Watlington Medical Centre

Updated 4 October 2018

• The name of the registered provider is Watlington Medical Centre.
• The practice is registered to provide diagnostic and screening procedures, family planning, surgical procedures, maternity and midwifery services and treatment of disease, disorder or injury.
• The practice has a general medical services (GMS) contract with the West Norfolk Clinical Commissioning Group (CCG).
• There are approximately 6,700 patients registered at the practice.
• The website for the practice is http://www.watlingtonmedicalcentre.co.uk
• The practice has four GP partners (two male two female), two salaried GPs (both female), a business manager, an administration manager, a dispensary team with a manager, two nurse practitioners (of which one was advanced), three practice nurses, one healthcare assistant, administrative staff and cleaning staff. The practice offers dispensing services to those patients on the practice list who live more than one mile (1.6km) from their nearest pharmacy.

• The practice is open from 8.30am to 1pm and from 2pm to 6.30pm on Mondays, Wednesdays, Thursdays and Fridays and from 8.30am to 12noon on Tuesdays. The practice is routinely closed on Tuesday afternoons for staff training. On Tuesday afternoons and between 1pm and 2pm on the other days, patients have access through a medical call handling service (Medicom) who pass the calls through to an onsite on call duty doctor at Watlington Medical Centre who can review patients as needed.

• When the practice was closed patients were directed to the out of hours service provided by Integrated Care 24 via the NHS 111 service.

• The most recent data available from Public Health England showed the practice has an average number of patients under the age of 18 and a higher than average number of patients aged 65 to 75 compared to the England average. Income deprivation affecting children is 12%, which is lower than the CCG average of 17% and the national average of 20%. Income deprivation affecting older people is 12%, which is also lower than the CCG average of 15% and national average of 20%. Life expectancy for patients at the practice is 81 years for males and 84 years for females; this is above the national expectancy of 79 years and 83 years respectively.

Updated 4 October 2018

This practice is rated as Good overall. (Previous rating published 18 December 2017, good overall.)

The key questions at this inspection are rated as:

Are services safe? – Good

We carried out an announced comprehensive inspection at Watlington Medical Centre on 2 November 2017 as part of our regulatory function. The practice was rated as good overall, and good for providing effective, caring, responsive and well led services. It was rated as requires improvement for providing safe services. We carried out an announced desktop inspection on 19 September 2018 to follow up on the breach of regulation identified at the 2 November 2017 inspection.

At this inspection we found:

• A range of health and safety risk assessments had been completed and identified actions implemented. This included for example, premises, legionella (a bacterium which can contaminate water systems in buildings) and the Control of Substances Hazardous to Health.
• A hard wiring test of the premises had been undertaken.
• The practice had reviewed their system for Disclosure and Barring Service checks to ensure that staff were not employed before relevant checks had been completed.
• An audit had been undertaken on infection rates for minor surgery interventions from November 2017 to June 2018. This audit identified that from 31 minor surgeries, there were no post-operative infections. The audit had been discussed at a clinical meeting on 18 July 2018. A further audit was planned for January 2019.

Professor Steve Field CBE FRCP FFPH FRCGPChief Inspector of General Practice

Please refer to the detailed report and the evidence table for further information.

Updated 27 August 2015

The practice is rated as good for people with long term conditions.

The practice had a recall system in place for patients with long-term conditions. Once a patient is diagnosed they were put onto an appropriate recall for that condition. The nurses have responsibility for certain long-term conditions. They ran computer searches monthly for their dedicated diseases and phoned patients inviting them to attend as appropriate. If the patient failed to attend for review then two follow up letters would be sent. Should the patient still not attend, the nurse would then investigate.

Any patient who was on regular medication would have, as a minimum, an annual medication review.

The practice prescribed monthly prescriptions.

Immunosuppressant patients were closely monitored by both the clinical and dispensary staff. All patients who were immunosuppressed were recalled as appropriate, to remind them to have their blood test. When patients ordered their repeat medication, dispensary staff check if the relevant blood test had been recorded and if the results had been checked by a GP, before the medication is issued. If that was not the case then this would be referred to a GP before any medication could be dispensed. The practice ran their own in-house anticoagulation clinics, thus providing care closer to home.

Updated 27 August 2015

The practice is rated as good for the population group of families, children and young people.

The practice provided extended hours appointments with GPs to accommodate those patients who needed an appointment outside of school/work time. They run alternate Saturday morning clinics.

The practice carried out teenager reviews and offered free condoms.

The community midwives saw the practice ante-natal patients on Thursdays in the practice.

The practice GPs saw all pregnant women, before they are referred to the midwife services. The six week post natal checks were carried out by the GP’s.

The practice met monthly with the health visitor to discuss any potential problems and highlight at risk children and families

Updated 27 August 2015

The practice is rated as good for the treatment of older people.

All patients who are 75 or over have a named GP and all those patients had been notified of their named GP. They have an Admission Avoidance register, with a named Care-Coordinator on the patients’ Home Screens. This was a member of staff who has knowledge of the patient. They reviewed all patients on the Admission Avoidance register on a monthly basis.

The practice had monthly MDT meeting with social services, occupational therapists, district nurses, community matrons and MacMillan nurses. All patients with recent unplanned hospital admissions were discussed. Palliative care patients were discussed.

The practice offered a home delivery service to patients who are unable/too ill to collect their medication from the premises.

MDS boxes (monitored dosage system) were provided to patients who struggle to remember to take their medication. These were provided on a weekly basis. Dispensary staff monitored this.

The West Norfolk Deaf Association provided a hearing aid clinic at the practice, once a month and a hearing aid loop was fitted in the reception and dispensary.

Updated 27 August 2015

The practice is rated as good for this population group.

The needs of the working population had been identified, and services adjusted and reviewed accordingly. Routine appointments could be booked in advance or made online. Repeat prescriptions could be ordered online. Extended hours appointments were available on alternate Saturday mornings to enable patients who work to have access to a clinician without the need to take time off work. They also had routine appointments after 5pm on most days which would benefit the working population and parents bringing children outside of school hours.

Updated 27 August 2015

The practice is rated as good for this population group

The practice offered a recall system for people experiencing poor mental health (including people with dementia).

The Wellbeing Service held regular clinics at the practice, and provided counselling. The practice also employed a counsellor who provides CBT to our patients. (Cognitive behavioural therapy (CBT) is a talking therapy that can help manage your problems by changing the way you think and behave).

The practice had an award winning Yellow Card system in place, which identified very vulnerable patients with mental health problems. Those patients were able to obtain on the day appointments if they were in crisis, without having to explain why they needed to be seen to the receptionists.

Patients at risk of dementia had been identified and a reminder had been placed on the patient home screen on the practice computer, so opportunistic screening for these patients could take place.

For all patients the practice provided same day appointments or advanced booking of appointments up to five weeks in advance and daily telephone call backs from both GPs and Nurses if necessary.

The practice sent out SMS appointment reminders to patients.

Patients were able to book/cancel appointments, order repeat medication, request to change demographics and view Summary Care Records online.

Updated 27 August 2015

The practice is rated as good for this population group.

The practice worked with West Norfolk Carers to help support/identify carers in the community. As a result of this they implemented; carer drop in sessions with West Norfolk Carers held here at the practice once a month, carer support packs, recording of carer status in their medical records and a reminder of this status on the computer home screen so that staff could easily identify the patient had a carer. Carer information was displayed on the practice website and the practice leaflet.

Patients with a Learning Disability were on a recall to return for an annual review with a GP. They were seen with their carer and the carer is assessed at the same time. The carer was signposted to the appropriate resources to ensure they had adequate information about being a carer and were able to access help if required.

Patients with a communication difficulty were recorded as a reminder on the patient home screen on the practice computer with guidance as appropriate. The practice also had a hearing aid loop fitted in Reception and Dispensary. They also used Deaf Connexions to assist with British Sign Language for Deaf patients.

Domestic Abuse and Safeguarding training was provided to all staff.

The practice had wheelchair access throughout the building and the reception desk had been lowered to accommodate patients in a wheelchair. They also had two disabled toilets and automatic doors.