Improvement work 'under way' at Telford GP surgery found wanting by inspectors

The Care Quality Commission found that at busy periods the clinical streaming team at Wellington Medical Practice were too understaffed to "effectively manage the volume of inbound calls” leaving people waiting in the queue or placed on hold while call handlers obtained advice from clinicians to inform patients.

Nicola Williams, interim associate director of primary care at NHS Shropshire, Telford and Wrekin, said: “We acknowledge the recommendations raised within the recent CQC report and can reassure patients that work is already underway at the practice as part of an improvement plan.

“Following the inspection, which took place in October 2023, the practice was made aware of some of the potential issues that might be raised within the report and has since worked hard to provide solutions to these.

“Of these changes, digital access solutions are in the process of being set up to improve patient experiences of contacting the practice and cutting down on call wait times, as well as work to improve HR recording.

“Resolutions will also be subject to ongoing discussions between NHS Shropshire, Telford and Wrekin and Wellington Medical Practice so that any necessary support can be made available to ensure the practice delivers the best possible care to patients going forwards.”

The CQC had found that the doctors’ surgery claims to receive more than 500 telephone calls each day which has increased.

In one day inspectors "saw" 279 calls had been answered during the practice opening times, with 54 inbound calls abandoned.

For the month of July, the average waiting time was just over nine minutes, but maximum waiting times was over two hours. The following month the average waiting times on the phone was just under 10 minutes and maximum wait of one hour and 19 minutes.

The practice received an overall rating of “requires improvement” after an inspection by the Care Quality Commission during October. Four of the five assessed areas were found to “require improvement” while responsiveness was graded as "inadequate".

“Our observations found at busy periods the clinical streaming team were understaffed to effectively manage the volume of inbound calls,” found the inspectors.

“This meant people were left waiting in the queue or placed on hold while call handlers obtained advice from clinicians to inform patients.”

When inspectors spoke to staff they said that there were "sufficient" staffing levels and enough capacity, but said that demand for their services had increased.

“They told us the practice offered as many appointments as possible with the current resources available,” the inspectors added.

During a previous inspection in August 2018 the practice was rated as "good" overall but "requires improvement" for providing responsive services.

The practice's automated voicemail message says it receives 500 telephone calls each day.

The doctors said that a team of seven call handlers was available to take calls at peak times and additional staff were diverted to assist if required.

Inspectors witnessed two call handlers and a receptionist queued waiting for advice from the nurse manager. “Leaders told us they had not audited the effectiveness of this model,” added inspectors.

“They acknowledged the long wait times for patients on the phones and told us calls were discussed on a case-by-case basis and therefore took time to deal with.

“Leaders were aware of the challenges which included the increasing demand for appointments and their lack of capacity, impact of secondary care wait times in addition to the recruitment and retention of staff.

“Leaders told us that maintaining good staff morale was also a challenge. They told us staff were being upskilled and in recognition of their work their annual leave and remuneration package had been reviewed and improved.

“The practice had reviewed the GP Patient Survey and had acknowledged the findings and had made some changes with regards to adjusting call queue functionality to try and address patient concerns.”

Inspectors added that the doctors’ practice had developed an action plan which included diverting patients to complete online requests such as eConsult ‘in an attempt to minimise the call volumes’.

Data shared by the Integrated Health Board showed for the month of August patients registered with Wellington Medical Practice ‘were the highest users of A&E’.

The report added that 52 patients had ‘potentially missed diagnosis of diabetes’. Of five patient records they randomly sampled, four had not been informed about the diagnosis.

Inspectors added that during their observations in the waiting area, they ‘overheard sensitive and personal information being shared by patients at the reception desk’.

The report added: “Significant events and complaints were not always handled in line with policy to improve patient care.

“Medication reviews were not always adequately structured or managed in a way to protect patients. The provider must ensure care and treatment is provided in a safe way to patients.

“Ensure recruitment procedures are established and operated effectively to ensure only fit and proper persons are employed."