Walton Medical Centre

Updated 27 February 2017

The Walton Surgery is located in the small sea side town Walton On The Naze, Clacton, Essex. The practice is situated in a side street off the main high street and there are parking facilities

available for patients during surgery hours. The practice is one of 44 GP practices in the North East Essex Clinical Commissioning Group (CCG) area.

The list size of the practice at the time of our inspection was around 8800. There are two male GP partners and one female salaried GP, with support from locum GPs supplied by an agency. There are four nurse practitioners, three female and one male, two female practice nurses and three female health care assistants (HCAs). There are a number of other staff carrying out administrative duties, led by a practice manager.

The practice is open between 8.30am and 6.30pm on Mondays to Fridays.

Appointments times are from 8.30am to 12.30pm and 1.30pm to 6pm Monday to Friday.

When the practice is closed patients are advised to call the practice number where they will be redirected to 111, or dial 111 direct if they require medical assistance and are unable to wait until the surgery reopens. The out of hour’s service is provided by Care UK.

The practice has lower than national average numbers of 0 to 49 year olds, and higher than the national average numbers of 65 to 85+ year olds. There is a higher percentage of income deprivation affecting children compared to the CCG and national average.

During our previous inspection at Walton Surgery on 16 June 2015, we found improvements were required in three of the five areas: safe, effective and well-led. The practice were issued with a requirement notice in relation to good governance. At that inspection the practice was found to not have an effective system in place to assess, monitor and mitigate some of the risks to patients. The full comprehensive report on the June 2015 inspection can be found by selecting the ‘all reports’ link for Walton Surgery on our website at www.cqc.org.uk.

Updated 27 February 2017

Letter from the Chief Inspector of General Practice

We carried out a comprehensive inspection at Walton Surgery on 16 June 2015. The practice was rated as requires improvement overall. Specifically they were rated as requires improvement for safe, effective and well-led services and good for providing a caring and responsive service.

In particular, on 16 June 2015, we found the following areas of concern:

• There was no audit trail that reflected that following incidents or concerns being raised improvement action had been taken.
• Infection control audits were not being carried out in line with recommended timescales.
• Risk relating to the management of medicines, medicines alerts, prescription reviews and stocks of emergency medicines were not being assessed.
• A legionella risk assessment had not been carried out.
• Reception staff acting as chaperones had not received a disclosure and barring service (DBS) check.
• Staff were unclear which training they were expected to undertake and when it was due.
• Annual appraisals had been undertaken for clinical staff but not for administration staff.
• Data showed patient outcomes were average for the locality but where the Quality and Outcomes Framework was not being used there was no other performance measure in place.
• The practice had not sought views from patients in the form of a survey or by other means.

As a result of our findings at this inspection we took regulatory action against the provider and issued them with requirement notices for improvement.

Following the inspection on 16 June 2015 the practice sent us an action plan that explained what actions they would take to meet the regulations in relation to the breaches of regulations.

We carried out a further comprehensive inspection at Walton Surgery on 23 November 2016 to check whether the practice had made the required improvements. We found that the majority of the improvements had been made across all areas of concern. Overall the practice is now rated as good.

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

• Staff were aware of their responsibilities regarding safety, and reporting and recording of significant events. There were policies and procedures in place to support this.
• The practice assessed risks to patients and staff. There were systems in place to manage these risks.
• Processes and systems around medicines management kept patients safe.
• Staff used current guidelines and best practice to inform the care and treatment they provided to patients.
• All patients said that they were treated with dignity and respect and involved in decisions about their care and treatment.
• There was a clear and effective complaints system in place.
• Patients had mixed views regarding access to appointments. Getting through on the telephone in the morning was identified as an issue by some patients. Others told us that access to same day appointments was good.
• The practice had difficulty recruiting GPs to the practice and had reviewed the way it provided clinical services to meet the needs of its patient population.
• There was a strong leadership structure in place and staff were supported to increase their knowledge and skills. Appraisals for non-clinical staff were not taking place, however we saw evidence that they still had access to training and career progression. 
• There was an open and transparent approach evident throughout the practice. The practice management were aware of both their strengths and areas for improvement and had incorporated this into their planning for the future.

However, there were also areas of practice where the provider needs to make improvements.

The provider should:

• Provide non-clinical staff with regular performance appraisals.
• Improve access to appointments via telephone.
• Improve the monitoring of patients with poor mental health.

Professor Steve Field (CBE FRCP FFPH FRCGP) 

Chief Inspector of General Practice

Updated 27 February 2017

The practice is rated as good for the care of people with long-term conditions.

• The practice adjusted their nurses’ appointments to meet the needs of patients with co-morbidities. For example, when a patient attended for another health condition a review of their long-term condition may be completed at the same time.
• The practice performance for diabetes indicators was in line with or below the CCG and national average. For example, the percentage of patients with diabetes with a record of an annual foot examination and risk assessment was in line with the CCG and national averages.
• Longer appointments and home visits were available when needed.
• All these patients had a named GP. For those patients with the most complex needs, the named GP worked with relevant health and care professionals to deliver a multidisciplinary package of care. 

Updated 27 February 2017

The practice is rated as good for the care of families, children and young people.

• There were systems and processes in place to enable staff to identify and take appropriate action to monitor and safeguard children and young people living in disadvantaged circumstances.
• Immunisation rates were in line with CCG and national averages for standard childhood immunisations.
• Patients told us that children and young people were treated appropriately.
• Weekday appointments were available at the end of school hours.
• There was a small table and chairs with books available for children to read whilst waiting.
• The practice encouraged breast feeding and had signs to show mothers were welcome to breast feed their children.

Updated 27 February 2017

The practice is rated as good for the care of older people.

• Patients had a named GP.
• The practice was accessible for those with limited mobility.
• The practice offered proactive, personalised care to meet the needs of the older people in its population.
• The practice was responsive to the needs of older people in their practice population. They provided information about community facilities to these patients and worked with multi-disciplinary teams from health and social care to keep patients in their own homes where this was their preference.
• The practice offered planned home visits for patients with enhanced needs, as well as urgent ones.

Updated 27 February 2017

The practice is rated as good for the care of working-age people (including those recently retired and students).

• The practice offered online services such as online booking and prescriptions
• The practice offered a range of health promotion and screening that reflected the needs for this age group.
• The practice offered in-house anti-coagulation and phlebotomy.
• The practice offered coil fittings.
• The percentage of women aged 25-64 who have had a cervical screening test in the past 5 years was higher than the CCG and national average.

Updated 27 February 2017

The practice is rated as good for the care of people experiencing poor mental health (including people with dementia).

• The percentage of patients diagnosed with dementia who had their care reviewed in a face to face meeting in the last 12 months was lower than the CCG and national average.
• Performance data for the number of patients with a mental health diagnosis with an agreed care plan recorded in their record in the last 12 months was lower than CCG and national average.
• The practice regularly worked with multi-disciplinary teams in the case management of patients experiencing poor mental health, including those with dementia.
• The practice had told patients experiencing poor mental health about how to access various support groups and voluntary organisations.
• The practice referred patients to a local dementia support service.

Updated 27 February 2017

The practice is rated as good for the care of people whose circumstances may make them vulnerable.

• The practice held a register of patients living in vulnerable circumstances such as those with a learning disability.
• The practice offered longer appointments for those patients who needed them.
• The practice worked with other health care professionals as needed in the case management of vulnerable patients.
• The practice sign-posted vulnerable patients to various support groups and voluntary organisations.
• Staff had received training in identifying and reporting possible signs of abuse.
• The practice had identified 197 carers which was 2.25% of the patient list.
• There was a local care advisor who the practice referred patients to for support.
• The practice referred vulnerable patient to an external agency which provided a multi-agency approach to supporting vulnerable patients and aimed at avoid unplanned admissions into hospital.