

Updated 10 December 2015

The practice is rated as inadequate for the care of older people. There were aspects of the practice which were inadequate and these related to all population groups. Care and treatment of older people did not reflect current evidence-based practice. The safety of care for older people was not a priority and there were limited attempts at measuring safe practice. Nationally reported data showed that outcomes for patients for conditions commonly found in older people were below the national average. For example: The percentage of patients aged 65 and older who have received a seasonal flu vaccination was 64.3% compared to 73.2%. There was no data available regarding the percentage of patients aged 75 or over with a fragility fracture who were currently being treated with an appropriate bone-sparing medicine. Home visits were available for older people when needed, some of these were carried out by the Home Visiting Service.

Updated 10 December 2015

The practice is rated as inadequate for the care of working-age people (including those recently retired and students). There were aspects of the practice which were inadequate and these related to all population groups. Appointments could be booked by telephone, in person and on line. Extended opening hours were available on evening a week for working people. Health promotion advice was offered but there was limited accessible health promotion material available through the practice.

Updated 10 December 2015

The practice is rated as inadequate for the care of people experiencing poor mental health (including people with dementia). There were aspects of the practice which were inadequate and these related to all population groups. The practice regularly worked with multi-disciplinary teams in the case management of people experiencing poor mental health, including those with dementia. It carried out advance care planning for patients with dementia. Patients and their families were supported by mental health nurses from the practice, and the consultant clinic was held at the practice every month.

Updated 10 December 2015

The practice is rated as inadequate for the care of people whose circumstances may make them vulnerable. There were aspects of the practice which were inadequate and these related to all population groups. The practice was able to identify the number of patients with a learning disability.

Staff told us they worked with multi-disciplinary teams in the case management of vulnerable people. Staff knew how to recognise signs of abuse in vulnerable adults and children, and were aware of their responsibilities regarding information sharing, documentation of safeguarding concerns and how to contact relevant agencies out of normal working hours.