This practice is rated as Good overall.

The key questions at this inspection are rated as:

Are services safe? – Good

Are services effective? – Good

Are services caring? – Good

Are services responsive? – Good

Are services well-led? - Good

We carried out an announced comprehensive inspection at OHP-Wake Green Surgery on 14 June 2016. This was to follow up progress made by the practice since our previous inspections in December 2016 and September 2017 and ensure the legal requirements of the Health and Social Care Act 2008 (Regulated Activities) Regulations 2014 were being met. The practice was rated as inadequate following the inspection in December 2016 and placed into special measures. We inspected again in September 2017 and found significant improvements had been made and the practice was rated as good overall with requires improvement for providing responsive services.

At this inspection we found:

• The practice demonstrated that improvements seen at our previous inspection in September 2017 had been sustained.
• The practice had clear systems to manage risk so that safety incidents were less likely to happen. When incidents did happen, the practice learned from them and improved their processes.
• The practice routinely reviewed the effectiveness and appropriateness of the care it provided. It ensured that care and treatment was delivered according to evidence- based guidelines and was in line with local and national averages for patient outcome indicators.
• Staff involved and treated patients with compassion, kindness, dignity and respect. Patients were the improvements being made to the service and the practice was evaluating the changes being made and the impact on the patient experience.
• Access to appointments had been a main cause of complaints about the practice as a result the practice had made significant changes to the appointment system. The practice had made adjustments in response to patient feedback and were continuously monitoring and evaluating the changes made. Recent patient feedback indicated that improvements were starting to impact on patient satisfaction.
• There was a strong focus on continuous learning and improvement. The practice had been receptive to feedback received about the service and were driven to make improvements. There was noticeable energy and drive within the staff team to continue to make further improvements and to deliver a high quality service.

The areas where the provider should make improvements are:

• Continue to evaluate and monitor impact of changes on patient satisfaction and access to the service.
• Continue to review trends in complaints to identify areas for further improvements.

Professor Steve Field CBE FRCP FFPH FRCGP
Chief Inspector of General Practice

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

Letter from the Chief Inspector of General Practice

This inspection was an announced comprehensive inspection, carried out on 18 September 2017. We previously inspected Wake Green Surgery on 17 August 2015. The overall rating for the practice at the time was requires improvement.

We carried out a further comprehensive inspection on the 16 December 2016 to follow up progress made by the practice since the inspection in August 2015. We found the practice had failed to make sufficient improvement. The overall rating for the practice was inadequate and the practice was placed in special measures for a period of six months. We also took enforcement action.

The full comprehensive reports for the August 2015 and December 2016 inspection can be found by selecting the ‘all reports’ link for Wake Green Surgery on our website at www.cqc.org.uk.

Since the inspection in December 2016 the original provider has joined the Our Health Partnership (OHP) group as a partner. The registered provider is now Our Health Partnership.

This inspection on the 18 September 2017 was undertaken following the period of special measures. Overall the practice is now rated as good.

Our key findings were as follows:

• Since our previous inspection in December 2016 we found the practice had made significant improvement to address the concerns identified. This included systems and processes to ensure safe services were delivered.
• The practice had recruited several staff over the last six months, including a practice manager, two salaried GPs, a pharmacist, a practice nurse and two additional receptionists. There was clearer leadership within the practice and greater staffing to deliver the service and meet patient needs.
• The practice also had the wider support of Our Health Partnership to support the administration and governance of the practice.
• The practice had effective systems for reporting, recording and acting on significant events with evidence of shared learning.
• There were clearly defined systems to minimise the risks to patient safety which included safeguarding, medicines management, staff recruitment and infection control.
• Staff were aware of current evidence based guidance. Staff had been trained to provide them with the skills and knowledge to deliver effective care and treatment. There were opportunities and support for staff to develop in their roles.
• Concerns identified at our inspection in December 2016 in relation to the timely management of patient information and referrals had been appropriately responded to. Systems and processes had been established to monitor and help minimise the risk of potential delays in patients care and treatment.
• Working relationships with health and social care professionals in the management of vulnerable patients including those with complex health needs had improved since our previous inspection.
• There was mixed feedback on patient satisfaction. Most patients felt they were treated with compassion, dignity and respect. However, this was not consistently the case and we received complaints and some comment cards in which patients indicated that they had not received a positive patient experience. National patient survey results also showed slightly lower scores in relation to questions about patient involvement in decisions about their care and treatment.
• There had been significant changes to improve access to appointments. This included recruitment of additional clinical and reception staff (including two salaried GPs), a review and changes to the appointment system and imminent changes to the telephone system. Some of these changes were still in their infancy and the impact on patient satisfaction had yet to be fully determined. Results from the GP national patient survey published in July 2017 and feedback from patients through our comment cards showed patients continued to have difficulties accessing appointments. However, the practice’s in-house annual patient survey of 450 patients in 2017 showed improved patient satisfaction with access since 2016.

However, there were also areas of practice where the provider needs to make improvements.

The provider should:

• Ensure local safety alerts are treated with the same rigor as medicine safety alerts.
• Continue to review and focus on the patient experience and identify ways in which this could be further improved.
• Ensure all staff are aware of recording verbal complaints so that they may also be used for monitoring trends.

I am taking this service out of special measures. This recognises the significant improvements made to the quality of care provided by the service.

Professor Steve Field (CBE FRCP FFPH FRCGP) 

Chief Inspector of General Practice