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The Waterfield Practice Good

Reports


Inspection carried out on 4 March 2020

During a routine inspection

We carried out an announced comprehensive inspection at The Waterfield Practice on 4 March 2020 to follow up on concerns and breaches of regulation identified at our last inspection in February 2019.

At our last inspection (February 2019) we rated the practice as Requires Improvement overall. Specifically, the practice was rated Requires Improvement for providing Safe and Well led services and Good for providing Effective, Caring and Responsive services. We issued requirement notices for regulation 12: Safe care and treatment and regulation 17: Good governance.

At this inspection in March 2020, we found that the provider had satisfactorily addressed these areas, however we identified new areas of concern.

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

We have rated this practice as good overall and good for all population groups. Specifically, we have rated the provider as Requires improvement for Safe services and Good for Effective, Caring, Responsive and Well led services.

We rated the practice as Requires improvement for providing Safe services because:

  • Non-medical prescribers did not receive formal clinical supervision in line with the practice’s own policy. There had been no audits of their consultations or prescribing.
  • Blank prescription stationery had been securely stored but had not been effectively tracked throughout the practice.
  • A fire risk assessment carried out in January 2019 had not had risks actioned for the branch site risk, in regard to fire marshal training or carrying out a fire drill.

We rated the practice as Good for providing Effective, Caring, responsive and Well led services because:

  • Patients received effective care and treatment that met their needs.
  • Staff training oversight had improved and the practice maintained training records for all staff.
  • Staff dealt with patients with kindness and respect and involved them in decisions about their care.
  • The practice organised and delivered services to meet patients’ needs. Patients could access care and treatment in a timely way.
  • The practice had reviewed their governance arrangements following the last inspection and had recruited a quality lead to oversee systems and processes.

The areas where the provider must make improvements are:

  • Establish effective systems and processes to ensure good governance in accordance with the fundamental standards of care.

Please see the specific details on action required at the end of this report.

In addition, the provider should:

  • Improve disclosure and barring service risk assessments to include the types of risks being measured against.
  • Improve oversight of all new staff recruitment to ensure the practice recruitment process is followed.

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

Inspection carried out on 20 February 2019

During a routine inspection

We carried out an announced comprehensive inspection at The Waterfield Practice on 6 February 2019 as part of our inspection programme.

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.

We have rated this practice as requires improvement overall. We found the practice requires improvement for safe and well led and good for effective, caring and responsive. All the population groups were rated as good.

During this inspection we found:

  • Systems and processes around safeguarding were well managed.
  • Some risks had not been identified, such as control of substances hazardous to health or assessing emergency medicine provision and storage.
  • Identifying and learning from significant events was inconsistent and the practice had recently reviewed their systems and processes but these were not yet embedded.
  • The practice monitored patient care effectively and had achieved positive outcomes for their patients.
  • Uptake of health checks for patients with learning disabilities was low.
  • The majority of patients were positive about the care they received.
  • The practice website had been developed with patient access in mind. It was utilised well and had reduced appointment requests and telephone calls to the practice.
  • Governance arrangements required review as these were inconsistently applied. Risks and areas of concern were not always identified or effectively managed.
  • Staff felt supported by management and enjoyed working at the practice.

The areas where the provider must make improvements are:

  • Ensure care and treatment is provided in a safe way to patients
  • Establish effective systems and processes to ensure good governance in accordance with the fundamental standards of care.

(Please see the specific details on action required at the end of this report).

The areas where the provider should make improvements are:

  • Review the arrangements for recall of female patients for the cervical screening programme to improve uptake.
  • Review the processes for engaging with patients with a learning disability to improve uptake of annual health checks.
  • Continue to consider the need for and review the effectiveness of, an effective patient participation group.

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

Professor Steve Field CBE FRCP FFPH FRCGP

Chief Inspector of General Practice

Inspection carried out on We have not revisited The Waterfield Practice as part of this review because they were able to demonstrate that they were meeting the standards without the need for a visit.

During a routine inspection

Letter from the Chief Inspector of General Practice

In October 2014 we found concerns related to the training of staff, the recruitment of staff and infection control during a comprehensive inspection of Waterfield Practice. Following the inspection the practice sent us an action plan detailing how they would revise the practice training programme, review recruitment undertaking necessary staff checks and complete infection control audits.

We carried out desktop review of the Waterfield Practice on 2 July 2015 to ensure these changes had been implemented and that the practice was meeting regulations. Our previous inspection in October 2014 had found breaches of regulations relating to the safe delivery of services and services being well-led. The ratings for the practice have been updated to reflect our findings.

We found the practice had made improvements since our last inspection on 15 October 2014 and they were meeting the regulation relating to the recruitment of staff that had previously been breached.

Specifically the practice was:

  • Operating safe systems in relation to the recruitment of staff.

  • Ensuring staff completed training appropriate to their roles and any further training needs had been identified and planned.

  • Monitoring hygiene and infection control, including a system of audit, identifying and assessing any risk of legionella.

We have changed the rating for this practice to reflect these changes. The practice is now rated good for the provision of safe, effective, caring, responsive and well led services. Furthermore, the rating for all six population groups are now rated as good.

Professor Steve Field CBE FRCP FFPH FRCGP 

Chief Inspector of General Practice

Inspection carried out on 15 October 2014

During a routine inspection

Letter from the Chief Inspector of General Practice

We undertook a comprehensive inspection of The Waterfield practice on 15 October 2014. We visited The Waterfield practice, Ralph's Ride, Harmanswater, Bracknell, RG12 9LH. We did not visit the branch site at 1 County Lane, Warfield, Bracknell, RG42 3JP during this inspection. The practice is rated as requires improvement. Although many aspects of the practice were good, improvements in the domains of safe and well-led were required.

Our key findings were as follows:

Patient feedback from surveys, comment cards and verbal feedback was very positive. The majority of patients said they were treated with compassion, dignity and respect and they were involved in care and treatment decisions. The appointment system was robust and offered both online and telephone booking for patients. Appointments could also be booked in person. Patients with limited mobility were able to access the practice. There were concerns regarding the identifying and delivery of training required by staff. Some staff did not receive all the training they needed to provide safe and effective care.

The practice followed clinical guidelines. There were care planning arrangements for the management of different health conditions. There were arrangements to ensure vulnerable patients received the care and treatment they needed. There was evidence that the practice was extremely compassionate and caring. The practice had a clear leadership structure and an open and transparent culture. Staff were valued, supported and their views were considered in the running of the practice.

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

Importantly, the provider must:

  • ensure that training and development needs are identified for all staff to deliver safe, effective and responsive care to patients. For example, equality and diversity, information governance training and Mental Capacity Act (2005)
  • review its recruitment processes to ensure all information required including background checks is up to date.

  • implement monitoring systems for hygiene and infection control, including a system of audit, identifying and assessing any risk of legionella and cleaning check system to ensure relevant guidance is followed by staff.

We have issued three compliance actions for the regulation relating to the Requirements of Relating to Workers, Supporting Workers and Hygiene and Infection Control.

In addition the provider should:

  • provide health checks to new patients.
  • review how all staff are involved in the management and clinical governance of the practice.

Professor Steve Field CBE FRCP FFPH FRCGP

Chief Inspector of General Practice