We carried out an announced comprehensive inspection at Whitwell Health Centre on 18 December 2017. The overall rating for the practice was ‘good’, however, the practice was rated as ‘requires improvement’ for providing safe services. The practice was asked to develop an action plan to address the areas of concern that were identified during our inspection.

The full comprehensive report can be found by selecting the ‘all reports’ link for Whitwell Health Centre on our website at

This inspection was an announced focused inspection carried out on 24 October 2018 to review actions taken by the practice since our previous inspection in December 2017. This report covers our findings in relation to actions taken by the practice since our last inspection in respect of the ‘Are services safe?’ domain.

Overall the practice remains rated as ‘good’. The practice is now also rated ‘good’ for providing safe services.

Our key findings were as follows:

• The practice had reviewed and improved their processes when alerts were received from the Medicines and Healthcare products Regulatory Authority (MHRA).
• Patient experience in respect of GP consultations had improved. This was demonstrated by the practice achieving results in line with local and national averages in the latest national GP patient survey published in July 2018. In addition, the practice was monitoring this through their own internal survey, and training had been sourced for clinicians to enhance their consultation skills.
• The practice had considered formal succession planning, and had appointed a clinical practitioner to work at the practice four days each week, since our previous inspection.
• We saw that clinical and non-clinical staff training was up to date, and in accordance with the practice’s own mandatory training schedule.
• The prescribing of high-risk medicines was monitored closely supported by regular patient searches on the computer system, with evidence of follow-up actions that were documented.
• The practice had implemented a more structured approach to a quality improvement programme.
• Written protocols were available for reception staff, including dealing with medical emergencies.

Professor Steve Field CBE FRCP FFPH FRCGP

Chief Inspector of General Practice

Letter from the Chief Inspector of General Practice

This practice is rated as good overall. At the previous Care Quality Commission (CQC) inspection in July 2016, the practice received a good overall rating. This inspection had been undertaken following a six month period when the practice had been placed in special measures, further to our initial inspection and overall inadequate rating in December 2015.

Our announced comprehensive inspection on 18 December 2017 was undertaken to ensure the improvements that had been achieved in July 2016 were being sustained.

The inspection of Whitwell Health Centre was carried out under Section 60 of the Health and Social Care Act 2008 as part of our regulatory functions. The inspection was planned to check whether the provider was meeting the legal requirements and regulations associated with the Health and Social Care Act 2008, to look at the overall quality of the service, and to provide a rating for the service under the Care Act 2014

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

At this inspection we found:

• Significant work had been undertaken by the practice to address the findings of our initial inspection in December 2015. A new practice manager helped to drive improvements and we saw notable progress had been achieved with regards to infection control management and the oversight of carers.
• The practice team worked in partnership with community based teams to deliver effective care for their patients. Regular meetings were held with health, social and voluntary care representatives to plan and review the care of the practice’s most vulnerable patients.
• The practice provided additional hours to compliment the Clinical Commissioning Group (CCG) funded care co-ordinator post in recognition of the benefits this role provided for patients.
• Plans for a new building at the branch site were progressing in recognition that the existing site did not allow for expansion or deliver services in an environment conducive to 21st century health care.
• The practice benchmarked their performance by reviewing monthly data provided by the CCG. We saw that the practice was not an outlier for any of the performance indicators being monitored by their CCG.
• The practice did not have a written strategy and had not developed clear succession planning arrangements for the future. However, they did engage in locality meetings which encompassed discussions on issues such as the NHS Five Year Forward View.
• We spoke with community based health, social and care home staff who provided us with positive feedback about their interactions with the practice team.
• Results from the latest national GP patient survey showed that the practice had mostly performed in line with local and national averages in the majority of the questions about patient experience. However, results relating to GP consultations were below average and we did not see any evidence that the practice were actively seeking to address this.
• Patients were mostly positive about access to GP appointments. Most said they found it easy to get through to the practice by telephone and were able to obtain a convenient appointment when they needed one. Results from the latest national GP survey demonstrated that 72% of patients were able to see or speak to their preferred GP (local average 60%; national average 56%).
• The practice had identified almost 3% of their patients as being carers. They had developed a carers support and network meeting which was held at the practice every two months.
• The practice encouraged and supported staff to report incidents. When incidents did happen, the practice learned from them and improved their processes.
• Continuous learning and improvement was encouraged at all levels within the practice. Staff training records showed that most essential training had been completed, and regular appraisals helped to encourage the development of the practice team.
• The practice provided some evidence of a quality improvement programme, but audits produced were basic and not followed through to effectively demonstrate their impact on patient care. There was no quality assurance of the clinical coding undertaken within the practice.
• The practice had a procedure to review alerts received from the Medicines and Healthcare products Regulatory Agency (MHRA). However, we found that some alerts had not been recorded on the log maintained by the practice, and the outcomes achieved were not clearly indicated or evidenced within patient records.

Importantly, the provider must make improvements to the following areas of practice:

• Ensure care and treatment is provided in a safe way to patients by reviewing all relevant patient safety alerts, including those issued from the MHRA. The practice should ensure that documented evidence was available to support timely and appropriate follow up actions were completed, and that all clinical staff were updated.

The areas where the provider should make improvements are:

• Continue to explore ways to improve patient experience with regards to GP consultations.
• Consider formal succession planning arrangements within the practice.
• Explore a more structured approach to the practice’s quality improvement programme.
• Review the approach to clinical audit and develop a formal in-house audit programme.
• Encourage staff to maintain individual training requirements in accordance with the practice schedule for mandatory and role specific training.
• Review the need for written protocols to support reception staff, for example in dealing with potential medical emergencies.

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 Whitwell Health Centre on 1 December 2015. Overall the rating for the practice was inadequate and was placed in special measures for a period of six months.

This inspection was undertaken following the period of special measures and was an announced comprehensive inspection on 29 July 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 within the practice. Effective systems were in place to report, record and learn from significant events.

• Risks to patients were assessed and well managed.

• Staff assessed patients’ needs and delivered care in line with current evidence based guidance.

• Training was provided for staff which equipped them with the skills, knowledge and experience to deliver effective care and treatment.

• Patients said they were treated with compassion, dignity and respect and they were involved in their care and decisions about their treatment.

• Patients told us they were able to get an appointment with a GP when they needed one, with urgent appointments available on the same day.

• 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 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.

• Staff worked well together as a team and had approached areas highlighted in the first inspection in a strategic and well led manner.

At this inspection we found the providers had significantly strengthened their leadership and management and had taken a proactive team approach towards making and sustaining improvements in quality. I am therefore taking this service out of special measures. This recognises the significant improvements made to the quality of care provided by this service.

Professor Steve Field (CBE FRCP FFPH FRCGP) 

Chief Inspector of General Practice

Letter from the Chief Inspector of General Practice

We carried out an unannounced focused inspection of Whitwell Health Centre on 23 March 2016. This inspection was undertaken to follow up on a warning notice we issued to the provider about infection control, responding to complaints and making sure staff were safely recruited.

The practice received an overall rating of inadequate at our inspection on 1 December 2015 and this will remain unchanged until we undertake a further full comprehensive inspection within six months of the publication date of the initial report.

You can read the report from our last comprehensive inspection, on our website at www.cqc.org.uk .

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

• The practice had complied with the warning notice we issued and had taken the action needed to comply with legal requirements

• Significant improvements had been achieved in addressing the infection control concerns identified at the comprehensive inspection on 1 December 2015. The practice had sought advice from the local Clinical Commissioning Group’s (CCG) Infection Prevention and Control Nurse who had assisted the practice manager and lead practice nurse in undertaking a comprehensive infection control audit. A robust action plan had been developed to address the identified areas of concern and multiple audits were available during this inspection showing improvements made.

• Effective systems had been put in place to carry out recruitment checks making sure staff were suitable to work with patients.
• Staff appraisals had been planned and support put in place for the development of staff.
• There was evidence that the partners and deputy practice manager had provided leadership in responding to the actions required following the issue of the warning notice to ensure compliance with the regulations.
• An effective system had been implemented to monitor the management of complaints and analyse for trends. This recorded both written and verbal complaints.
• Staff we spoke with told us they felt engaged in the changes made following the initial inspection and were well supported by the partners throughout the development of the new processes and systems.

Professor Steve Field CBE FRCP FFPH FRCGPChief Inspector of General Practice

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 on 1 December 2015. Overall, the practice is rated as inadequate.

We found the practice inadequate for providing safe and well-led services and required improvement for providing responsive, caring and effective services. The concerns that led to these ratings applied to all the population groups.

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

Patients said they were treated with compassion and told us they were involved in decisions about their care and treatment. Patients commended the reception staff who were friendly and approachable in providing a good level of service.

Urgent appointments were usually available on the day they were requested. Patients told us routine appointments were usually easy to get with GPs, although there was often a long wait when making the appointment and patients had to wait beyond their allocated appointment times.

The practice did not act on feedback from staff or patients to continually evaluate and improve the service they provided.

The confidentiality of patients was compromised at the reception desk; personal information being discussed by receptionists could be overheard by others in the waiting room. This was specifically an issue at the branch practice.  Practice staff told us they had taken steps to try and mitigate this risk but these actions had not been successful. Personal information being discussed by receptionist could be overheard. This was specifically an issue at the Branch practice.

The practice did not have a systematic approach to identifying risks, assessing the extent and probable impact of the risks, and did not put in place robust procedures and systems to mitigate the risks and improve patient safety. For example there had been no infection control risk assessment conducted in the practice.

The management of significant events was not effective and did not allow for analysis of trends as there was no template available for staff to report these. Although staff told us events were discussed at meetings they could not provide when requested evidence to demonstrate this.

The practice did not have a clear leadership structure; there was insufficient leadership capacity and limited formal governance arrangements. Staff told us they felt unsupported by management and were not aware of the long-term vision for the practice.

The areas of practice where the provider must make improvements are:

• Ensure there are effective systems and processes in place to make sure they assess and monitor their service to enable them to respond to the changing needs of patients

• The provider must put in place effective systems to enable them to identify, assess and mitigate risks to patients, staff and others such as infection control policies and audits, and managing the storage of vaccines in line with guidance.

• Ensure risk assessments are in place so that the practice can be assured that care and treatments are being delivered in a safe manner such as health and safety assessments.

• Seek and act on feedback from relevant persons and other persons on the services provided, for the purposes of continually evaluating and improving such services, such as significant event monitoring and managing complaints appropriately.

• Assess the risk of neither sites having a defibrillator for use in an emergency situation.

• Clarify the leadership structure and ensure there is leadership capacity to deliver all improvements and there is a named lead in key areas.

The areas where the provider should make improvement are:

• Take steps to review the lack of privacy and confidentiality for patients at reception in the branch site.

• Review and customise all policies that are currently in place so they reflect the practices own arrangements and enable staff to carry out their roles in a safe and effective manner in addition to implementing policies for areas not currently covered.

• Support the infection control lead with relevant training and development.

I am placing this practice in special measures. Practices placed in special measures will be inspected again within six months. If insufficient improvements have been made such that there remains a rating of inadequate for any population group, key question or overall, we will take action in line with our enforcement procedures to begin the process of preventing the provider from operating the service. This will lead to cancelling their registration or to varying the terms of their registration within six months if they do not improve. The practice will be kept under review and if needed could be escalated to urgent enforcement action. Where necessary, another inspection will be conducted within a further six months, and if there is not enough improvement we will move to close the service by adopting our proposal to vary the provider’s registration to remove this location or cancel the provider’s registration. Special measures will give people who use the practice the reassurance that the care they get should improve.

Professor Steve Field (CBE FRCP FFPH FRCGP) 

Chief Inspector of General Practice