Letter from the Chief Inspector of General Practice

We carried out an unannounced inspection of Wimbledon Village Surgery on 9 December 2015. Breaches of legal requirements were found. After the comprehensive inspection, the practice wrote to us to say what they would do to meet the legal requirements in relation to the breaches of regulation 12 (Safe care and treatment) and regulation 18 (Staffing) of the Health and Social Care Act 2008 (Regulated Activities) Regulations 2014.

We undertook this focussed inspection on 18 October 2016 to check they had followed their plan and to confirm that they now meet the legal requirements. This report covers our findings in relation to those requirements and also where additional improvements have been made following the initial inspection. You can read the report from our last comprehensive inspection by selecting the ‘all reports’ link for Wimbledon Village Surgery on our website at www.cqc.org.uk.

After the focussed inspection of 9 December 2015, the practice was rated as requires improvement. They were rated as requires improvement for providing safe and well led services. Following the focussed inspection of 18 October 2016 we found the practice to be good overall, and good for providing safe and effective services.

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

• The practice had undertaken a fire risk assessment two weeks prior to the inspection, and had a fire safety checklist in place to repeat basic checks on a quarterly basis.
• All staff had been trained in infection control.
• The practice designated Fire Marshalls had attended training on fire safety and had trained other staff at the 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 of the practice on 4 March 2015. Breaches of legal requirements were found. Specifically, breaches of regulation 12(2)(a)(c), relating to the provision of safe care and treatment and regulation 18(2)(a), relating to staffing, of the Health and Social Care Act 2008 (Regulated Activities) Regulations 2014.

After the comprehensive inspection, the practice wrote to us to inform us that in their consideration, no further action was necessary following the comprehensive inspection. CQC subsequently informed the provider that as breaches of regulations had been identified, we would expect services to respond to areas of concern and to make required improvements. We advised the provider that the service would be re-inspected to review compliance with the regulations breached.

We undertook this unannounced focussed inspection on 9 December 2015 to confirm that the practice now met the legal requirements. This report covers our findings in relation to those requirements and also where improvements have been made following the initial inspection. You can read the report from our last comprehensive inspection by selecting the ‘all reports’ link for Wimbledon Village Surgery on our website at www.cqc.org.uk.

Overall the practice is rated as requires improvement. Specifically, following the focussed inspection we found the practice to be requires improvement for both providing safe services and well-led services. As the practice remains rated as requires improvement overall, the ratings for the population groups have not changed. Therefore, it remains requires improvement for providing services for older people; people with long-term conditions; families, children and young people; working age people (including those recently retired and students); people whose circumstances make them vulnerable and people experiencing poor mental health (including people with dementia).

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

• Significant event systems in the practice ensured information about safety was recorded, monitored, appropriately reviewed and addressed.
• There were appropriate arrangements in place to support the health care assistant to provide immunisations.
• Some risks to patients were not fully assessed or mitigated, specifically those for infection control and fire.
• The practice had a number of policies and procedures to govern activity which were accessible to staff.
• The practice held regular staff and partnership meetings.
• Most staff felt supported by the partners and management and there were strategies in place which had improved communication in the practice.
• Staff had received inductions, annual appraisals and personal development plans.
• The practice had did not have an active Patient Participation Group (PPG), but there was evidence that feedback from patients was analysed and acted on.

However, there were areas where the practice must make improvements:

• Ensure that the practice has assessed the risks in relation to fire safety.

• Ensure that leads in infection control and fire safety have received appropriate training for their roles.

The practice should also:

• Ensure that there are formalised systems in place to improve communication with the practice nursing team, including involvement in practice and clinical meetings.

• Establish an active Patient Participation Group (PPG) or alternative systems for engaging formally with service users.

• Act on improvements identified in the infection control audit dated December 2014.

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 8.30am on 4 March 2015. The practice had previously been inspected during our pilot phase in May 2014. We must conduct inspections at those practices that were inspected during our pilot phase in order to provide a rating for the service under the Care Act 2014.

We rated the practice as ‘good’ for the service providing effective, caring and responsive services, ‘requires improvement’ for providing safe services, and ‘inadequate’ for the service being ‘well-led’. We rated the practice as ‘requires improvement’ for the care provided to older people and people with long term conditions and ‘requires improvement’ for the care provided to, families, children and young people, working age people (including those recently retired and students), people living in vulnerable circumstances and people experiencing poor mental health (including people with dementia).

Overall the practice is rated as requires improvement.

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

• Staff understood and fulfilled their responsibilities to raise concerns and report incidents and near misses.
• Patients said they were treated with compassion, dignity and respect and they were involved in their care and decisions about their treatment. Information was provided to help patients understand the care available to them.
• Patients were satisfied with the appointments system and could get an appointment that was convenient for them.
• The practice had good facilities and was generally well equipped to treat patients and meet their needs.
• Information about how to complain was available and easy to understand.
• The practice did not have a clear vision and strategy and staff we spoke with were not clear about their responsibilities in relation to it.
• There was no effective system for identifying and managing risks relating to fire safety, and risks associated with infection prevention and control had not been reviewed.
• Some staff described a negative culture within the practice and did not feel comfortable to raise issues.
• Some staff expressed a low level of job satisfaction and did not feel respected, valued, supported and appreciated.
• Patient engagement was limited to responses from the Friends and Family Test (FFT) and opportunistic verbal feedback.

We saw some areas of outstanding practice:

• The practice offered an anticoagulation service which included initiation and peri-operative care for patients taking medicines such as warfarin. Patients could attend the practice to have a blood test (international normalisation ratio [INR]) which measured how well their warfarin medication was working. NICE guidance states that a minimum of 60% of people under the care of an anticoagulation service should be within the therapeutic INR range at a given point in time. The practice had exceeded the target and achieved 75%.

There were areas of practice where the provider needs to make improvements.

Importantly, the provider must:

• Carry out a comprehensive risk assessment to identify, assess and mitigate the risks associated with fire.
• Ensure the use of the large generator in the front office is risk assessed.
• Have evidence to demonstrate that training and assessment of competency have taken place for the health care assistant’s role in administering vaccinations, and ensure that they are not in a position where they have to make a stand-alone clinical decision.
• Ensure staff receive training in infection prevention and control and fire safety.
• Involve staff in the appraisal process to ensure their development needs are acted on.
• Ensure induction training is consistently implemented for all new staff.

In addition the provider should:

• Review the infection control audit carried out in December 2014 by NHS England.
• Develop a vision and strategy for the practice and involve staff in its delivery.
• Ensure staff are aware of where all practice policies and procedures are located.
• Ensure topics discussed and actions agreed in staff meetings are recorded and disseminated.
• Review the operation and effectiveness of the practice’s patient participation group (PPG) which was inactive at the time of our inspection.
• Ensure all members of staff are aware of how to locate the practice’s safeguarding policies and the telephone numbers and names of people to ring should they have urgent safeguarding concerns.

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 inspection of Wimbledon Village Surgery on 9 December 2015. Breaches of legal requirements were found. After the comprehensive inspection, the practice wrote to us to say what they would do to meet the legal requirements in relation to the breaches of regulation 12 (Safe care and treatment) and regulation 18 (Staffing) of the Health and Social Care Act 2008 (Regulated Activities) Regulations 2014.

We undertook this focussed inspection on 18 October 2016 to check they had followed their plan and to confirm that they now meet the legal requirements. This report covers our findings in relation to those requirements and also where additional improvements have been made following the initial inspection. You can read the report from our last comprehensive inspection by selecting the ‘all reports’ link for Wimbledon Village Surgery on our website at www.cqc.org.uk.

After the focussed inspection of 9 December 2015, the practice was rated as requires improvement. They were rated as requires improvement for providing safe and well led services. Following the focussed inspection of 18 October 2016 we found the practice to be good overall, and good for providing safe and effective services.

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

• The practice had undertaken a fire risk assessment two weeks prior to the inspection, and had a fire safety checklist in place to repeat basic checks on a quarterly basis.
• All staff had been trained in infection control.
• The practice designated Fire Marshalls had attended training on fire safety and had trained other staff at the practice.

Professor Steve Field CBE FRCP FFPH FRCGP 

Chief Inspector of General Practice