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Archived: St Marks Hospital Primary Care Centre Good

Inspection Summary


Overall summary & rating

Good

Updated 18 August 2017

Letter from the Chief Inspector of General Practice

Our previous comprehensive inspection at East Berkshire Primary Care Out of Hours Services Limited – St Marks Hospital Primary Care Centre on 5 October 2016 found a breach of regulations relating to the safe and well-led delivery of services. The overall rating for the service was requires improvement. Specifically, we found the service to require improvement for the provision of safe and well led services. The service was rated good for providing effective, caring and responsive services. The full comprehensive report on the October 2016 inspection can be found by selecting the ‘all reports’ link for East Berkshire Primary Care Out of Hours Services Limited on our website at www.cqc.org.uk.

This inspection was an announced focused inspection carried out on 5 July 2017 to confirm that the service had carried out their plan to meet the legal requirements in relation to the breach in regulations that we identified in our previous inspection in October 2016. This report covers our findings in relation to those requirements and improvements made since our last inspection.

We found the service had made improvements since our last inspection. At our inspection on the 5 July 2017 we found the service was meeting the regulations that had previously been breached. We have amended the rating for the service to reflect these changes and improvements. East Berkshire Primary Care Out of Hours Services Limited – St Marks Hospital Primary Care Centre is now rated good for the provision of safe, effective, caring, responsive and well led services. Overall the service is now rated as good.

Our key findings were as follows:

  • East Berkshire Primary Care Out of Hours Services had comprehensively reviewed the existing governance framework in place and embedded the current models of best practice across all of the services locations.

  • The medicines management team had implemented new processes to ensure that the service actioned all patient safety alerts and MHRA (Medicines and Healthcare Products Regulatory Agency) alerts.

  • The service reviewed the Controlled Drug Home Office licence requirements and contacted the Home Office for confirmation and to begin the registration process.

  • There was now a designated person specifically to manage quality, ensure improvements were made and sustained. This included consideration of location specific clinical audits to review, monitor and improve outcomes for people accessing care and treatment at the different locations within the service.

  • The service had reviewed the internal arrangements to respond to emergencies and major incidents. This review had led to the emergency grab bags positioned throughout the service with appropriately signage and awareness training for staff.
  • There was a monitoring system to manage risks associated with cleanliness, infection control and consumables (medical equipment and medicines) across the service. Internal auditing (including premises and out of hours vehicles) infection control auditing and quality auditing was now bi-monthly and specific to each site. We saw there had been a complete review of the medical equipment and medicines held across the service.
  • The service had reviewed and taken steps to improve signage across all five primary care centres to ensure patients visiting each site could access the services without delay.
  • Arrangements to manage training had been strengthened. Specifically, we saw all staff undertaking chaperoning duties, including the drivers of out of hours vehicles, had received appropriate chaperone training. Furthermore, as part of the review of training arrangements a member of staff had been appointed to monitor all training arrangements within the service.
  • Information for patients about the complaints procedure was clearly on display and carried in vehicles for patients receiving care and treatment in their place of residence.
  • There was an appraisal programme and all staff had received an annual appraisal within the last 12 months.

Professor Steve Field CBE FRCP FFPH FRCGP

Chief Inspector of General Practice

Inspection areas

Safe

Good

Updated 18 August 2017

The service had taken appropriate action and is now rated as good for the provision of safe services.

Our last inspection in October 2016 identified concerns relating to the management of medicines across the service. This included a limited system used to monitor patient safety alerts and MHRA (Medicines and Healthcare Products Regulatory Agency) alerts, security of prescription stationery and the lack of a Controlled Drug Home Office licence.

We also saw concerns regarding the system used to record chaperone training and the medical supplies and equipment used in the extended hours service. Furthermore, there was also a concern regarding the availability of emergency equipment and emergency medicines.

During the inspection in July 2017, we saw the concerns had been addressed:

  • The service had comprehensively reviewed national guidance relating to the management of medicines. This included a specific review of guidance relating to out of hours GP services.

  • The review resulted in a new system which monitored patient safety alerts and MHRA alerts. We saw an effective system whereby notifications were investigated by the medicines management team and appropriate action taken.

  • Prescription stationery was stored securely and tracked through the service at all times; this included when prescriptions were in the out of hours vehicles.

  • We saw that, immediately after the October 2016 inspection, the service had reviewed the Controlled Drug Home Office licence requirements and contacted the Home Office for confirmation and the registration process. Until the licence was issued there was a contingency arrangement to mitigate potential risks in place. This arrangement was with local pharmacists to provide an on-call Controlled Drugs service.

  • Staff had undertaken chaperone training relevant to their role. We saw chaperone training arrangements were now consistent; there was a system to identify when staff had training and when it would need to be refreshed. This system and staff files including certificates indicated all staff had completed chaperone training relevant to their role and to cover the scope of their work. This included the drivers of out of hours vehicles.
  • The service had reviewed the internal arrangements to respond to emergencies and major incidents. This review had led to the emergency grab bags positioned throughout the service with appropriate signage and awareness training for staff.
  • There was a monitoring system to manage risks associated with cleanliness, infection control and consumables (medical equipment and medicines) across the service. Internal auditing (including premises and out of hours vehicles) infection control auditing and quality auditing was now bi-monthly and specific to each site. We saw there had been a complete review of the medical equipment and medicines held across the service.

Effective

Good

Updated 12 January 2017

The provider is rated as good for providing effective services.

  • Quality measures demonstrated organisational performance also focussed on individual clinician’s decisions. However, there was limited activity to ensure clinical quality improvement which made it difficult to identify positive patient outcomes.

  • Clinical audits demonstrated quality improvement and as well organisational performance also focussed on individual clinician’s decisions. However, these were at a provider level and not always site specific.

  • OOH data showed the provider Limited had consistently high performance against the National Quality Requirements (the minimum standards for all out-of-hours GP services) to help ensure patient needs were met in a timely way.

  • Staff assessed needs and delivered care in line with current evidence based guidance. A range of methods were used to help ensure that clinicians kept up to date.

Staff had the skills, knowledge and experience to deliver effective care and treatment. There was a consistent focus on ensuring staff had completed mandatory training. There was an inconsistent approach to appraisals and personal development plans for staff. Members of staff in the OOH service had annual appraisals and development plans; however, we noted not all nursing staff working on the extended hours service had received an appraisal within the last 12 months.

Caring

Good

Updated 12 January 2017

The provider is rated as good for providing caring services.

  • Feedback from patients about their care and treatment was consistently and strongly positive. Patients, their relatives and carers were all positive about their experience and said they found the staff friendly, caring and responded to their needs.

  • We observed and heard a kind, compassionate culture.

  • The provider took positive steps to promote the service and informed patients of what they could expect from the service.

  • Although uptake was low, patient experience surveys conducted by the provider indicated a high degree of satisfaction with how they were treated by staff and a high number of patients who had used the service would recommend it.

The provider was mindful and respectful of the needs of patients, and their carers, receiving end of life care and, where necessary, provided them with a direct telephone number so that they were able to access clinician’s directly.

Responsive

Good

Updated 12 January 2017

The provider is rated as good for providing responsive services.

  • The service engaged with the NHS England Area Team and local clinical commissioning groups to secure improvements to services where these were identified.

  • Two interlinked services were provided from St Marks Hospital Primary Care Centre. One service is the Out of Hours (OOH) GP service and the other service is an extended hours service. The extended hours service offered pre-bookable appointments with GPs and practice nurses.

  • Patients said access was good and National Quality Requirements data and extended hours Quality and Activity Reports showed patients were consistently seen or contacted in a timely manner by clinical staff.

  • There were good facilities and mobile vehicles were well equipped to treat patients and meet their needs. However, signage for patients visiting St Marks Hospital Primary Care Centre was limited. Patients we spoke with and comment cards we received showed that patients were satisfied with the service provided.

  • Information about how to complain was available but not clearly displayed or carried in mobile vehicles. Complaints we reviewed showed that the service responded quickly to issues raised. Learning from complaints was shared with staff and other stakeholders.

Well-led

Good

Updated 18 August 2017

The service had taken appropriate action and is now rated as good for the provision of well-led services.

Our last inspection in October 2016 identified concerns relating to several areas of weakness within the services’ governance arrangements. There was a governance framework, but this did not always support appropriate arrangements to monitor and improve quality and identify risk. The service and management team were not sighted on matters contributing to patient safety such as the process for ensuring staff had completed chaperone training, patient safety and MHRA alerts and some medicines management systems were not always effective.

We saw clinical and internal audits were used to monitor quality and to make improvements at a provider level. However, there was no consideration of location-specific clinical audits to review, monitor and improve outcomes for people accessing care and treatment at the different locations within the service.

During the inspection in July 2017, we saw the concerns had been addressed:

  • The service had taken steps to improve systems, processes and practices in place to manage medicines and keep patients safe. For example, there was a new system which monitored patient safety alerts and MHRA alerts. We saw an effective system whereby notifications were investigated by the medicines management team and appropriate action taken.

  • We saw evidence that there was an effective monitoring system in place to ensure all staff had undertaken training relevant to their role, specifically chaperone training.

  • The service had employed a Quality Manager with a view to manage and monitor quality improvement activity. We saw location specific audits had been completed including GP demand audits and clinical audits for example antibiotic prescribing audits reviewing prescribing habits across all of the different locations within the service. We saw all recommendations made within the variety of completed audits had been discussed with the Quality Governance Patient Safety and Risk (QGPSR) Committee.

  • We saw the Quality Manager had completed appraisals for members of the nursing team and all staff working on the service had received an annual appraisal within the last 12 months.
  • The leadership team now ensured infection control was now comprehensively monitored through weekly checks and bi-monthly infection control audits. We saw when a check or audit highlighted an area for improvement, the remedial action was recorded and subsequent actions completed and reviewed.
  • Governance arrangements had been proactively reviewed and took account of current models of best practice. For example, in January 2017 the service was issued with the Care Quality Commission inspection report (following the October 2016 inspections) which highlighted a regulatory breach relating to good governance. We found all the actions had been completed at the inspection on the 5 July 2017.