Wensum Valley Medical Practice West Earlham Health Centre

Letter from the Chief Inspector of General Practice

We previously carried out an announced comprehensive inspection at Wensum Valley Medical Practice on 12 October 2016. The overall rating for the practice was requires improvement (safe and effective were rated as requires improvement, caring, responsive and well-led all rated as good). We carried out an announced focused inspection on 18 July 2017 to confirm that the practice had carried out their plan to meet the legal requirements in relation to the breaches in regulations that we identified in our previous inspection. However, insufficient improvements had been made and we subsequently carried out an announced comprehensive inspection on 24 July 2017 with a follow-up unannounced focused inspection on 31 July 2017 to assess the immediate actions taken.

The full comprehensive report on the October 2016 inspection can be found by selecting the ‘all reports’ link for Wensum Valley Medical Practice on our website at www.cqc.org.uk.

This report covers our findings in relation to those requirements and to the new concerns identified from the inspections on 18, 24 and 31 July.

Our key findings were as follows:

• The practice was aware of their population needs and the levels of deprivation that affected them.

• The practice served an area where deprivation was one of the highest in Norwich. Public Health England 2015 – 2016 data showed the deprivation affecting children scored 39% compared to the local clinical commissioning group (CCG) figure of 23% and the national figure of 20%.

• The practice lacked clinical leadership to ensure it delivered high quality and safe care.

• We found the system in place for reporting and recording significant events and complaints was not effective enough to ensure that all incidents had been recorded, learning from events was shared effectively with the practice team or changes made to improve the service. The opportunities to make early interventions to encourage improvement were missed.

• The patients and practice staff were at risk of harm, the practice had not undertaken sufficient risk assessments to ensure they would be kept safe. For example the practice was not able to evidence they had undertaken risk assessments for fire or health and safety. The practice took immediate action to address these issues.

• The systems and process to manage infection prevention and control needed to be improved.

• The system in place to deal with and monitor patient safety alerts needed to be improved, as they did not have a system to ensure alerts were recorded for future monitoring.

• The practice had a medicine review system in place to support patients who take medicines that require monitoring. However, we identified the medical records did not evidence which GP had reviewed the medicines and authorised that more prescriptions could be issued.

• Patients were at risk of harm because the practice system to ensure GPs saw all relevant correspondence was not effective.

• We saw doctors and nurses were appropriately registered and they had medical indemnity in place. However, the practice did not have systems and processes in place to easily monitor these requirements.

• During our inspection we saw generic policies and procedures were in place. These policies had not been reviewed or amended to be practice specific.

• Not all practice staff had received annual appraisals; nursing staff including those with a prescribing qualification had limited formalised clinical supervision with GPs and did not have one to one peer reviews. Some staff told us they felt isolated and that the communication within the practice could be improved.

• We found there was not always a consistent approach to the allocation of home visits by non-clinical staff.

• Data from the Quality and Outcomes Framework showed patient outcomes in many areas were below national averages. The practice exception reporting for 2015-2016 was higher than the local or national averages. The practice had discussed the high exception reporting as a team and had put some actions in place. However, there was no system in place to monitor any improvements to ensure they had been effective.

• Results from the national GP patient survey, published in July 2017, showed the practice was in line with or below local and national averages for many aspects of care. The practice gathered regular feedback from patients.

• Patients we spoke with said they did not find it easy to make an appointment with a named GP but urgent appointments were usually available.

• The practice training log was not up to date and the practice was not able to evidence that all staff had received training they deemed mandatory, for example safeguarding training.

• The practice had good facilities and was well equipped to treat patients and meet their needs.

• The practice supported and wrote regular articles for a local charity, the Henderson Trust, who produce a regular newsletter. For example, the practice wrote an article to encourage patients with pulmonary disorders such as asthma to attend their regular follow up appointments and avoid having to attend Accident and Emergency.

• The practice worked with the local schools to encourage healthy lifestyles. Children from a nearby school had designed posters for a notice board in the waiting area.

• The areas where the provider must make improvements are:

• Ensure care and treatment is provided in a safe way to patients.

• Establish effective systems and processes to ensure good governance in accordance with the fundamental standards of care.

The areas where the practice should make improvements are:

• Complete all staff occupational health assessments to ensure the immunisation status of staff is recorded, or risk assessed.

• Continue to explore ways to engage effectively with patients.

I am placing this service in special measures. Services placed in special measures will be inspected again within six months. If insufficient improvements have been made such that there remains a rating of inadequate for any population group, key question or overall, we will take action in line with our enforcement procedures to begin the process of preventing the provider from operating the service. This will lead to cancelling their registration or to varying the terms of their registration within six months if they do not improve.

The service will be kept under review and if needed could be escalated to urgent enforcement action. Where necessary, another inspection will be conducted within a further six months, and if there is not enough improvement we will move to close the service by adopting our proposal to remove this location or 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