Archived: The Westwood Surgery

Updated 22 September 2016

The Westwood Surgery is located in a large semi-detached house converted for the sole use as a surgery. The property is located in a mainly residential area of Welling in the London Borough of Bexley. Bexley Clinical Commissioning Group (CCG) is responsible for commissioning health services for the locality.

Services are provided from two locations, Westwood Surgery (main surgery) located at 24 Westwood Lane, Welling, DA16 2HE and Pickford Surgery (branch surgery) located at 55 Pickford Lane, Bexleyheath DA7 4RN (2.5 miles from the main surgery). Both locations were visited during this inspection.

The practice has 8622 registered patients. The practice age distribution is similar to the national average. The surgery is based in an area with a deprivation score of 9 out of 10 (10 being the least deprived).

Services are delivered under a Personal Medical Services (PMS) contract. The practice is registered with the CQC to provide the regulated activities of family planning; surgical procedures; maternity and midwifery services; treatment of disease, disorder and injury and diagnostic and screening procedures.

The provider’s contractual arrangements include the provision of the following Directed Enhanced Services (DES): Childhood Vaccination and Immunisation Scheme; Extended Hours Access: Facilitating Timely Diagnosis and support for people with Dementia; Improving patient on-line access; Influenza and Pneumococcal Immunisations; Learning Disabilities; Minor Surgery; Patient Participation; Risk Profiling and Case Management; Rotavirus and Shingles immunisation and Unplanned admissions. (A DES requires an enhanced level of service provision above what is required under the core PMS contract).

The Westwood Surgery is a training practice offering placements for medical students as well as doctors undergoing specialist GP training.

The practice is currently registered with the CQC as a Partnership. However, following the recent resignation of one of the two partners the practice is in the process of reregistering to sole practitioner status.

Clinical services are provided by the full time lead GP (female), two full time salaried GPs (male and female) and two part time (0.9 wte) locum GPs (male and female) providing a total of 31 GP sessions per week. A GP Registrar provides an additional 8 sessions per week. The practice also employs two Practice Nurses (1.65 wte) and two Health Care Assistants (1.56 wte).

Administrative services are provided by a Practice Manager (1.0 wte) and administrative, secretarial and reception staff (10.8 wte).

Telephone lines are open on Monday and Tuesday from 8am to 8.30pm and on Wednesday to Friday from 8am to 6.30pm. Westwood Surgery reception is open on Monday and Tuesday from 8.30am to 8.30pm and Wednesday to Friday from 8.30am to 6.30pm. Pickford Surgery reception is open on Monday, Tuesday, Wednesday and Friday from 8.30am to 6.30pm and on Thursday from 8.30am to 1pm.

Appointments were available with the GP from 8.30am to 8.30pm Monday and Tuesday and from 8.30am to 6pm Wednesday to Friday.

Extended hours were provided on Monday and Tuesday evening at Westwood Surgery until 8.30pm.

Appointments were available with the practice nurse between 8.30am and 5.30pm Monday to Friday with extended hours available at Westwood Surgery until 7.30pm on Tuesday.

In addition to pre-bookable appointments, that could be booked up to four weeks in advance, urgent appointments were also available for people that needed them at the ‘Walk-in’ GP surgery held daily between 11.00 and midday.

When the surgery is closed the out of hours GP services are available via NHS 111.

A practice leaflet was available and the practice website included details of services provided by the surgery and within the local area.

The practice was previously inspected as part of the new comprehensive inspection programme. An announced comprehensive inspection was carried out on 28 July 2015 at The Westwood Surgery resulting in an overall rating of Inadequate. Following this inspection the practice was placed in special measures.

The ratings from the previous inspection for the safe, effective and well-led domains were Inadequate and for the responsive domain the rating was Requires Improvement. The provider was rated Good for the caring domain.

The areas of concern identified from the previous inspection on 28 July 2015 were:

• Systems, processes and practices did not keep people safe: Over 1200 documents consisting of patient related letters from hospitals and other third parties had not been actioned since October 2014 and the practice had failed to identify this as a risk.

• A member of staff had been recruited to assist with the handling of patient related letters. This member of staff was non-clinical but was making clinical decisions. Recruitment checks had not been carried out on this member of staff.

• Governance arrangements were unclear and the practice leadership had failed to identify and manage significant issues that threatened the delivery of safe and effective care.

• There was little evidence that learning from events was shared with all relevant staff in order to improve safety.

We saw evidence during this inspection that these concerns had been addressed satisfactorily by the provider and that appropriate systems, processes and practices had been implemented.

Updated 22 September 2016

Letter from the Chief Inspector of General Practice

The Westwood Surgery was placed in special measures following a previous inspection.  An announced comprehensive inspection was carried out on 28 July 2015 resulting in an overall rating of Inadequate. The ratings from the  inspection for the safe, effective and well-led domains were Inadequate and for the responsive domain the rating was Requires Improvement. The provider was rated Good for the caring domain. The report for the inspection was published on 15 October 2015. Practices placed in special measures are inspected again six months after publication of the report to check whether the provider has made sufficient improvements to show they are meeting the legal requirements and regulations associated with the Health and Social Care Act 2008.

The areas of concern identified from the previous inspection on 28 July 2015 were:

• Systems, processes and practices did not keep people safe: Over 1200 documents consisting of patient related letters from hospitals and other third parties had not been actioned since October 2014 and the practice had failed to identify this as a risk.

• A member of staff had been recruited to assist with the handling of patient related letters. This member of staff was non-clinical but was making clinical decisions. Recruitment checks had not been carried out on this member of staff.

• Governance arrangements were unclear and the practice leadership had failed to identify and manage significant issues that threatened the delivery of safe and effective care.

• There was little evidence that learning from events was shared with all relevant staff in order to improve safety.

We then carried out a follow up announced comprehensive inspection of  the practice on 18 May 2016. We saw evidence during this inspection that previous concerns had been addressed satisfactorily by the provider and that appropriate systems, processes and practices were now in place. Overall the practice is rated as good.

Our key findings across all the areas we inspected were as follows:

• There was an open and transparent approach to safety and an effective system in place for the reporting and recording of significant events. Staff understood and fulfilled their responsibilities to raise concerns and report incidents and near misses.

• Risks to patients were assessed and well managed. Clinical staff told us they received patient safety alerts such as those from Medicines and Healthcare Products Regulatory Agency (MHRA) via email but there was no system in place to monitor and record that all relevant staff had been informed and appropriate action taken where required.
• Staff assessed patients’ needs and delivered care in line with current evidence based guidance. However, data showed that outcomes for patients with asthma were significantly lower than the CCG and national average.
• Staff had been trained to provide them with the skills, knowledge and experience to deliver effective care and treatment.

• Feedback from patients about their care was consistently positive. Patients said they were treated with compassion, dignity and respect and they were involved in their care and decisions about their treatment.

• Information about services and how to complain was available and easy to understand and improvements were made to the quality of care as a result of complaints and concerns.
• Patients said they found it easy to make an appointment with a named GP and there was continuity of care, with urgent appointments available the same day.
• The practice had good facilities and was well equipped to treat patients and meet their needs.
• The practice had a clear vision and leadership structure which had quality and safety as its top priority. The strategy to deliver this vision had been produced and discussed with staff and other stakeholders and was monitored and reviewed.
• Staff felt supported by management and the provider proactively sought feedback from staff and patients which it acted on.
• The practice implemented suggestions for improvements and made changes to the way it delivered services as a consequence of feedback from staff, patients and the patient participation group.
• The practice had strong and visible clinical and managerial leadership and governance arrangements.
• The provider was aware of and complied with the requirements of the duty of candour.

The areas where the provider should make improvements are:

• The provider should take action in response to patient feedback regarding the lack of available non-urgent appointments.

• The provider should monitor the practice procedure to ensure that all staff are aware of MHRA alerts and have taken action where appropriate.
• The provider should complete all outstanding tasks identified in the Legionella assessment action plan (April 2015).

I am taking this service out of special measures. This recognises the significant improvements made to the quality of care provided by this service.

Professor Steve Field CBE FRCP FFPH FRCGP

Chief Inspector of General Practice

Updated 22 September 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.

• Nationally reported data showed that outcomes for patients with long-term conditions were comparable to CCG and national averages. However, data showed that outcomes for patients with asthma were below the CCG and national average. The practice had taken action to address the issue and current data showed an improvement.

• Longer appointments and home visits were available when needed.

• All patients had a named GP and were offered 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.

Updated 22 September 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 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.

• The practice’s uptake for the cervical screening programme was 89%, which was comparable to the CCG average of 83% and the national average of 82%.

• Appointments were available outside of school hours and the premises were suitable for children and babies.

• We saw positive examples of joint working with the practice health visitor who was based in the surgery and the midwife who held weekly antenatal clinics at the surgery.

Updated 22 September 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.

• Nationally reported data showed that outcomes for patients for conditions commonly found in older people were comparable to CCG and national averages.

• The practice was responsible for providing GP services to a local care home for 50 residents. A named GP handled all queries from the home and would also carry out a weekly visit to the home.

Updated 22 September 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.

• The practice was proactive in offering online services. Patients could book appointments and order repeat prescriptions online.

• Health promotion and screening advice was available and there was accessible health promotion material available through the practice.

Updated 22 September 2016

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

• 77% of patients diagnosed with dementia had their care reviewed in a face to face meeting in the last 12 months, which is comparable to the CCG average of 81% and national average of 84%.

• 89% of patients with a diagnosed mental health disorder had a comprehensive agreed care plan documented in the preceding 12 months, which is comparable to the CCG average of 94% and national average of 88%.

• The practice regularly worked with multi-disciplinary teams in the case management of patients experiencing poor mental health, including those with dementia.

• The practice informed patients experiencing poor mental health how to access various support groups and voluntary organisations.

• The practice had a system in place to follow up patients who had attended accident and emergency where they may have been experiencing poor mental health.

• Staff had a good understanding of how to support patients with mental health needs and dementia.

Updated 22 September 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 those with a learning disability.

• The practice offered longer appointments for patients with a learning disability.

• The practice worked with other health care professionals in the case management of vulnerable patients.

• The practice informed vulnerable patients 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.