This practice is rated as Good overall.

The previous inspection was in December 2014 and the practice was rated Good.

The key questions at this inspection are rated as:

Are services safe? – Good

Are services effective? – Good

Are services caring? – Good

Are services responsive? – Good

Are services well-led? - Outstanding

We carried out an announced comprehensive inspection at Westongrove Partnership – Wendover Health Centre in Buckinghamshire on 23 April 2018. We carried out this inspection under Section 60 of the Health and Social Care Act 2008 as part of our regulatory functions.

This inspection was planned to check whether the practice was meeting the legal requirements and regulations associated with the Health and Social Care Act 2008.

At this inspection we found:

• The practice had comprehensive systems in place to manage and monitor risks to patients, staff and visitors. This included risks to the building, environment, medicines management, staffing, equipment and a range of emergencies that might affect operation.

• Patient outcomes and information collected for the Quality Outcome Framework (QOF), the local performance scheme (known as Primary Care Development Scheme) and performance compared to national screening programmes was high.

• The practice routinely reviewed the quality and effectiveness of the care it provided. Care and treatment was delivered according to evidence based guidelines. We saw that a wide range of clinical audits were carried out and there was a whole practice approach to improvement.

• The leadership, governance and culture were used to drive and improve the delivery of its service. All staff were involved in the development of the practice and were proud of their achievements.

• The practice reviewed the needs of their local population and had initiated positive services for patients.

• Services were tailored to meet the needs of individual people and were delivered in a way that ensured flexibility and choice.

• There was a strong focus on education, continuous learning and improvements at all levels in the practice. When incidents did happen, the practice learned from them and improved their processes.

• There was evidence that service improvement was a priority among staff and leaders. High standards were promoted by all practice staff and there was strong team working and a commitment to personal and professional development.

We saw several areas of outstanding practice:

• The practice leadership was committed to meeting the needs of its population. This was evidenced through themed and targeted services, clinical audits and health promotion. This included a range of initiatives to meet the needs of specific groups – for example older people and people with dementia.

• The practice was aware of an increasing elderly population within the community. This led to the development of a service specifically for older people; this service was known as The Weston Service. The focus was to support patients (aged over 75) and their carers with a GP led nurse team to oversee and co-ordinate health and social needs. We saw the practice reviewed and audited the efficiency of the service; we saw recent data which indicated the service had 70 new cases and reduced hospital admissions by 33% (101 avoided admissions). The service and the impact on patients have been recognised both locally and nationally. For example, the project won an innovation award from the Queen’s Nursing Institute (a nationally recognised award celebrating innovation and commitment to patient care and nursing practice) and Bucks County Council Dignity and Respect awards.
• There was clear, inclusive and effective leadership at all levels. Leaders demonstrated the high levels of experience, capacity and capability needed to deliver sustainable care. There were deeply embedded systems of leadership which aimed to ensure that senior staff had considered the needs for the future.

There was an area where the provider should make improvements:

• Consider the implementation of a hearing loop system at all three sites to support patients with impaired hearing.

Professor Steve Field CBE FRCP FFPH FRCGP

Chief Inspector of General Practice

Letter from the Chief Inspector of General Practice

In December 2014 we found concerns related to the management of medicines during a comprehensive inspection of Westongrove Partnership – Wendover Health Centre in Wendover, Buckinghamshire. Following the inspection the provider sent us an action plan detailing how they would improve the areas of concern. The previous inspection in December 2014 had found one breach of the regulations relating to the safe delivery of services.

We carried out a follow up inspection of Westongrove Partnership – Wendover Health Centre on 25 February 2016 to ensure these changes had been implemented and that the service was meeting the requirements of the regulations.

This follow up inspection was undertaken more than six months after the original inspection and as a result our follow up methodology would not support a re-rating. However the practice were offered the opportunity of a full comprehensive inspection which would have included a change in ratings.

The ratings for the practice have not been updated to reflect our findings however following the improvements made since our last inspection on 11 December 2014; the practice was now meeting the regulations that had previously been breached.

Specifically the practice was:

• Operating safe systems in relation to management of medicines. This included appropriate arrangements in place for obtaining, recording, handling, using, storing and dispensing medicines.

The practice had also taken full heed of our report following the December 2014 inspection with regards operating safe systems in relation to the recruitment of staff and identifying and managing risk through the completion of a legionella risk assessment.

We have not changed the rating for this practice to reflect these changes, although the practice was now meeting the regulations that had previously been breached.

Professor Steve Field CBE FRCP FFPH FRCGP 

Chief Inspector of General Practice

Letter from the Chief Inspector of General Practice

We inspected Wendover Health Centre part of the Westongrove Partnership on 11 December 2014. This was a comprehensive inspection. The practice has two other registered locations which were not inspected as part of this inspection.

We have rated the practice as good, although improvements in safety, specifically medicines management are required.

Our key findings were as follows:

The practice provided good care and treatment to its patients. National data showed the practice performed well in managing long term conditions. Patients reported that they could access the practice and the system of phone triage worked well (the triage system was usually a phone consultation with a GP to determine what assistance a patient needs). The premises were accessible, clean and safe. There were some areas of medicines management which required improving, specifically storage and monitoring of medicines. Staff were aware of the needs of their patients including small numbers of vulnerable patients such as those who were homeless or travellers. The practice was responsive to potentially vulnerable patients. There were clear leadership structures and an open culture which was inclusive and encouraged staff to participate in the running of the practice. Patients were consulted to assist the leadership in making improvements to the service.

We saw three areas of outstanding practice these were:

• Robust assessments of vulnerable patients were undertaken in order to ensure the needs of vulnerable groups were understood and met. This included training staff in the needs of patients with autism and ex-service personnel.
• A ‘friends service’ was in place at the practice to provide support to vulnerable patients such as those who were housebound. The ‘friends’ service’ had a desk open to patients in the waiting area of the practice for up to four hours each day.
• the practice was trying to provide local travellers, who may not have been registered with a practice, with medical records where these were missing. This would enable the practice to provide care planning for these patients, where necessary, and a better continuity in their care.

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

Importantly, the provider must:

• Review protocols and risks associated with medicines management including group directives to ensure staff are administering vaccines in line with national guidance, arrangements for emergency medicines to ensure staff could access these if required and assess and manage the risk of un-authorised persons accessing the dispensary.

In addition the provider should:

• undertake a legionella risk assessment.
• ensure all information required is available in regards to staffing checks and recruitment.
• ensure audits are collated in one place for all staff to access.
• consider the patient feedback from the national patient survey 2014 particularly regarding involvement in care decisions.

Professor Steve Field (CBE FRCP FFPH FRCGP) 

Chief Inspector of General Practice