Letter from the Chief Inspector of General Practice

We carried out an announced comprehensive inspection at Wideopen Medical Centre on 25 August 2016. The overall rating for the practice was requires improvement. The full comprehensive report on the August 2016 inspection can be found by selecting the ‘all reports’ link for Wideopen Medical Centre on our website at www.cqc.org.uk.

This inspection was an announced focused inspection carried out on 14 February 2017 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 25 August 2016. This report covers our findings in relation to those requirements and also additional improvements made since our last inspection.

Overall the practice is now rated as good.

Our key findings were as follows:

• The practice had implemented a new infection control policy. Infection control audits had been undertaken at both sites and action plans were in place to address the small number of minor areas identified which required improvement.
• Processes for managing medicines had improved.
• A fire evacuation drill had been carried out at both sites. This was recorded and learning points were documented.
• All clinicians had completed fire safety training.
• New systems had been implemented to check expiry dates for medicines and equipment.
• Improved processes for disseminating patient safety alerts had been implemented
• Managers showed us records which demonstrated that exception rates were very low across all areas of QOF and informed us the records on the NHS database were not reflective of the practice’s own clinical records.

When we last inspected we found the systems in place for arranging home visits were not in line with recent NHS England guidelines (Patient Safety Alert, March 2016). The practice had a system in place to assess whether a home visit was clinically necessary; but there were no formal arrangements to assess the urgency of the need for medical attention during morning clinics.

During this inspection we found improvements had been made. Each morning, one of the GPs had dedicated time to triage all requests for home visits to ensure visits for those patients with more urgent needs were prioritised.

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 Wideopen Medical Centre on 25 August 2016. Overall the practice is rated as requires improvement.

Our key findings were as follows:

• Staff assessed patients’ needs and delivered care in line with current evidence based guidance.
• Staff understood and fulfilled their responsibilities to raise concerns, and to report incidents and near misses.
• A programme of clinical audit was used to monitor quality and to make improvements. However, there was no designated lead for infection control; as a consequence no infection control audits had been carried out.
• Managers did not have a comprehensive understanding of the practice’s Quality and Outcomes Framework (QOF) exception rates.
• 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 were able to get an appointment with a GP when they needed one, with urgent appointments available the same day.
• Patients could book appointments and order repeat prescriptions in person, on-line, by telephone or by using an ‘App’ on a mobile device.
• The practice was well equipped to treat patients and meet their needs. There was a disabled WC at each site; however there were no grab rails or alarm call systems installed at the Dudley surgery. After the inspection the practice informed us that grab rails had been fitted to the WC at the Dudley site and doorbells had been installed at both surgeries.
• There was step-free access to both surgeries, however, the external doors did not open automatically and there were no facilities for patients who need assistance to summon support.
• There was a clear leadership structure in place and staff felt supported by management. The practice proactively sought feedback from staff and patients, which they acted on.
• Staff throughout the practice worked well together as a team.

The areas where the provider must make improvements are:

• Ensure arrangements are in place for the proper and safe management of medicines; including; appropriate monitoring of the temperatures of the refrigerators used to store vaccines, maintaining records of blank prescription form serial numbers and ensuring non-prescribing staff are properly authorised to administer vaccines.
• Implement effective processes to assess the risk of, prevent, detect and control the spread of healthcare related infections, ensuring; appropriate management and monitoring arrangements are in place and the proper labelling of sharps bins.
• Put systems and processes in place so managers have a comprehensive understanding of the practice’s Quality and Outcomes Framework (QOF) exception rates.

In addition, the provider should:

• Implement processes for arranging home visits in line with recent NHS England guidelines (Patient Safety Alert, March 2016).
• Review the arrangements for fire safety; implement the recommendations made following a visit by the fire service and take steps to ensure all staff are adequately trained.
• Review staffing levels within the administrative staff team to ensure sufficient staff are deployed.

Professor Steve Field CBE FRCP FFPH FRCGP 

Chief Inspector of General Practice

Wideopen Medical centre is a practice with just over 7,000 patients, five GP's, two practice nurses and clinical and administrative support staff. The practice offers a wide range of services and can refer patients on to other healthcare providers when necessary.

Patients told us that they were extremely happy with the care, support, treatment and service that they received from the medical centre. One patient said, "My doctor has always looked after me really well." Another patient said, "The doctor actually listens to what you say. I feel included in the diagnosis and treatment not just told what to do. I can't see any faults with the practice."

We found that patients' privacy and dignity were respected and they were involved in decisions made about their care.

Care and treatment was planned and delivered in line with patients' needs.

Patients told us they felt safe when in receipt of care and we saw that the provider had measures in place to identify abuse and prevent abuse from happening.

There were effective systems in place to monitor and control the spread of infection. Patients received care in a clean and hygienic environment.

Appropriate checks were carried out before staff began work and patients were cared for by suitably qualified, skilled and experienced staff.