Archived: Dosthill Surgery Also known as Wilnecote and Dosthill Surgeries

Updated 21 February 2017

Wilnecote and Dosthill Surgeries is registered with the Care Quality Commission as a two GP partnership provider of primary medical services.

The provider operates from a purpose built premises at Dosthill surgery within the NHS South East Staffs and Seisdon Peninsula Clinical Commissioning Group area. There is a branch practice at Wilnecote. The provider holds a General Medical Services contract with NHS England. At the time of our inspection 7,800 patients were registered at the practice.

Since our last inspection in September 2015 the provider cancelled their registration of the Wilnecote Branch Practice. This is now included in their registration of Dosthill Surgery as a branch practice. Our inspection focussed on the care and experiences of all registered patients, who can access either the Dosthill or Wilnecote sites.

Demographically the practice area has overall lower rates of deprivation than the national average, although there are pockets of deprivation within the practice catchment area. The average age range of patients at the practice broadly follows the national average and the ethnicity estimate is 97% white British. As well as providing the contracted range of primary medical services, the practice provides additional services including:

• Minor surgery.
• Avoiding unplanned admission to hospital.

The opening hours of both practices are similar. Dosthill opening hours are 8.30am to 6pm Monday to Friday with the exception of Thursday when they close at 1pm and Wednesdays when they offer extended hours to 8pm.The telephone lines are answered from 8am. The practice has opted out of providing cover to patients outside of normal working hours but has arrangements for patients which are accessed using the 111 service.

Staffing at the practice includes:

• Two full time male GP partners.
• One female long term locum GP (since 2006) and two part time male GPs.
• Four female practice nurses.
• One female practice healthcare assistant.
• Two mental health nurses on a self-employed basis.
• A practice manager and team of administrative/reception staff.

Updated 21 February 2017

Letter from the Chief Inspector of General Practice

When we carried out an unannounced comprehensive inspection of Wilnecote Surgery on 28 September 2015, we found three breaches of legal requirements. As a result, we issued two warning notices in relation to:

• Regulation 12 of the Health and Social Care Act 2008 (Regulated Activities) 2014. Safe care and treatment.
• Regulation 17 of the Health and Social Care Act 2008 (Regulated Activities) 2014. Good governance

We also issued a requirement notice in relation to:

• Regulation 19 of the Health and Social Care Act 2008(Regulated Activities) 2014. Fit and proper persons employed.

We undertook an unannounced focussed inspection on 17 March 2016 to follow up on the warning notices. Further concerns were identified and the practice was required to complete an urgent response to demonstrate that these concerns had been addressed. A weekly report has been sent to the Care Quality Commission (CQC) since 17 March 2016 to demonstrate that improvements have been sustained.

We undertook another announced comprehensive inspection on 23 May 2016 to check that the practice 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 Wilnecote Surgery on our website at www.cqc.org.uk.

Please note that when referring to information throughout this report, for example any reference to the Quality and Outcomes Framework data, this relates to the most recent information available to the CQC at that time.

Our key findings were as follows:

• The practice had made improvements to the way it acted on patients’ blood test results. Test results were viewed on the same day or next working day and a weekly report, submitted to the CQC since March 2016, showed that test results had been completed by the end of each week.
• A robust system had been implemented to manage patients on shared care arrangements. However, we saw examples of clinical alerts that had not been acted on to minimise risks to patient safety.
• A structured approach had been adopted to coordinate patient medication reviews.
• Patients were seen to be treated with compassion, dignity and respect. However the national GP survey scores relating to care were below local and national averages.
• The leadership team within the practice did not demonstrate the necessary capability and appropriate knowledge.
• Patients spoke of good access to appointments with a named GP and there was continuity of care, with urgent appointments available the same day.

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

Importantly, the provider must:

• Implement and operate a consistent and effective system for receiving and acting on safety alerts affecting patient safety.
• Hold appropriate emergency medication in the practice to treat a severe infection in the blood due to meningitis and to treat adverse symptoms from a low heart rate.
• Ensure that leadership addresses the continued poor performance in meeting the legislative requirements.
• Demonstrate clinical governance to minimise the risks to patient safety.

In addition the provider should:

• Ensure that the safeguarding lead is aware of, and follows up on, those patients identified as vulnerable.
• Ensure infection prevention control audits meet nationally recognised guidelines.
• Ensure learning outcomes from significant events
• are understood by appropriate staff.
• Implement and operate an effective system for receiving and issuing blank prescriptions.
• Include the next of kin details on the care plans of patients identified as vulnerable and at increased risk of hospital admission.
• Consider how to improve performance in the national GP patient survey regarding registered patient satisfaction rates in relation to their interactions with GPs.
• Ensure that clinical judgements such as medicine initiation are not inputted onto the clinical system by non-clinical, non-qualified staff unless in an emergency when a documented reason should be included.

Where a service is rated as inadequate for one of the five key questions or one of the six population groups or overall, it will be re-inspected within six months after the report is published. Remaining in special measures represents a decision by the Care Quality Commission (CQC) that a service has to improve within six months to avoid CQC taking steps to cancel the provider’s registration.

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

Updated 21 February 2017

The practice is rated as requires improvement for caring and responsive services and this includes this population group. The practice was rated as requires improvement for safe, effective and well-led services. This concerns which led to these ratings applies to everyone using the practice, including this population group.

There were, however, examples of good practice.

• Nursing staff had lead roles in chronic disease management and patients at risk of hospital admission were identified as a priority.
• Home visits were available for patients with long-term conditions when needed, with the majority of these carried out by the GPs.
• The healthcare assistant visited patients in their home to take blood tests to support the GPs management of medication used to thin the blood.
• Written management plans had been developed for patients with long term conditions and those at risk of hospital admissions
• Performance for diabetes related indicators was significantly below local and national averages. In 2014/15 the overall performance combined for the 11 indicators of diabetes management was 70%, compared with the CCG average of 86% and national average of 89%. The practice provided data to show that the performance for 2015/16 had improved to 73%.

Updated 21 February 2017

The practice is rated as requires improvement for caring and responsive services and this includes this population group. The practice was rated as requires improvement for safe, effective and well-led services. This concerns which led to these ratings applies to everyone using the practice, including this population group.

• There were, however, examples of good practice.
• A system had been implemented to follow up patients who were living in disadvantaged circumstances and who were at risk. The clinical system had an icon on the patient records of children and a major alert on the records of adults.
• The practice offered same day access for all children with illness.
• Appointments were available outside of school hours and the premises were suitable for children and babies.
• The practice’s uptake for the cervical screening programme was 74% compared with the national average of 82%. The practice provided data to show that the performance for 2015/16 had improved to 76%.

Updated 21 February 2017

The practice is rated as requires improvement for caring and responsive services and this includes this population group. The practice was rated as requires improvement for safe, effective and well-led services. This concerns which led to these ratings applies to everyone using the practice, including this population group.

There were, however, examples of good practice.

• Home visits were available for older patients when needed, with the majority of these carried out by the GPs. Staff could refer patients to a Home Visiting Service which the provider contracts and funds. The service performed home visits for patients with acute conditions.
• 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 had received a seasonal flu vaccination was 64.3% compared to 73.2%.
• All patients over the age of 75 had a named GP. A monthly review identified any patients approaching the age of 75 and a letter was sent to each patient who had not been notified.
• Patients identified as being at risk of hospital admission, which included those that resided in nursing and care homes, had a written care plan.
• All hospital admissions were reviewed for those patients with a care plan.

Updated 21 February 2017

The practice is rated as requires improvement for caring and responsive services and this includes this population group. The practice was rated as requires improvement for safe, effective and well-led services. This concerns which led to these ratings applies to everyone using the practice, including this population group.

There were, however, examples of good practice.

• 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 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.
• Extended opening hours were available one evening a week. This had been extended in 2016 to include a second evening from January to March as part of the winter pressure scheme.
• Health promotion advice was offered and health promotion material was available in the waiting rooms.

Updated 21 February 2017

The practice is rated as requires improvement for caring and responsive services and this includes this population group. The practice was rated as requires improvement for safe, effective and well-led services. This concerns which led to these ratings applies to everyone using the practice, including this population group.

There were, however, examples of good practice.

• The practice regularly worked with multi-disciplinary teams in the case management of people experiencing poor mental health, including those with dementia.
• Patients and their families were supported by mental health nurses from the practice.
• A dementia consultant clinic was held at the practice every month.

Updated 21 February 2017

The practice is rated as requires improvement for caring and responsive services and this includes this population group. The practice was rated as requires improvement for safe, effective and well-led services. This concerns which led to these ratings applies to everyone using the practice, including this population group.

There were, however, examples of good practice.

• The practice had implemented a patient recall system for 2016/17 and a template used to complete the check had been added to the clinical system.
• 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.
• The practice had registers of vulnerable children and vulnerable adults. However, when asked, the safeguarding lead could not recall that there was any patients on the vulnerable child register.