Archived: Wake Green Surgery

Updated 23 March 2017

Wake Green Surgery is part of the NHS Birmingham Cross City Clinical Commissioning Group (CCG). CCGs are groups of general practices that work together to plan and design local health services in England. They do this by 'commissioning' or buying health and care services.

Wake Green Surgery is located in a converted house adapted to provide primary health services. Clinical services are provided on the ground and first floors. The practice registered list size is approximately 9700 patients. Services to patients are provided under a General Medical Services (GMS) contract with NHS England. A GMS contract ensures practices provide essential services for people who are sick as well as, for example, chronic disease management and end of life care and is a nationally agreed contract. The practice also provides some enhanced services such as childhood vaccinations.

Based on data available from Public Health England, the practice is located in an area with higher than average levels of deprivation.

Updated 23 March 2017

Letter from the Chief Inspector of General Practice

We previously carried out an announced comprehensive inspection at Wake Green Surgery on 17 August 2015. The overall rating for the practice at the time was requires improvement. We found breaches in relation to regulation 12 (safe care and treatment) of the Health and Social Care Act 2008 (Regulated Activities) Regulations 2014. The full comprehensive report on the Wake Green Surgery inspection can be found by selecting the ‘all reports’ link for Wake Green Surgery on our website at www.cqc.org.uk.

This inspection was undertaken to follow up progress made by the practice since the inspection on 17 August 2015. It was an announced comprehensive inspection on 16 December 2016. Overall the practice is now rated as inadequate.

Our key findings were as follows:

• Although the practice had taken some action since our previous inspection we continued to identify issues relating to the provision of safe services. This included prescription safety and security, staffing arrangements and support and with the effective monitoring of safety arrangements.
• There had been some improvements in the management of risks to patients although there was a lack of consistency in the effective assessment and monitoring of those risks.
• Significant events and incidents were generally well managed but there was little evidence of shared learning with all staff and we saw evidence of opportunities for learning missed.
• Staff made use of current evidence based guidance in the provision of care and had the skills, knowledge and experience to deliver effective care and treatment. However, it was difficult to ascertain the level of supervision and support that all staff had received as there was no formal system in place to monitor this and records seen were incomplete.
• The practice did not always respond in a timely way to patient information received or when making referrals leading to potential delays in patients care and treatment.
• Working relationships with health and social care professionals were in place to understand and meet the range and complexity of patients’ needs. However, health and social care professionals experienced a range of difficulties when working with the practice which impacted on patient care.
• Patients said they were treated with compassion, dignity and respect. Results from the national GP patient survey showed patients rated the quality of consultations in line with others but slightly lower than others in relation to involvement in decisions about their care and treatment.
• Information about services and how to complain was available and easy to understand. The practice responded to complaints in an open an honest way. However, we saw trends in the complaints that had not reviewed to identify where systems and processes may be improved.
• Not all patients said they found it easy to make an appointment. The practice was taking action to try and improve access for patients.
• The practice was equipped to treat patients and meet their needs.
• The practice had no clear leadership structure and the practice was unable to demonstrate effective team working.
• Systems in place for responding to feedback from staff and patients were not always effective.
• The provider was aware of the requirements of the duty of candour.

The areas where the provider must make improvement are:

• Ensure the safety and security of prescription stationery in the practice and the management of uncollected prescriptions.
• Ensure effective systems are in place for the timely management of patient information and referrals.
• Ensure effective working arrangements with health and social care professionals.
• Ensure effective governance arrangements to ensure risks are effectively assessed and monitored such as the cleaning of clinical equipment, carpets and curtains and for checking of defibrillator and the availability of safety information for the control of substances hazardous to health.
• Ensure effective systems for managing incidents and significant events to ensure learning and to support safety improvements.
• Ensure effective system are put place to respond to trends in incidents and complaints to support safety improvements and ensure learning.
• Ensure appropriate information is available to verify the fitness of staff to work with vulnerable patients and others.

The areas where the provider should make improvement are:

• Ensure all patients with a learning disability are offered an annual health review.
• Review and take action to improve the induction and appraisal process for newly recruited staff.
• Review how patient involvement in their care and treatment may be improved.
• Continue to review and take action to improve patients access to appointments.
• Ensure the practice website is updated to ensure accurate information about the complaints process is available.

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

Updated 23 March 2017

The provider was rated as inadequate for safe, effective and for well-led. The issues identified as inadequate overall affected all patients including this population group.

• The practice had a long term locum nurse who supported the practice in chronic disease management. They had additional training in the management of long term conditions including asthma, chronic obstructive pulmonary disease, diabetes and heart disease.
• The practice had systems in place to follow up patients who were at risk of unplanned hospital admissions. For those patients with the most complex needs, the GPs worked with relevant health and care professionals to deliver a multidisciplinary package of care.
• Overall performance for diabetes related indicators (2015/16) was 90% which was comparable to the CCG and national average of 90%.
• Patients with long term conditions received a structured annual review to check their health and medicines needs were being met.

Updated 23 March 2017

The provider was rated as inadequate for safe, effective and for well-led services. The issues identified as inadequate overall affected all patients 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, children and young people who had a high number of A&E attendances. Immunisation rates were relatively high for all standard childhood immunisations.
• Uptake for the cervical screening programme (2015/16) was at 81% which was similar to the CCG average of 79% and national average of 81%.
• Appointments were available outside of school hours with both doctors and nurses and the premises were suitable for children and babies. The practice had baby changing facilities and was accessible to pushchairs.
• Child health clinics and monthly meetings with the health visitor took place.

Updated 23 March 2017

The provider was rated as inadequate for safe, effective and for well-led services. The issues identified as inadequate overall affected all patients including this population group.

• Nationally reported data showed that outcomes for patients were good for conditions commonly found in older people.
• The practice was participating in the ambulance triage scheme in which the GPs provided advice to paramedics and supported patients in primary care as an alternative to attendance to accident and emergency departments.
• Home visits and urgent appointments were available for those with enhanced needs.
• The practice offered flu vaccinations.
• The practice was accessible to patients with mobility difficulties.
• However, improvements were required in the management of patients with end of life care needs to ensure these patients consistently received the care and support they needed.

Updated 23 March 2017

The provider was rated as inadequate for safe, effective and for well-led services. The issues identified as inadequate overall affected all patients including this population group.

• The practice offered extended opening Monday to Friday between 7.30am and 8pm. However, not all patients found it easy to access appointments.
• The practice offered online services (including online appointments and repeat prescriptions).
• The practice offered NHS health checks for patients aged 40-74 years. .

Updated 23 March 2017

The provider was rated as inadequate for safe, effective and for well-led services. The issues identified as inadequate overall affected all patients including this population group.

• Nationally reported data for 2015/16 showed 86% of patients diagnosed with dementia had their care reviewed in a face to face meeting in the last 12 months, which was comparable to the CCG average of 85% and national average 84%.
• National reported data for (2015/16) showed 94% of patients with poor mental health had comprehensive, agreed care plans documented, in the preceding 12 months which was comparable to the CCG average of 88% and national average 89%.

Updated 23 March 2017

The provider was rated as inadequate for safe, effective and for well-led services. The issues identified as inadequate overall affected all patients including this population group.

• The practice held a register of patients living in vulnerable circumstances such as those with a learning disability and those with caring responsibilities.
• The practice offered longer appointments for patients with a learning disability.
• Data available from the practice showed that there were 83 patients on the practice’s learning disability register. However, only 21 (25%) had received a health review in the last 12 months.
• 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 in normal working hours and out of hours.
• The practice worked closely with the substance misuse workers to provide support to relevant patients.
• The practice advertised the provision of information in a variety of formats.