This practice is rated as Good overall.

The key questions at this inspection are rated as:

• Are services effective? – Good

When we visited Trowbridge Health Centre on 22 and 23 February 2018, to carry out a comprehensive inspection, we found the practice was not compliant with the regulation relating to staffing. Overall the practice was rated as Good. They were rated as good for providing safe, caring, responsive and well-led services, and as requires improvement for providing effective services. The full report on the February 2018, inspection can be found by selecting the ‘all reports’ link for Trowbridge Health Centre on our website at www.cqc.org.uk.

This report covers the announced follow up focused inspection we carried out at Trowbridge Health Centre on 15 August 2018, to review the actions taken by the practice to improve the quality of care and to confirm that the practice was meeting legal requirements.

At this inspection we found:

• New ways of working were becoming embedded in the practice culture. At our last inspection the practice was coming out of a significant period of change which including merging with two other local practices and moving into a new main surgery building that had not been completed on time. The practice told us the disruption caused by these changes was now behind them. The evidence we saw and our conversations with staff during this inspection confirmed this.
• The practice had a clear system for staff records which had been reviewed since our last inspection in February 2018.
• Since our last inspection the practice had reviewed the mandatory training requirements for all staff. There was a clear system for monitoring all mandatory and non-mandatory training.

Trowbridge Health Centre is now rated as good overall and in all key questions.

• Are services safe? – Good
• Are services effective? – Good
• Are services caring? – Good
• Are services responsive? –Good
• Are services well-led? - Good

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

We carried out an announced comprehensive inspection at Adcroft Surgery on 23 November 2016. Overall the practice is rated as good.

Our key findings across all the areas we inspected were as follows:

• There was an open and transparent approach to safety and an effective system for reporting and recording significant events. Incidents were discussed at a range of meetings depending on the priority; the GPs met daily for immediate concerns, there were weekly clinical meetings and a monthly meeting to discuss any learning or action from significant events.
• Risks to patients were assessed and well managed.
• The practice had a strong focus on quality improvement including utilising opportunities for sharing learning and development and clinical audit. The practice held regular teaching and training sessions for the staff, including external speakers, cascading learning from updates and training sessions across the staff teams.
• The practice had won a national award for their apprenticeship scheme. The practice also offered work experience for local sixth form students who were interested in entering healthcare. The GPs offered mentoring for their own and external local nurses wanting to become nurse prescribers.
• 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. Improvements were made to the quality of care as a result of complaints and concerns.
• The patients we spoke to said they sometimes experienced some delays getting through to the practice but many patients reported good access with urgent appointments available on the same day.
• 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 sought feedback from staff and patients, which it acted on.
• The provider was aware of and complied with the requirements of the duty of candour.

We saw one area of outstanding practice:

The practice had won an award for their apprenticeship scheme.

The areas where the provider should make improvement are:

• Ensure the legionella monitoring process and policy is updated and monitored.

Professor Steve Field (CBE FRCP FFPH FRCGP) 

Chief Inspector of General Practice

This practice is rated as Good overall.

The key questions are rated as:

• Are services safe? – Good

• Are services effective? –Requires Improvement

• Are services caring? – Good

• Are services responsive? – Good

• Are services well-led? –  Good

As part of our inspection process, we also look at the quality of care for specific population groups. The population groups are rated as:

• Older People – Good

• People with long-term conditions – Good

• Families, children and young people – Good

• Working age people (including those recently retired and students – Good

• People whose circumstances may make them vulnerable – Good

• People experiencing poor mental health (including people with dementia) – Good

In 2017 three GP practices, known as Adcroft Surgery, Bradford Road Medical Centre and Widbrook Surgery merged, and changed their name to Trowbridge Health Centre. The surgery at Bradford Road has since been decommissioned. We inspected Adcroft Surgery (now Trowbridge Health Centre) in November 2016 and rated them as Good. We inspected Bradford Road Medical Centre in November 2016 and rated them as GoodWhen we inspected Widbrook Surgery in Dec 2015 we rated them as Inadequate and put them in to Special Measures. We did a follow up inspection in October 2016 and although we found improvements had been made, there were some on-going breaches of the regulations and at that time we rated them as Requires Improvement. The full reports of these previous inspections can be found by selecting the ‘all reports’ links for Trowbridge Health Centre and Widbrook Surgery on our website at www.cqc.org.uk.

This report covers the announced comprehensive inspection we carried out at Trowbridge Health Centre on 22 and 23 February 2018 as part of our inspection programme and to follow up on breaches of regulations we previously found at Widbrook Surgery, which is now a branch of Trowbridge Health Centre.

At this inspection we found:

• In the past year the practice had been through a period of significant change, we saw evidence the practice was working to develop one team culture from the three recently merged practices and to merge their systems and processes so they were the same across both sites.

• The practice had clear systems to manage risk so that safety incidents were less likely to occur. When incidents did occur, 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.

• Following the practice merger and moving into the new practice building, patients had found it difficult to access the appointments system. The practice took action to address this and patients we spoke to on the day of our inspection said they had found it easy to make appointments and were able to access care when they needed it.

• In some areas, such as staff training records, the practice had not completed the task of integrating the systems from the three recently merged practices.

• There was a strong focus on continuous learning and improvement at all levels of the organisation.

We saw two area of outstanding practice:

• The practice was proactive in providing additional services for patients with memory problems. They ran a memory café once a month at a local garden centre. It was promoted through leaflets in the surgery and on the practice website. Staff from the local Alzheimer’s charity usually attended. The service was led by two staff from the practice who arranged for speakers such as the local fire officer to attend.  It was open to patients with memory problems and their carers.

• The practice ran a community cardiology unit that was led by one of the practice GP partners. There was a dedicated service suite that offered echocardiograms, exercise tolerance tests and 24 hour ECG monitoring. This meant that patients needing this service avoided travel to the nearest hospital.

There was one area where the provider must make improvements:

• The provider must ensure they maintain adequate records in relation to persons employed. Specifically, the practice systems did not ensure that all staff had received the training they considered essential for their role.

The areas where the provider should make improvements are:

• Improve the uptake of cervical screening.

• Review their exception reporting for mental health criteria within the the Quality Outcome Framework, which were above the national average.  (Exception reporting is the removal of patients from QOF calculations where, for example, the patients decline or do not respond to invitations to attend a review of their condition or when a medicine is not appropriate.)

• Review staff knowledge of how to access meetings minutes on the practice IT system.​

Professor Steve Field (CBE FRCP FFPH FRCGP) 

Chief Inspector of General Practice