Letter from the Chief Inspector of General Practice

We carried out an unannounced focused inspection at Woodroyd Medical Practice on 6 April 2017. This inspection was carried out in response to some information of concern we had received from an anonymous source.

Following our initial inspection in September 2016, the practice was rated as good overall, requires improvement for providing safe services. We re-inspected the practice in January 2017 and the safe domain was rated as good.

The unannounced inspection was carried out to ensure that the specific risks identified were being addressed and to monitor the progress being made by the provider.

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

• The practice actively reviewed their performance in the management of long term conditions, and was proactive in offering review and screening services, such as extra checks offered to people in pre-diabetic stages (247 patients seen by the practice in total in the last 12 months).

• People with long term conditions were monitored and discussed at multi-disciplinary clinical meetings so the practice was able to respond to their changing needs. Outcomes were monitored through clinical audits. People with conditions such as diabetes attended regular clinics to ensure their conditions were monitored, and were given individualised management plans. Nurses and GPs worked collaboratively. Attempts were made to contact non-attenders to ensure they had appropriate routine health checks. The practice had developed a recall competence check and we reviewed the data for December 2016 to March 2017.

• Patients with pre-diabetes or who were identified as at risk of developing the condition were given early access to tests and GP appointments, and then referred if necessary into a preventative pathway incorporating diet and lifestyle changes.

• The practice offered in-house diagnostics and services to support patients with long-term conditions, such as blood pressure machines, electrocardiogram (ECG) tests, spirometry checks (Spirometry is used to diagnose asthma, chronic obstructive pulmonary disease (COPD) and other conditions that affect breathing), blood taking, health screening, minor injuries and minor surgery.

• Incidents and significant events were recorded, processes were followed and outcomes and learning were shared with all clinical staff.

• The practice managed patients living with diabetes, chronic obstructive pulmonary disease (COPD) and Asthma by reviewing their medication.

• NICE (National Institute for Health and Care Excellence) guidelines were being followed.

• The practice used the Spirometry and interpretation of results to deliver effective care to patients.

• Patients with Long Term Conditions (LTCs) told us that they were able to speak with GPs, nurses and non-clinical staff, as and when required. These patients had longer 45 minute time slots for appointments.

• The clinical systems had up to date records of patients living with diabetes, COPD and Asthma.

• The practice continued to review the results of patient satisfaction surveys and ensured that it could meet the needs of the patient population in the future and improve access.

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 Woodroyd Medical Practice on 13 September 2016. The overall rating for the practice was good. However, a breach of the legal requirements was found which resulted in the practice being rated as requires improvement for providing safe services. The full comprehensive report on the September 2016 inspection can be found by selecting the ‘all reports’ link for Woodroyd Medical Practice our website at www.cqc.org.uk.

In addition to the breach of regulation, at the inspection on 13 September 2016 we also said the practice should consider the following areas:

• The practice should review the necessity of requesting DBS checks for staff prior to them commencing in their new roles and be able to assure themselves of the suitability of the candidate for the post. The practice should ensure that all staff who act as chaperones for patients have undergone training and have a Disclosure and Barring Service check (DBS) or a risk assessment is in place.
• The practice should ensure that when things go wrong with care or treatment that any actions taken to improve safety are fed back to staff and patients.
• The practice should continue with their plan to ensure that staff are suitably trained to carry out their roles.
• The practice should continue to review the results of patient satisfaction surveys and ensure that it can meet the needs of the patient population in the future and improve access.

This inspection was an announced focused inspection carried out on 19 January 2017 to confirm that the practice had carried out their plan to meet the legal requirements in relation to the breach of regulations that we identified in our previous inspection on 13 September 2016. This report covers our findings in relation to those requirements and also additional improvements made since our last inspection.

The practice has now met the legal requirements in the key question of safe which is also now rated as good.

Our key findings were as follows:

• Risks to patients were assessed and well managed. The practice had implemented Disclosure and Barring Service (DBS) checks for all members of staff.
• We saw evidence that staff who acted as chaperones for patients had undergone training and had a DBS check in place.
• The practice ensured that when things went wrong with care or treatment, this was documented and action was taken to improve safety in the practice. These actions were fed back to staff and patients, for example, through meetings.
• The practice had ensured that the staff team were suitably trained to carry out their roles. We saw evidence that training had been completed in areas including safeguarding, infection prevention, information governance, fire and health and safety.
• The practice encouraged patients to complete patient satisfaction surveys and had increased the number of nurse appointments available each week in response to patient feedback. Feedback was obtained through the Friends and Family test. This is a feedback tool which asks patients if they would recommend the services they have used to their friends and family. Figures given to us by the practice for surveys undertaken between August 2016 and January 2017, showed of 32 responses 99% of patients would be likely or extremely likely to recommend the surgery to their friends and family.

The areas where the provider should make improvement are:

• The practice should continue to review the results of patient satisfaction surveys and ensure that it can meet the needs of the patient population in the future and improve access.

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 Woodroyd Medical Practice on 13 September 2016. Overall the practice is rated as good.

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

• The new partners in the practice encouraged an open and transparent approach to safety and had introduced an effective system for reporting and recording significant events.
• Partners had worked in collaboration with a neighbouring practice to produce a comprehensive action plan to reduce risks to patients and improve patient care.

• We saw that staff were dedicated to improving the quality of care in the practice and were positive about the changes which were being made to achieve this and the support offered by the neighbouring practice.
• Not all risks to patients were assessed and well managed.
• At the time of our visit there was not an identified infection prevention and control clinical lead (IPC). An IPC audit was booked for two weeks after our visit and we saw that a comprehensive cleaning audit had recently been undertaken. There was an IPC protocol in place but not all staff had received up to date training.
• We saw a training plan for all staff was in place but this had yet to be completed.
• Staff who had worked at the practice were acting as chaperones (a chaperone is a person who serves as a witness for both a patient and a medical professional as a safeguard for both parties during an intimate medical examination or procedure) without a Disclosure and Barring Service check (DBS), training or a risk assessment in place. (DBS checks identify whether a person has a criminal record or is on an official list of people barred from working in roles where they may have contact with children or adults who may be vulnerable).
• Staff assessed patients’ needs and in most cases delivered care in line with current evidence based guidance. Staff had the skills, knowledge and experience to deliver effective care and treatment. We saw that the team were actively reviewing and recalling patients.
• Computer icons were used to identify military veterans. These patients were offered priority appointments and this was noted on all referrals to the hospital to assist in their care and treatment.
• The GP patient survey results showed that 99% of patients said that nursing staff were good at explaining tests and treatments which was above the Clinical Commissioning Group (CCG) average of 89% and the national average of 90%.
• Information about services and how to complain was available and easy to understand. We saw that patients were offered an explanation and improvements were made as a result of complaints and concerns. For example all staff would now introduce themselves by name when speaking to patients.
• Patients said they did not always find it easy to make an appointment with a named GP.
• 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 the new management team. The practice had begun to proactively seek feedback from staff and patients, which it acted on. The practice had a virtual PPG with whom it communicated by e mail.
• The provider was aware of and complied with the requirements of the duty of candour.

The areas where the provider must make improvement are:

• The practice must ensure that all vaccines are stored and managed properly so that immunisations are carried out safely and efficiently in line with Public Health England guidance and that any issues are acted upon.

The areas where the provider should make improvement are:

• The practice should review the necessity of requesting DBS checks for staff prior to them commencing in their new roles and be able to assure themselves of the suitability of the candidate for the post. The practice should ensure that all staff who act as chaperones for patients have undergone training and have a Disclosure and Barring Service check (DBS) or a risk assessment is in place.
• The practice should ensure that when things go wrong with care or treatment that any actions taken to improve safety are fed back to staff and patients .
• The practice should continue with their plan to ensure that staff are suitably trained to carry out their roles.
• The practice should continue to review the results of patient satisfaction surveys and ensure that it can meet the needs of the patient population in the future and improve access.

Professor Steve Field (CBE FRCP FFPH FRCGP) 

Chief Inspector of General Practice

This practice is rated as Good overall. However, we rated the practice as requires improvement for providing responsive services. (Previous rating April 2017 – 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? – Requires Improvement

Are services well-led? - Good

We carried out an announced inspection at Woodroyd Medical Practice on 16th October and 8th November 2018, as part of our inspection programme.

At this inspection we found:

• The practice had clear systems to manage risk so that safety incidents were less likely to happen. When incidents did happen, the practice learned from them and improved their processes.
• The practice routinely reviewed the effectiveness and appropriateness of the care it provided. It ensured that care and treatment was delivered according to evidence- based guidelines.
• Staff involved and treated patients with compassion, kindness, dignity and respect.
• Patients were offered appointments according to their needs. However, some patients told us that it was difficult to get a convenient routine appointment. Demand for on- the- day appointments was high and available appointments were quickly allocated, leading to disappointment.
• There was a strong focus on continuous learning and improvement at all levels of the organisation.

The areas where the provider should make improvements are:

• Review arrangements for the authorisation of patient group directions (PGDs) to be assured they comply with published guidance.
• Continue to review and improve on the management of diabetes and rates of cervical screening.
• Continue to review and improve on patient access to routine and on the day appointments and take action to address areas of the national patient survey that have scored below the national average.

Professor Steve Field CBE FRCP FFPH FRCGP
Chief Inspector of General Practice

Please refer to the detailed report and the evidence tables for further information.