Archived: Wellington Practice

We previously carried out an announced focused inspection at Wellington Practice on 28 October 2018 as part of our inspection programme. We rated the practice as Good overall, however we found a breach of regulations and rated Effective and all the population groups as Requires Improvement. You can read the full report by selecting the ‘all reports’ link for Wellington Practice on our website at .

We were due to follow up on the breach of regulation in October 2019, but this was delayed due to changes with the practice registration with the Care Quality Commission. Our inspection was then further delayed by the restrictions put in place in relation to the COVID-19 pandemic.

We were mindful of the impact of the Covid-19 pandemic on our regulatory function. This meant we took account of the exceptional circumstances arising as a result of the COVID-19 pandemic when considering what type of inspection was necessary and proportionate, this was therefore a desk-based review. On 11 September 2020, we carried out the desk-based review to confirm that the practice had carried out its plan to meet the legal requirements in relation to the breach of regulations that we identified at our previous inspection in October 2018.

At this desk-based review we found that the practice had met those requirements and we have amended the rating for this practice accordingly. The practice is now rated Good for the provision of Effective services and Good for all population groups, except for Working age people (including those recently retired and students), who remain as Requires Improvement. We previously rated the practice as Good for providing Safe, Caring, Responsive and Well led services.

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

• what we found when we reviewed the information sent to us by the provider
• information from our ongoing monitoring of data about services and
• information from the provider.

We have rated Effective as Good because:

• The practice had reviewed their recall and review processes for quality outcomes. We saw a reduction in the practice’s exception reporting rates, which demonstrated more patients were receiving appropriate care.
• There was an improvement in the uptake of childhood immunisations, with unverified data showing the practice had achieved the minimum 90% target for all the sub indicators.
• Cervical screening recall processes had been reviewed and eligible patients were contacted when they did not attend for screening. The practice’s overall uptake had improved but it was still below the national target of 80%.

Although not part of the practice’s previous regulatory breach, the practice demonstrated it had also made improvements since our last inspection which included:

• The practice no longer had spirometer testing equipment onsite (since the last inspection). This was in part due to the availability of trained staff to undertake the testing and partly due to restrictions on aerosol generating procedures during the COVID-19 pandemic. We were told by the practice that a replacement spirometer would be purchased once a clinician had completed an additional specialist qualification in the management of respiratory conditions and could safely undertake spirometry testing.
• The practice had reviewed its arrangements regarding the location of the oxygen cylinders. They told us all staff were aware of the location of the cylinders, so they could be accessed quickly in an emergency. The practice was working with the building management team to determine if safety notices were required (signage which indicates to emergency services where medical oxygen is stored).
• The practice had reviewed and updated its policy regarding the provision of carers support in July 2020. The policy included ways in which patients who were also carers were identified. Clinicians and staff were reminded that they could identify a carer during a consultation or through reviewing documents such as discharge letters. The practice had also contacted all patients through their text messaging system to identify if they were a carer, so that appropriate support could be offered.

We were told the practice held a carer’s register and added alerts to patient’s clinical records, which enabled clinical staff to check their wellbeing during consultations or promoted other communications with those particular patients.

We were shown evidence that the carer’s register had increased from 27 (in October 2018) to 73, which now represented 2% of the practice population.

Whilst we found no breaches of regulations, the provider should:

• Continue to review and improve uptake rates for cervical screening and childhood immunisations.

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

Dr Rosie Benneyworth BM BS BMedSci MRCGP

Chief Inspector of Primary Medical Services and Integrated Care