This practice is rated as Good overall. (Previous inspection 02/2015 – Good)

The key questions 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

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

We carried out an announced comprehensive inspection Watlington Medical Centre on 2 November 2017.

At this inspection we found:

• The practice had systems to manage risk so that safety incidents were less likely to happen, although improvement was required. Risk assessments for the control of substances hazardous to health (COSHH) and a Disclosure and Barring Service (DBS) check for one nurse were not in place. However, when incidents happened, 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.
• The facilities and premises were appropriate for the services delivered.
• The practice had a robotic appliance installed in the dispensary to aid dispensing processes.
• Patients found the appointment system easy to use and reported that they were able to access care when they needed it. Patient feedback on access to appointments was positive, this was supported by a review of the appointment system and data from the national GP Patient Survey.
• Staff had the skills, knowledge and experience to carry out their roles and there was a strong focus on continuous learning and improvement at all levels of the organisation.
• The practice was above average for its satisfaction scores on consultations with GPs and in line with the averages for nurses.
• The practice was a dementia friendly practice with a member of staff trained as a dementia champion and there was dementia friendly signage throughout the premises.
• The practice actively promoted equality and diversity. It identified and addressed the causes of any workforce inequality. Staff had received equality and diversity training. Staff felt they were treated equally.
• Staff we spoke with told us they were able to raise concerns and were encouraged to do so. They had confidence that these concerns would be addressed.

We saw one area of outstanding practice:

• 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.This aided the removal of any obstructions for these patients in making appointments or having the ability to attend their appointment.

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

• Ensure care and treatment is provided in a safe way to patients

The areas where the provider should make improvements are:

• Undertake an audit on infection rates for minor surgery interventions.
• Complete the hard wiring test of the premises.

Professor Steve Field CBE FRCP FFPH FRCGP

Chief Inspector of General Practice

Letter from the Chief Inspector of General Practice

We carried out an announced comprehensive inspection at Watlington Medical Centre on 10 February 2015. Overall the practice is rated as good.

Specifically, we found the practice to be good for providing caring, effective services, responsive, well led and safe.  The practice was also good for providing services for people whose circumstances may make them vulnerable,people experiencing poor mental health, services to older people, people with long term conditions, families, children and young people, working age people (including those recently retired and students).

Our key findings across all the areas we inspected 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.

• Risks to patients were assessed and well managed, with the exception of those relating to recruitment checks.

• 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 with a named GP and that there was continuity of care, with appointments available 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 proactively sought feedback from staff and patients, which it acted on.

• The practice had a clear vision which had quality and safety as its top priority. A business plan was in place which was monitored and regularly reviewed and discussed with all staff. High standards were promoted and owned by all practice staff with evidence of team working across all roles.

We saw an area of outstanding practice including:

• The practice had a 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..

Professor Steve Field (CBE FRCP FFPH FRCGP) 

Chief Inspector of General Practice

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.