We carried out an announced comprehensive inspection at OHP-Wychall Lane Surgery on 14 May 2019 as part of our inspection programme.
We based our judgement of the quality of care at this service on a combination of:
- what we found when we inspected
- information from our ongoing monitoring of data about services and
- information from the provider, patients, the public and other organisations.
We have rated this practice as good overall and good for all population groups.
We rated the practice as requires improvement for providing safe services because:
- We saw effective systems in relation to keeping patients safe from abuse or harm. We found the practice was proactive in learning from incidents and events to improve the service.
- However, systems for managing risks in relation to the service were not always comprehensive or well embedded. Following the inspection, the practice told us of action they had taken in order to improve the management of risks which needed to be strengthened.
We rated the practice as good for providing effective, caring and responsive and well led services because:
- Patients received effective care and treatment that met their needs. Patient outcomes as reported through national data showed performance was in line with local and national averages in most areas.
- Staff dealt with patients with kindness and respect and involved them in decisions about their care. Results from the GP national patient survey were above local and national averages.
- The practice organised and delivered services to meet patients’ needs. Patients could access care and treatment in a timely way.
- Leaders of the practice were passionate about the service they provided and promoted the delivery of high-quality person-centred care.
The areas where the provider must make improvements are:
- Establish effective systems and processes to ensure good governance in accordance with the fundamental standards of care.
(Please see the specific details on action required at the end of this report).
The areas where the provider should make improvements are:
- Continue to review and identify ways to improve uptake of all child immunisations.
Details of our findings and the evidence supporting our ratings are set out in the evidence tables.
Dr Rosie Benneyworth BM BS BMedSci MRCGP
Chief Inspector of Primary Medical Services and Integrated Care