Archived: Wilnecote Surgery Also known as Wilnecote and Dosthill Surgeries

Letter from the Chief Inspector of General Practice

We carried out a short notice announced inspection on 28 September 2015. We inspected both locations Wilnecote Surgery and Dosthill Surgery. We found that the provider was incorrectly registered as they had registered two separate locations. We found that they operate as a main location with a branch surgery with the same patient list, and the governance arrangements managed from Dosthill Surgery. The opening hours of both surgeries were similar and patients were able to make appointments at either surgery to see a GP or a member of the nursing team.

We found both Wilnecote and Dosthill surgery locations to be inadequate in three of the five key domains inspected (safe, effective and well-led). They were good for providing a caring service and responsive service. There were aspects of practice which were inadequate that related to all population groups; it was also therefore inadequate for providing services for the all population groups.

Our key findings were as follows:

• Patients were at risk of harm because systems and processes were not in place to keep them safe. For example not all appropriate recruitment checks on staff had been undertaken prior to their employment. Staff who supported patients as a chaperone had not completed chaperone training and non-clinical staff had not had appropriate police checks completed.

• There was a lack of sufficient quality assurance and governance processes in place to support staff to deliver high quality evidence-based care to patients accessing the service.

• There was insufficient assurance to demonstrate people received effective care and treatment.

• There was a lack of appropriate policies or guidance in place to support staff and ensure that risks to patients were identified, monitored and reviewed.

• Staff were clear about reporting incidents, near misses and concerns but the systems in place were not robust and there was no evidence of learning and communication with staff.

• There was a leadership structure with named members of staff in lead roles, but limited formal governance arrangements.

• Patients were positive about their interactions with staff and said they were treated with compassion and dignity. The Patient Involvement Group reported positively on their engagement and the responsiveness of the practice to their suggestions and surveys.

• Appointments with both the GP and the nurse were available at short notice, with the waiting time for non-urgent appointments generally around 24 hours. All urgent requests were usually addressed on the day either with a telephone consultation or a face-to-face appointment.

• We received positive comments from the patients we spoke to during the visit. They were complimentary about all their interactions with staff and felt they dealt with them with compassion, dignity and empathy.

• All areas of the practice were clean, tidy and well-maintained.

There were areas of practice where the provider needs to make improvements.

Importantly, the provider must:

• Ensure staff have appropriate and current policies and guidance readily available, in order to carry out their roles in a safe and effective manner, with a system to verify the staff‘s understanding and competency of policies and procedures.
• Ensure there are robust systems in place to review and monitor patients who may be at risk or vulnerable within the practice population.
• Take action to ensure patients on disease modifying medicines are monitored and managed by staff qualified and competent to do so.
• Take action to ensure that all blood results whether within normal ranges or otherwise are reviewed by a suitably qualified, skilled and competent staff member.
• Take action to ensure its recruitment arrangements are in line with Schedule 3 of the Health and Social Care Act 2008 (Regulated Activities) Regulations 2010 and necessary employment checks are in place for all staff. Implement systems to be assured that all staff are appropriately registered with their professional bodies.
• Review its systems for assessing and monitoring the quality of service provision and take steps to ensure risks are managed appropriately.
• Put systems in place to ensure all clinicians are kept up to date with national guidance and guidelines.
• Ensure that staff training is effectively recorded and monitored.
• Accurately register their main and branch location with the Care Quality Commission.

In addition the provider should:

• Consider implementing a lone worker policy.
• Ensure policies have a review date and that this is actioned by the review or should change occur.
• Ensure that practice staff meeting minutes are distributed to all staff members and that staff have the opportunity to add to the meeting agenda.
• Ensure that staff are aware of the practice mission statement, vision and values.
• Ensure there is a policy for the management; testing and investigation of legionella (a bacterium found in the environment which can contaminate water systems in buildings).
• Ensure there is a clear strategy for the future of the practice.

On the basis of the ratings given to this practice at this inspection, I am placing the provider into special measures. This will be for a period of six months. We will inspect the practice again in six months to consider whether sufficient improvements have been made. If we find that the provider is still providing inadequate care we will take steps to cancel its registration with CQC.

Professor Steve Field (CBE FRCP FFPH FRCGP) 

Chief Inspector of General Practice