This practice is rated as Good overall. (Previous inspection November 2017– Requires Improvement)

The key questions are rated as:

Are services safe? – Good

Are services effective? – Good

Are services caring? – Good

Are services responsive? – Good

Are services well-led? – Requires Improvement

We carried out an announced comprehensive inspection at Wearside Medical Practice on 1 May 2018 to follow up on breach of regulations following our inspection in November 2017.

We first carried out an announced comprehensive inspection of this practice on 31 August 2016. We rated the practice then as good overall and requiring improvement for providing well-led care. This was because although the practice had some governance arrangements in place, there were areas that needed improvement. We carried out an announced focused inspection in November 2017; we rated the practice as requires improvement overall and inadequate for providing well-led care. We issued a warning notice following this inspection as we found the practices leadership, oversight and governance were not effective.

These reports can be found by selecting the ‘all reports’ link for Wearside Medical Practice on our on our website at www.cqc.org.uk.

At our previous inspection on 6 November 2017, we told the provider that they must make improvements in some areas. These included the leadership of the practice, the practice’s governance framework and the lack of focus on improvement at the practice.

At this inspection we found:

• We saw that some improvements had been made with respect to leadership, however, they were not yet fully established or embedded into practice. When we inspected the practice, there was continuing uncertainty about the partnership at the practice that meant that we were unable to determine if the leadership and governance issues were fully resolved.
• 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.
• Staff involved and treated patients with compassion, kindness, dignity and respect.
• Most patients found the appointment system easy to use and reported that they were able to access care when they needed it.
• The practice had developed an increased focus on continuous learning and improvement at all levels of the organisation. We saw that the lead GP was actively engaged with work to improve the practice.

The areas where the provider should make improvements are:

• Continue to develop effective systems and processes to ensure good governance in accordance with the fundamental standards of care.
• Review the recruitment procedures so that they are established and operated effectively to ensure only fit and proper persons are employed. In particular, to ensure the practice completes disclosure and barring check process prior to employment of new members of staff.
• Continue work to complete the process of recording the immunisation status for non-clinical members of staff.
• The provider should ensure that INR (international normalized ratio) results for warfarin are appropriately added to patients medical records.

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

Letter from the Chief Inspector of General Practice

This practice is rated requires improvement overall. We have limited this rating, in line with our principles of aggregation, because there is an underlying rating of inadequate in one of the key questions.

The key question we inspected is rated as:

Are services well-led? - Inadequate

We first carried out an announced comprehensive inspection of this practice on 31 August 2016. We rated the practice then as good overall and requiring improvement for providing well-led care. This was because although the practice had some governance arrangements in place, there were areas that needed improvement.

We carried out this announced focused inspection at Wearside Medical Practice on 6 November 2017 to check whether the practice had followed their action plan and taken steps to comply with legal requirements. The practice had submitted an action plan, which showed they planned to address the concerns by 31 March 2017. This inspection focused on the key question – is the practice well led.

We rated the practice as requires improvement overall.

At this inspection we found:

• The lack of leadership and oversight in the practice resulted in ineffective systems to identify and proactively manage risks, issues and performance.
• There was a lack of shared vision within the partnership. The practice did not have effective strategies in place to make sustainable improvements.
• The practice overarching governance framework was not effective and did not support the practice to identify and act upon areas for improvement. The practice had not made sufficient improvements in many of the areas identified by CQC previously. This included their approach to audit, the process for reviewing and updating policies and procedures, organisation of staff records and the process for reviewing trends and themes of significant events.

• Improvement was not a priority among staff and leaders.

At the 31 August 2016 inspection, we said the practice should ensure there were systems and processes in place to identify and meet the needs of carers. In November 2017, we found the number of carers had increased from 0.4% (29 carers) to 0.6% (46 carers). However, this was still lower than expected given the demongraphics of the practice population. The 2011 census data for the local authority area indicated that 11.8% of patients provided some level of unpaid care.

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

• Establish effective systems and processes to ensure good governance in accordance with the fundamental standards of care.

The areas where the provider should make improvements are:

• Ensure there are systems and processes in place to identify and meet the needs of carers.

Where a service is rated as inadequate for one of the five key questions or one of the six population groups, it will be re-inspected within six months after the report is published. If, after re-inspection, the service has failed to make sufficient improvement, and is still rated as inadequate for any key question or population group or overall, we will place the service into special measures. Being placed into special measures represents a decision by CQC that a service has to improve within six months to avoid CQC taking steps to cancel the provider’s registration.

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 Wearside Medical Practice on 31 August 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 in place for reporting and recording significant events. However, there was no process in place to review incidents over a period of time to identify trends and themes.
• Risks to patients were assessed and well managed.
• Staff assessed patients’ needs and delivered care in line with current evidence based guidance. Staff had been trained to provide them with the skills, knowledge and experience to deliver effective care and treatment.
• Data from the 2014-15 Quality and Outcomes Framework (QOF) showed patient outcomes were below average when compared to the local clinical commissioning group (CCG) and national averages. The practice provided unverified data for 2015-16, which demonstrated some improvement.
• Data from the national GP patient survey showed although the majority of patients felt they were treated with compassion, dignity and respect, scores were variable, with some below average.
• Information about services and how to complain was available and easy to understand. Some improvements were made to the quality of care as a result of complaints and concerns.
• Patients told us of recent difficulty in making appointments. We found the practice had kept patients informed of recent staffing difficulties and had taken action to recruit clinical staff. The practice offered extended hours every working day and urgent 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 had a clear vision and strategy to deliver high quality care and promote good outcomes for patients. However, they had not developed this into supporting business plans. The practice told us they had been through a turbulent few months, but felt they had now come through this, were in a position to move forward.
• The practice had some governance arrangements in place, but there were areas that needed improvement.
• The provider was aware of and complied with the requirements of the duty of candour.

The areas where the provider must make improvement are:

• Ensure there are systems and processes in place to assure themselves the service operates effectively. This includes maintaining complete and accurate records, as necessary, including those related to managing the service and for staff members employed to deliver the service. Assure themselves they are appropriately registered with the Care Quality Commission (CQC), including registration for all regulated activities they plan to deliver. Consider their approach to quality improvement to ensure they make use of the full range of information available to them about the quality and safety of the service to support them to improve, including targeted use of audit and learning from complaints and significant events.

An area where the practice should make improvements is:

• Ensure there are systems and processes in place to identify and meet the needs of carers.

Professor Steve Field (CBE FRCP FFPH FRCGP) 

Chief Inspector of General Practice

The practice is located in Pallion Health Centre, Sunderland and provides primary medical care services to patients living in the City of Sunderland.

Processes are in place to identify unsafe practices, and measures are put in place to prevent avoidable harm to people. However there is no written evidence available to show any learning from incidents or action that had been taken to prevent a recurrence.

Care and treatment is being delivered in line with current published best practice. Patients’ needs are being met and referrals to other services are made in a timely manner. The practice has recently started  undertaking clinical audits.

All of the patients we spoke with said they are treated with respect and dignity by the practice staff at all times. Patients also reported they feel involved in decisions surrounding their care or treatment.

Patients said they are satisfied with the appointment systems operated by the practice. The practice has a policy for handling any concerns or complaints people raise.

There is an established management structure within the practice. Staff demonstrated an understanding of their areas of responsibility and report feeling supported and valued by their peers.

Please note that when referring to information throughout this report, for example any reference to the Quality and Outcomes Framework data, this relates to the most recent information available to the CQC at  the time of the inspection that time.