Ilkley Moor Medical Practice

Updated 14 September 2021

WACA (Wharfedale, Airedale and Craven Alliance) Ltd is a GP Federation, serving the needs of the population of Airedale, Wharfedale and Craven, the registered location is Ilkley Moor Medical Practice, Springs Lane, Ilkley, LS29 8TH. The federation is made up of eight practices in the NHS Bradford District and Craven Clinical Commissioning Group (CCG) which spans West and North Yorkshire. WACA Ltd deliver extended access services to approximately 74,000 patients from the eight participating GP practices.

The registered governance and administrative centre for the service is located at The Millennium Business Park, Station Road, Steeton, BD20 6RB. At the time of inspection, the service were no longer using this address and were working from the hub sites.

The organisation is led by the board which is comprised of three GPs and a business manager. One of the board members is also the clinical director and Registered Manager. These lead officers are supported by clinical leads, an administrator, a social prescribing team, a prescribing team, a social media champion, and an IT lead.

Services are delivered from:

• The registered location, Ilkley Moor Medical Practice, Ilkley, LS29 8TH. Monday to Friday between 6.30pm and 8pm.
• Dyneley House Surgery, Skipton, BD23 2HZ. Wednesday and Thursday between 6pm and 8pm.
• Ling House Medical Centre, Keighley, BD21 2JH. Tuesday between 6pm and 8pm.
• Townhead Surgery, Settle, BD24 9JA. Monday and Tuesday between 6.30pm and 8pm and Saturday mornings between 9am and 11am.
• At the time of our inspection, weekend appointments with a GP had been suspended at the Ilkley Moor location and the Dyneley House Surgery location due to IT issues.

Non-clinical staff are located at each of the four hub sites during operational hours.

At the time of our inspection, approximately 20-40% of appointments were being offered face to face, the remaining appointments were offered as video or telephone consultations.

The focus of this inspection was the extended access service; 30% of the appointments offered within the extended access service are with GPs. The remaining appointments are with other multi-disciplinary clinicians such as pharmacists, nurses, physiotherapists and healthcare assistants.

The WACA alliance of eight practices also work collaboratively outside the remit of the provision of extended access services. Therefore, all staff who work to deliver regulated activities in the extended access service, with the exception of the three first contact physiotherapy practitioners, are also included in the training, learning and delivery of the wider services to the local community.

WACA sub-contract directly with a voluntary care sector service who provide mental health support and counselling appointments to children and young people. We have not inspected these services, as under the Health and Social Care Act 2008 (Regulated Activities) Regulations 2014, these services do not fall under the Care Quality Commission’s scope of registration. Notwithstanding this, we did not highlight any concerns regarding the oversight of these services.

WACA limited is registered to provide the following regulated activities:

• Diagnostic and screening procedures
• Treatment of disease, disorder or injury
• Family Planning
• Surgical procedures
• Maternity and midwifery services

Staff who work for the provider are contracted to work for the GP practices within the locality. The management of staff rotas is undertaken by practice managers at the hub sites and staffing costs are then re-charged to WACA. It is the responsibility of the practice from where services are delivered, to ensure that staffing is in place during the extended access service’s opening hours.

WACA is responsible for the governance and oversight of these staff whilst they work in the extended access service.

Updated 14 September 2021

We carried out an announced focused inspection on 18 and 24 August 2021. This service is rated as good overall.

We reviewed and rated the following key questions as below:

Are services safe? – good

Are services effective? – good

Are services well-led? – good

Following our previous inspection on 29 November 2019, the provider was rated as requires improvement overall and requires improvement for providing safe and well led services. We issued a Requirement Notice for a breach of Regulation 17 – Good governance. The full report for the previous inspection on 29 November 2019 can be found by selecting the ‘all reports’ link for Ilkley Moor Medical Practice: WACA Ltd on our website at www.cqc.org.uk.

Why we carried out this inspection

This focused inspection was carried out to check that improvements had been made in respect of concerns and issues identified at our previous inspection. We inspected the key questions of safe, effective and well-led. The ratings in relation to caring and responsive are carried forward from the inspection undertaken in 2019 and remain good.

How we carried out the inspection

Throughout the pandemic the Care Quality Commission (CQC) has continued to regulate and respond to risk. However, taking into account the circumstances arising as a result of the pandemic, and in order to reduce risk, we have conducted our inspections differently.

This inspection was carried out in a way which enabled us to spend a minimum amount of time on site. This was with consent from the provider and in line with all data protection and information governance requirements.

This included:

• Conducting staff interviews by telephone calls

• Requesting evidence from the provider

• Site visits.

As part of this inspection we interviewed by telephone; two nursing staff from different hub sites, one healthcare assistant (HCA), a physiotherapist and a pharmacist.

On the day of the inspection we interviewed the Registered Manager, a board director, three GPs working to deliver regulated activities, a reception team member, the business manager, social prescribing lead and the service administrator/ personal assistant.

We visited Townhead Surgery on 18 August 2021 as part of the inspection and spoke with the Registered Manager and the business manager on site.

Our findings:

We based our judgement of the quality of care at this service 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.

At this inspection we found:

• The service had reviewed and improved their understanding of health and safety at all sites. This included an oversight of issues relating to fire safety and infection prevention and control.
• The service had effective processes in place to assure themselves that staff who worked within the extended access service had the right knowledge, skills, competencies and training to carry out their roles, and were safe to do so.
• The service had a system in place to report and respond to significant events. However, we did not see that these were consistently reviewed, with learning and changes shared with staff who were working to deliver regulated activities to ensure that such safety incidents were less likely to happen in the future.
• Policies and procedures were reflective of the service and would direct staff to the best course of action when necessary. The provider was in the process of updating a small number of policies.
• The service reviewed the needs and demographics of their patients in each hub location and ensured that care and treatment was delivered by the clinician who was best suited to support the patient and according to evidence- based guidelines.
• Patients were able to access care and treatment from the service within an appropriate timescale for their needs.
• There was a renewed focus on continuous learning and improvement at all levels of the organisation.

The areas where the provider should make improvements are:

• Take steps to share the policy for the effective management and response to safety alerts with all staff.
• Provide staff with the opportunity to discuss and comment on their role within the extended access service during appraisals at their normal place of work.
• Take action to ensure that the service recruitment procedure is followed and that appropriate checks are completed prior to new staff commencing employment.
• Take steps to embed the recent changes made to the system for the reviewing and sharing of learning from incidents or significant events.
• Take action to ensure that all clinical staff have adequate immunity for vaccine preventable infectious diseases.
• Take action to ensure that staff working to deliver regulated activities are aware of the organisational leads such as the Freedom to speak up guardian.
• Improve the documentation of meetings held to ensure they are reflective of the discussion and are available for staff review.
• Act to formally notify the CQC of the decision taken to suspend the GP service at specific sites at weekends.

Dr Rosie Benneyworth BM BS BMedSci MRCGP

Chief Inspector of Primary Medical Services and Integrated Care