Letter from the Chief Inspector of General Practice

We inspected this service on 16 February 2015 as part of our new comprehensive inspection programme.

The overall rating for this service is good. We found the practice to be good in the safe, effective, caring, responsive and well-led domains. We found the practice provided good care to older people, people with long term conditions, families, children and young people, the working age population and those recently retired, people in vulnerable circumstances and people experiencing poor mental health.

Our key findings were as follows:

• Staff understood and fulfilled their responsibilities to raise concerns, and to report incidents and near misses. Information about safety was recorded, monitored, appropriately reviewed and addressed.
• Patients’ needs were assessed and care was planned and delivered following best practice guidance. Staff had received training appropriate to their roles and any further training needs had been identified and planned.
• Patients said they were treated with compassion, dignity and respect and they were involved in their care and decisions about their treatment.
• Information about services and how to complain was available and easy to understand.
• Patients said they found it easy to make an appointment, but not necessarily with their preferred GP, and urgent appointments were available the same day either with a GP or the advanced nurse practitioners.
• The practice had good facilities and was well equipped to treat patients and meet their needs.
• There was a clear leadership structure and staff felt supported by management. The practice proactively sought feedback from staff and patients, which it acted on.

There were some elements of outstanding practice within the population group for working age people;

• Appointments with a phlebotomist were available at times suitable for patients who commuted to work.
• In-house physiotherapist services were available for patients to help patients recover from injuries.
• The Westgate Practice was the first practice in the area to launch a virtual Patient Participation Group (PPG), allowing patients to contribute ideas and suggestions as to how services may be improved.
• The practice held evening health promotion events to provide information and advice to patients in relation to maintaining good health and disease prevention.
• The practice offered an extensive range of online services

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

The provider should:

• Ensure all required recruitment checks are kept in the relevant staff file.
• Strengthen the infection prevention and control processes.
• Include information on sibling’s records of children identified as at risk / vulnerable.

Professor Steve Field (CBE FRCP FFPH FRCGP) 

Chief Inspector of General Practice

We visited the surgery to establish that the needs of patients using the service were being met. On the day of the inspection we spoke with 14 patients, seven staff members, three doctors and the management team. The patients we spoke with were generally complimentary about the service. We were told that the staff were helpful, polite and respectful.

Patients told us that they received care, treatment and support that met their needs. One patient said; “The doctor always takes time to listen and explain things to me”.

Staff must be appropriately supported, trained and supervised in delivering care and treatment to patients who used the service. The staff we spoke with said the training available to them was good and met their requirements. All the staff we spoke with said they felt supported in their role.

The practice had systems in place to assess and monitor the quality of the service it provided. The practice had a Patient Participation Group (PPG). PPGs are an effective way for patients and GP surgeries to work together to improve the service and to promote and improve the quality of the care. Following the inspection we contacted members of the group, the members who gave feedback said they had be given the opportunity to feedback their views and comments on the quality of the service.

This practice is rated as Good overall. (Previous rating February 2015 – Good)

The key questions at this inspection are rated as:

Are services safe? – Requires Improvement

Are services effective? – Good

Are services caring? – Good

Are services responsive? – Good

Are services well-led? - Good

We carried out an announced comprehensive at The Westgate Practice in Lichfield on 30 October 2018 as part of our inspection programme under section 60 of the Health and Social Care Act 2008. The inspection was planned to check whether the provider was meeting the legal requirements and regulations associated with the Health and Social Care Act 2008, to look at the overall quality of the service and to provide a rating for the service under the Care Act 2014.

At this inspection we found:

• 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.
• Staff involved and treated patients with compassion, kindness, dignity and respect.
• Patients did not always find the appointment system easy to use and reported through surveys that they sometimes had difficulty making appointments. Some patients reported they found it difficult to access care when they needed it.
• There was a strong focus on continuous learning and improvement at all levels of the organisation.
• The practice had developed a large virtual patient participation group (PPG) which they involved in practice developments and feedback.
• The practice provided a GP service to seven care/nursing homes in the area. One of the homes reported that GP’s were respectful of their protected meal times and ensured visits avoided meal times.
• The practice clinical rooms were all on the ground floor with level access and wide corridors.
• The practice gained Research Ready accredited status in 2016.

The areas where the provider must make improvements as they are in breach of regulations are:

• Establish effective Infection prevention and control systems and processes.

The areas where the provider should make improvements are:

• Improve the patient safety alert process.
• Improve clinical audit processes.
• Improve the consent process for minor surgery.
• Update the safeguarding policy.
• Review the investigate process for incidents and serious incidents.
• Review the auditory privacy in reception.

Professor Steve Field CBE FRCP FFPH FRCGPChief Inspector of General Practice

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