We carried out an announced comprehensive inspection of Watling Medical Practice on 8 November 2018 as part of our inspection programme. The overall rating for the practice was good, however we rated the practice as requires improvement for safe. The full comprehensive report on the November 2018 inspection can be found by selecting the ‘all reports’ link for Watling Medical Practice on our website at www.cqc.org.uk.

This inspection was a desk-based review carried out on 6 February 2019 to confirm that the practice had carried out their plan to meet the legal requirements in relation to the breaches in regulations that we identified in our previous inspection on 8 November 2018. This report covers our findings in relation to those requirements and also additional improvements made since our last inspection.

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Overall the practice is now rated as Good.

Our key findings were as follows:

• The system for recruiting staff had been reviewed to ensure only fit and proper persons were employed.
• The provider had taken action to address the areas where we advised them that improvements should be made. Improvements had been made to the procedures for the management of prescriptions. The risk assessment for taking medication on home visits had been updated. Staff had received guidance on the updated safeguarding policies and procedures. A revised procedure had been developed to encourage the uptake of cervical screening which referred to screening being encouraged through monitoring of uptake, sending reminder letters and telephoning patients.
• At our previous inspection on 8 November 2018, we advised the provider that infection control should be improved by the provision of an elbow mixer tap in the minor surgery room and that curtains should be provided in two treatment rooms to promote privacy and dignity during examinations. At this inspection, this has not been fully addressed, however the provider told us the action being taken to address these issues.

The areas where the provider should make improvements are:

• Provide an elbow mixer tap to the sink in the minor surgery room to improve infection control.
• Provide curtains in two treatment rooms to promote privacy and dignity during examinations.

Professor Steve Field CBE FRCP FFPH FRCGP

Chief Inspector of General Practice

This practice is rated as Good overall. (Previous rating 23/06/2015 – 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 inspection at Watling Medical Practice on 8 November 2018 as part of our inspection programme.

At this inspection we found:

• Staff understood and fulfilled their responsibilities to raise concerns and report incidents and near misses.
• 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 system for recruiting staff did not fully ensure only fit and proper persons were employed as not all of the required information had been obtained or documented prior to employment.
• 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 had the skills, knowledge and experience to carry out their roles.
• Staff involved and treated patients with compassion, kindness, dignity and respect.
• The most recent results from the GP national patient survey (August 2018) showed patient satisfaction with the service. Feedback was overall in line with local and national averages. Feedback regarding being able to see or speak to a preferred GP was above these averages.
• The practice organised and delivered services to meet the needs of patients.
• There was an effective system for managing complaints.
• The practice had a culture of good quality sustainable care.
• There was a strong focus on continuous learning and improvement at all levels of the organisation.

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

• Ensure recruitment procedures are established and operated effectively to ensure only fit and proper persons are employed.

The areas where the provider should make improvements are:

• Provide guidance to all staff on the updated safeguarding policies and procedures.
• Review the procedure for monitoring uncollected prescriptions to ensure it is effective.
• Review the risk assessment for not carrying medication on home visits to ensure it incorporates how patients will be medically supported in an emergency.
• Provide an elbow mixer tap to the sink in the minor surgery room to improve infection control.
• Provide curtains in two treatment rooms to promote privacy and dignity during examinations.
• Review the system for encouraging the uptake of cervical screening by sending reminder letters.

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 Watling Medical Practice on the 23 June 2015.

Overall the practice is rated as good.

Our key findings were as follows:

• The practice had recently appointed a new practice manager who had begun to introduce new methods of improving communications for the staff team and to engage patients to provide feedback about the practice to drive forward future improvements.

• There were systems in place to mitigate safety risks including analysing significant events and information from complaints. Systems were in place to ensure medication including vaccines were appropriately stored and in date.

• Patients had their needs assessed in line with current guidance and the practice placed a strong emphasis on the continuity of care with one GP being responsible where possible for each episode of care. The practice had specific clinics for chronic disease management such as asthma and diabetes.

• The practice embraced medicines optimisation (a person centred approach to safe and effective use of medicines).The GPs ensured patients who had been advised to take new medications from other clinics were reviewed appropriately. They took time with patients to ensure that they understood how to take their medication and to ensure the medication was appropriate for them.

• The practice accommodate other visiting healthcare professionals and advisory groups so that patients did not have to be referred elsewhere.

• Feedback from patients and observations throughout our inspection highlighted the staff were respectful caring and helpful.

There were also areas of practice where the provider needs to make improvements.

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The provider should:

• Ensure that there are two signatures from staff when accessing controlled drugs.
• Ensure information and key learning points from complaints and incidents are disseminated to the whole practice team.
• Consider expanding the range of audits to include any minor surgery treatment and dispensing practices.
• Ensure staff receive training about the Mental Capacity Act 2005.
• Ensure complete documentation of recruitment files.

Professor Steve Field (CBE FRCP FFPH FRCGP) 

Chief Inspector of General Practice