We carried out an announced comprehensive inspection at Wish Park Surgery on 12 March 2019 as part of our inspection programme.

At our last inspection in March 2018 we rated the practice as requires improvement. Specifically, we said they must:

• Ensure care and treatment is provided in a safe way to patients.
• Establish effective systems and processes to ensure good governance in accordance with the fundamental standards of care.
• Ensure persons employed in the provision of the regulated activity receive the appropriate support, training, professional development, supervision and appraisal necessary to enable them to carry out the duties.

We also found areas where the provider should make improvements:

• Strengthen the guidance provided for reception staff to include identification of symptoms for potentially seriously ill patients, such as sepsis.
• Review and improve the process to record and action safety alerts.
• Consider ways to increase the visibility of information for patients that are carers.
• Review and improve the system for recording verbal complaints.

At this inspection, we found that the provider had satisfactorily addressed all of these areas.

We based our judgement of the quality of care at this service is on a combination of:

• what we found when we inspected
• information from our ongoing monitoring of data about services and
• information from the provider, patients, the public and other organisations.

Overall this practice is now rated as good and good for all population groups.

Details of our findings

At this inspection we found:

• The practice provided care in a way that kept patients safe and protected them from avoidable harm.
• Patients received effective care and treatment that met their needs.
• Staff dealt with patients with kindness and respect and involved them in decisions about their care.
• The practice organised and delivered services to meet patients’ needs. Patients could access care and treatment in a timely way.
• The way the practice was led and managed promoted the delivery of high-quality, person-centre care.
• There was a clear leadership structure and staff felt supported by management.
• Staff worked well together as a team and all felt supported to carry out their roles. There was a strong team ethos and culture of working together for a common aim.

The areas where the provider should make improvements are:

• Strengthen the methods to identify children and adults at risk on the practice system and the systems to follow up on children who fail to attend practice appointments or at secondary care.
• Strengthen the practice vaccination programme to include records of non-clinical members staff.
• Continue to complete regular infection prevention and control audits.
• Review the waiting room layout to consider solutions to increase visibility of the waiting area and confidentiality at the reception desk.
• Continue to monitor practice performance in relation to patients diagnosed with atrial fibrillation and those experiencing poor mental health.

Dr Rosie Benneyworth BM BS BMedSci MRCGP
Chief Inspector of Primary Medical Services and Integrated Care

Details of our findings and the evidence supporting our ratings are set out in the evidence tables.

This practice is rated as Requires Improvement overall.

Wish Park Surgery was previously inspected on 22 October 2015 and was rated good in all domains and overall.

The key questions are rated as:

Are services safe? – Requires Improvement

Are services effective? – Requires Improvement

Are services caring? – Good

Are services responsive? – Good

Are services well-led? - Requires Improvement

As part of our inspection process, we also look at the quality of care for specific population groups. The provider is rated as requires improvement for providing safe, effective and well-led services. They are rated as good for providing caring and responsive services. The issues identified as requiring improvement overall affected all patients. The population groups are therefore rated as:

Older People – Requires Improvement

People with long-term conditions – Requires Improvement

Families, children and young people – Requires Improvement

Working age people (including those recently retired and students – Requires Improvement

People whose circumstances may make them vulnerable – Requires Improvement

People experiencing poor mental health (including people with dementia) - Requires Improvement

We carried out an announced comprehensive inspection at Wish Park Surgery on 27 March 2018 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.

At this inspection we found:

• Patients said they were treated with compassion, dignity and respect and they were involved in their care and decisions about their treatment.
• The practice had systems to manage risk, including risk assessments, so that safety incidents were less likely to happen. However, some systems and processes to address risks were not implemented well enough to ensure patients and staff were kept safe. This included the arrangements for processing and storing incoming post from other services, infection prevention and control, completion of staff training, and the security and tracking of blank prescription paper.
• There was an open and transparent approach to safety and a system in place for reporting significant events, although we found the recording processes could be improved and learning was not always shared effectively with staff.
• Patients found the appointment system easy to use and reported that they were able to access care when they needed it. The practice ensured patients had good access to care by offering extended hours surgeries, and telephone consultations, as well as offering appointment booking on the practice website.
• 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.

The areas where the provider must make improvements are:

• Ensure care and treatment is provided in a safe way to patients.

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

• Ensure persons employed in the provision of the regulated activity receive the appropriate support, training, professional development, supervision and appraisal necessary to enable them to carry out the duties.

The areas where the provider should make improvements are:

• Strengthen the guidance provided for reception staff to include identification of symptoms for potentially seriously ill patients, such as sepsis.

• Review and improve the process to record and action safety alerts.

• Consider ways to increase the visibility of information for patients that are carers.

• Review and improve the system for recording verbal complaints.

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 Wish Park surgery on 22 October 2015. 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.
• Risks to patients were assessed and well managed.
• Staff assessed patients’ needs and delivered care in line with current evidence based guidance. Staff had 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.
• Some patients told us they weren’t happy with the opening hours of the practice and had difficulties getting through to the practice by phone. However, the practice was aware of these concerns and was working with the practice PPG to address them.
• Information about services and how to complain was available and easy to understand.
• Patients said they found it easy to make an appointment with a named GP and that there was continuity of care, with 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 proactively sought feedback from staff and patients, which it acted on.
• The provider was aware of and complied with the requirements of the Duty of Candour.
• The practice had performed below the national and local averages for mental health performance indicators.

The areas where the provider should make improvement are:

• Continue to work with the practice PPG and respond to feedback from patients to address the difficulties some patients are experiencing in getting through to the practice by phone and opening hours.
• Have a robust plan for improving mental health performance indicators.
• Have a plan for reviewing and improving their high QOF exception rates.

Professor Steve Field CBE FRCP FFPH FRCGPChief Inspector of General Practice