Archived: The Woottons Surgery

Updated 16 July 2015

The Woottons Surgery in Priory Lane, North Wootton provides services to patients living in North Wootton as well as the surrounding towns and villages, including Kings Lynn. The practice holds a Personal Medical Services (PMS) contract. The practice is managed by an individual GP who also holds the role of registered manager within the practice. The practice employs two salaried GPs, a long term locum GP, two nurse practitioners, two nurses, a nurse manager, a trainee phlebotomist/receptionist, a reception and administration team, two assistant practice managers and four housekeepers. The Woottons Surgery is located in a building which is used solely by the practice and serves a population of approximately 5,400. GP appointments are available every weekday between 8.30am and 12.30pm and 3pm and 5.30pm. The GP told us that they had tried extended opening but had stopped this service due to lack of interest from working age patients at whom this service was aimed. The practice operated a doctor call back service where a patient could request to speak with a doctor instead of attending in person. This service was available between 8.30am and 9.30am Monday to Friday. The practice website clearly details how patients may obtain services out-of-hours. The practice was going through the process of merging with another local practice: Southgates Medical and Surgical Centre. At the time of our inspection the merger had not yet occurred but was planned to take place on 01 April 2015. This meant that the merger will have taken place before this report is published. This report is reflective of our findings at The Woottons Surgery during our inspection. Representatives of Southgates Medical and Surgical Centre were present during our inspection and were informed of this report being written in relation to our findings on the day of inspection. There was a sincere interest from all parties present at the inspection to learn from the inspection and to take any findings forward post-merger.

Updated 16 July 2015

Letter from the Chief Inspector of General Practice

We inspected The Woottons Surgery on 23 March 2015 as part of our comprehensive inspection programme. Overall the practice is rated as requires improvement. Specifically, we found the practice to require improvement for providing safe, effective and well led services. It was good for providing a caring and responsive service. Due to the improvement required under the aforementioned domains it results in the practice being rated as requires improvement for the care to older patients, patients with long term conditions, patients in vulnerable circumstances, families, children and young patients, working age patients and patients experiencing poor mental health. Our key findings were as follows:

• Risks to patients were assessed and well managed with the exception of those relating to recruitment checks.
• Data showed patient outcomes were average for the locality. Although some audits had been carried out, we saw no evidence that audits were driving improvements in performance or patient outcomes.
• 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.
• The practice had a number of policies and procedures to govern activity, but the practice did not hold regular governance meetings.

However there were areas of practice where the provider needs to make improvements. Importantly the provider must:

• Carry out staff Disclosure and Barring Service checks for staff caring for patients.
• Improve and align staff records to include evidence of qualifications and training.

And the provider should:

• Take steps to improve the take up of annual health checks of people with a learning disability.
• Implement effective procedures to disseminate, and ascertain all relevant staff are familiar with, national patient safety alerts.
• Implement effective systems for all practice staff to record, review and learn from significant events.
• Carry out a risk assessment for the need to test for legionella.
• Ensure resuscitation training is up to date for all staff.
• Provide chaperone training for those staff that require this.
• Implement an effective clinical audit programme which demonstrates improved outcomes for patients.
• Improve performance reviews for staff and implement effective development plans for all staff.

Professor Steve Field (CBE FRCP FFPH FRCGP) 

Chief Inspector of General Practice

Updated 16 July 2015

The practice was rated as requires improvement in the domains of safe, effective and well-led. The concerns which led to these ratings apply to everyone using the practice, including this population group. There were emergency processes in place and referrals were made for patients whose health deteriorated suddenly. The practice offered nurse led smoking cessation services. Longer appointments and home visits were available when needed. For those patients with the most complex needs, the practice worked with relevant health and care professionals to support patients. The practice supported patients to manage a range of long term conditions in line with best evidence based practice.

Updated 16 July 2015

The practice was rated as requires improvement in the domains of safe, effective and well-led. The concerns which led to these ratings apply to everyone using the practice, including this population group. There were systems in place to identify and follow up children living in disadvantaged circumstances and who were at risk, for example, vulnerable children. Immunisation rates were generally 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. Babies received six week post natal checks. Appointments were available outside of school hours and the premises were suitable for children and babies. We saw good examples of joint working with health visitors, especially around safeguarding elements.

Updated 16 July 2015

The practice was rated as requires improvement in the domains of safe, effective and well-led. The concerns which led to these ratings apply to everyone using the practice, including this population group. Nationally reported data showed that outcomes for patients were good for conditions commonly found in older people. The practice offered proactive, personalised care to meet the needs of the older people in its population and had a range of enhanced services, for example, in end of life care. It was responsive to the needs of older people, and offered home visits and rapid access appointments for those with enhanced needs. Monthly multi-disciplinary meetings were held to identify the best ways to provide care to older people and, where appropriate, to avoid them going into hospital. Continued monitoring helped to ensure that older patients received the right treatment and care when they needed it. We spoke with a representative from five care homes where residents were patients at the practice. All of them told us that the practice offered effective care to their residents. A designated GP provided care to local care homes and held annual visits there in addition to the responsive visits. Older patients had a named GP and had the opportunity to take up the offer of a shingles vaccine.

Updated 16 July 2015

The practice was rated as requires improvement in the domains of safe, effective and well-led. The concerns which led to these ratings apply to everyone using the practice, including this population group. The needs of the working age population, those recently retired and students had been identified and the practice had previously provided extended hours, these were withdrawn following a low uptake of these appointments by this patient group. Telephone consultation had been made available instead. The practice provided the option of online booking for appointments. Health promotion and screening that reflected the needs for this age group was taking place.

Updated 16 July 2015

The practice was rated as requires improvement in the domains of safe, effective and well-led. The concerns which led to these ratings apply to everyone using the practice, including this population group. Clinicians provided empathetic and responsive care to patients with poor mental health. Patients experiencing poor mental health were invited to attend the practice for different physical health checks. 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. The practice had advised patients experiencing poor mental health about how to access various support groups and it had a system in place to follow up patients who had attended accident and emergency (A&E) where they may have been experiencing poor mental health.

Updated 16 July 2015

The practice was rated as requires improvement in the domains of safe, effective and well-led. The concerns which led to these ratings apply to everyone using the practice, including this population group. The practice held a register of patients living in vulnerable circumstances including those with a learning disability. It had carried out annual health checks and offered longer appointments for people that required this. However there was scope to better support patients with a learning disability to attend their review. 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. The practice had access to translation services and a hearing aid loop.