The Care Quality Commission
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Archived: Winton Health Centre

Overall: Good read more about inspection ratings

Alma Medical Centre, 31 Alma Road, Winton, Bournemouth, Dorset, BH9 1BP (01202) 519311

Provided and run by:
Winton Health Centre

All Inspections

17 and 19 August 2021

During a routine inspection

We carried out an announced inspection at Winton Health Centre on 17 and 19 August 2021. Overall, the practice is rated as Good.

Each key question was rated:

Safe - Good.

Effective - Good.

Caring - Good.

Responsive - Good.

Well-led - Good.

The full reports for inspections can be found by selecting the ‘all reports’ link for Winton Health Centre on our website at www.cqc.org.uk

Why we carried out this inspection

Winton Health Centre was rated as Requires Improvement at our inspection in February 2019 when the service was being run by a previous provider and was placed into special measures. A warning notice was served for regulation 17 Good governance. Safe and responsive key questions were rated as Requires Improvement; effective and caring key questions were rated as Good; and the well led key question was rated as Inadequate.

An unrated focused inspection was carried out in April 2019 to follow up on the warning notices, which were met. Two requirement notices were served relating to regulation 18 Staffing and regulation 17 Good governance. Concerns identified at that time included significant events not being recorded or analysed; lack of continuity of care; and lack of support for staff to carry out their roles.

In September 2019 the practice was taken over by a new provider. They were aware of the regulatory history of the service and put in place plans to address the concerns. This comprehensive inspection was the first one carried out on the new provider.

All key questions were inspected. Although the current provider is not responsible for meeting breaches of regulation from a previous provider, we take this information into account as part of the regulatory history of the service. Therefore, we looked at actions the provider had taken to address requirements served on the previous provider, to ensure the health safety and welfare of patients.

How we carried out the inspection

Throughout the pandemic CQC has continued to regulate and respond to risk. However, taking into account the circumstances arising as a result of the pandemic, and in order to reduce risk, we have conducted our inspections differently.

This inspection was carried out in a way which enabled us to spend a minimum amount of time on site. This was with consent from the provider and in line with all data protection and information governance requirements.

  • Conducting staff interviews using video conferencing
  • Completing clinical searches on the practice’s patient records system and discussing findings with the provider
  • Reviewing patient records to identify issues and clarify actions taken by the provider
  • Requesting evidence from the provider
  • A short site visit

Our findings

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 Good and good for all population groups.

We found that:

  • Winton Health Centre had address requirements served on the previous provider and reviewed all processes, policies and procedures to strengthen governance of the practice and the care and treatment provided to patients.
  • The provider was aware of areas which still needed improvement and had plans in place to address these. The plans were regularly monitored to ensure action taken was effective.
  • The practice provided care in a way that kept patients safe and protected them from avoidable harm.
  • Patients received effective care and treatment that met their needs.
  • Staff dealt with patients with kindness and respect and involved them in decisions about their care.
  • The practice adjusted how it delivered services to meet the needs of patients during the COVID-19 pandemic. Patients could access care and treatment in a timely way.
  • The way the practice was led and managed promoted the delivery of high-quality, person-centre care.
  • Feedback received from staff and patients showed that improvements made had been noticeable and service provision had improved.

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

  • Review the safeguarding policies and procedures to make sure they reflect current guidance.
  • Complete the infection control audit process by producing an annual statement.
  • Continue work on improving the systems for medicine reviews.
  • Continue to work on increasing cervical screening uptake.
  • Review records related to emergency medicine to enable effective checks to be carried out.
  • Review processes for Patient Group Directives (PGD’s) to demonstrate that staff have been authorised to administer medicines under these directives.
  • Consider reviewing how records are maintained of emergency medicines checks.
  • Continue to promote the patient participation group.

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

During an inspection looking at part of the service

Previously we carried out an announced comprehensive inspection at the Alma Partnership on 5 February 2019 to follow up on breaches of regulations identified at a previous inspection in July 2019.

We served a warning notice to the provider following a breach of regulations 18; Staffing of the Health and Social Care Act 2008. We also issued a requirement notice in relation to regulation 17, Good governance. Following our inspection in February 2019, the practice was rated as requires improvement overall and placed into special measures.

We carried out an announced focused inspection at The Alma Partnership on 30 April 2019 and found that the requirements of the warning notice had been met. As this was to check compliance with the warning notice, the ratings from the previous inspection in February 2019 have not been changed. At that time, we served a requirement notice in relation to regulation 12; Safe care and treatment and regulation18; Staffing.

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.

At this inspection we found that arrangements relating to efficient numbers of suitably qualified staff to meet patients’ needs had been reviewed where needed to improve care, but there were still some actions remaining.

We found that:

  • The practice had employed a full-time practice manager who had implemented an action plan on 1st April 2019 to address the requirements of the warning notice, and all other areas that require improvement.
  • The practice had improved the amount of administration staff available and work had been distributed across a larger number of staff to ensure all tasks were completed in a timely manner.
  • Administration staff reported they felt supported by managers, however, not all clinicians felt supported.
  • Administration tasks had been completed in a timely manner. However, other activitiestasks had not been completed including significant event activity and recalls for some childhood immunisations.
  • Patient feedback indicated that there was limited continuity of care due to the staffing of GP sessions with the use of locums.
  • Since our last inspection a salaried GP post and a full-time practice nurse post had become vacant. The practice had employed an advanced nurse practitioner one day per week and an additional locum GP one day per week.

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
  • Ensure sufficient numbers of suitably qualified, competent, skilled and experienced persons are deployed to meet the fundamental standards of care and treatment

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

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

Professor Steve Field CBE FRCP FFPH FRCGPChief Inspector of General Practice

During a routine inspection

We carried out an announced comprehensive inspection at the Alma Partnership on 5 February 2019.

We carried out a comprehensive inspection at The Alma Partnership on 25 July 2018. At that time we served a warning notice in relation to regulation 17 Good governance, with a compliance date of 5 October 2018. The practice was rated as requires improvement overall.

We carried out an announced focused inspection at The Alma Partnership on 9 October 2018 and found that the requirements of the warning notice had been met. As this was to check compliance with the warning notice, the ratings from the previous inspection in July 2018 have not been changed. At that time, we served a requirement notice in relation to regulation 17 Good governance.

At this inspection, we followed up on breaches of regulations identified at the previous inspection on 9 October 2018.

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 rated the practice as requires improvement for providing safe services because:

  • The practice had not documented staff immunisation status.
  • Fire alarm, emergency lights and firefighting equipment were not properly tested and maintained.
  • Infection prevention and control audits had not identified all potential risks.
  • There was a shortfall in the timely management of test results.

We rated the practice as Requires Improvement for providing responsive services because:

  • Continuity of care was not reflected in the services provided.
  • People were not able to access care and treatment in a timely way.

These areas affected all population groups so we rated all population groups as requires improvement.

We rated the practice as inadequate for providing well-led services because:

  • While the practice had made improvements since our inspection on 10 October 2018, to address the Requirement Notice in relation to good governance, at this inspection we identified additional concerns that put patients at risk.
  • Leaders could not show that they had the capacity to deliver high quality, sustainable care.
  • The practice culture did not effectively support high quality sustainable care.
  • The overall governance arrangements were ineffective.
  • The practice did not have clear and effective processes for managing risks, issues and performance.

We rated the practice as good for providing effective and caring services because:

  • The practice had a comprehensive programme of quality improvement activity and routinely reviewed the effectiveness and appropriateness of the care provided.
  • Staff dealt with patients with kindness and respect and involved them in decisions about their care.

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
  • Ensure sufficient numbers of suitably qualified, competent, skilled and experienced persons are deployed to meet the fundamental standards of care and treatment

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

The areas where the provider should make improvements are:

  • Record staff immunisation status.
  • Review systems to inform relevant practice staff, including the practice manager of all action taken, following significant events.
  • Review systems to promote uptake of cervical screening to improve positive outcomes for patients.
  • Review systems to identify patients who are also carers.

I am placing this service in special measures. Services placed in special measures will be inspected again within six months. If insufficient improvements have been made such that there remains a rating of inadequate for any population group, key question or overall, we will take action in line with our enforcement procedures to begin the process of preventing the provider from operating the service. This will lead to cancelling their registration or to varying the terms of their registration within six months if they do not improve.

The service will be kept under review and if needed could be escalated to urgent enforcement action. Where necessary, another inspection will be conducted within a further six months, and if there is not enough improvement we will move to close the service by adopting our proposal to remove this location or cancel the provider’s registration.

Special measures will give people who use the service the reassurance that the care they get should improve.

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

Professor Steve Field CBE FRCP FFPH FRCGPChief Inspector of General Practice

9 October 2018

During an inspection looking at part of the service

This practice is rated as requires improvement overall. (Previous rating July 2018- requires improvement)

The key questions were rated in July 2018 as:

Are services safe? – requires improvement

Are services effective? – requires improvement

Are services caring? – requires improvement

Are services responsive? – requires improvement

Are services well-led? - inadequate

We carried out a comprehensive inspection at The Alma Partnership on 25 July 2018 and served a warning notice in relation to regulation 17 Good governance, with a compliance date of 5 October 2018. We found shortfalls in systems or processes in place:

  • To assess, monitor and improve the quality and safety of the services being provided.
  • To assess, monitor and mitigate the risks relating to the health, safety and welfare of service users and others who may be at risk.
  • To seek and act on feedback from relevant persons and other persons on the services provided in the carrying on of the regulated activity, for the purposes of continually evaluating and improving such services.

We carried out an announced focused inspection at The Alma Partnership on 9 October 2018 to check whether the requirements of the warning notice had been met. As this was to check compliance with the warning notice, the ratings from the previous inspection in July 2018 have not been changed.

At this inspection we found:

Systems and processes had been reviewed and re-implemented where needed to improve care, but there were still some actions remaining.

  • Actions from the fire risk assessment undertaken in August 2016 had been actioned.
  • The fixed electrical wiring check had been carried out and the practice were waiting for minor remedial actions to be completed, in order that a certificate could be issued.
  • The gas boiler had been serviced.
  • There was some oversight of monitoring systems.
  • The practice informed us that they were using two regular locums and one salaried GP to provide improved consistency of care.
  • A range of meetings had been implemented for staff to discuss performance and roles and responsibilities. One meeting had taken place prior to the inspection for different staff groups.
  • A Quality and Outcomes Framework monitoring plan had been implemented, along with actions to promote patient engagement in health reviews. However, limited actions had been taken since the inspection in July 2018.
  • The practice was liaising with health visitors to promote uptake of childhood immunisations.
  • Limited progress had been made on acting on patient feedback.
  • Systems and processes for handling complaints and significant events showed that the process was being followed. There were still some shortfalls in identifying themes and trends and using this information to drive improvement.

The areas where the provider must make improvements as they are in breach of regulations are:

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

Where a service is rated as inadequate for one of the five key questions or one of the six population groups, it will be re-inspected no longer than six months after the report is published. In the case of this practice this will be no later than March 2019. If, after re-inspection, the service has failed to make sufficient improvement, and is still rated as inadequate for any key question or population group or overall, we will place the service into special measures. Being placed into special measures represents a decision by CQC that a service has to improve within six months to avoid CQC taking steps to cancel the provider’s registration.

Professor Steve Field CBE FRCP FFPH FRCGPChief Inspector of General Practice

25 July 2018

During a routine inspection

This practice is rated as requires improvement overall. (Previous rating September 2016 -Good)

The key questions are rated as:

Are services safe? – requires improvement

Are services effective? – requires improvement

Are services caring? – requires improvement

Are services responsive? – requires improvement

Are services well-led? - inadequate

We carried out an announced comprehensive at The Alma partnership on 25 July 2018, as part of our inspection programme.

At this inspection we found:

  • The practice had systems to manage risk so that safety incidents were less likely to happen.
  • Risk assessments were completed, but there were unreasonable delays in taking appropriate action to minimise risk. There was a lack of clarity on what constituted a significant event.
  • The practice did not routinely review the effectiveness and appropriateness of the care it provided.
  • Recruitment processes did not ensure that staff were of good character prior to commencing employment.
  • Staff did not always treat patients with compassion, kindness, dignity and respect.
  • Patients did not always find the appointment system easy to use and reported that they were not always able to access care when they needed it.
  • There was limited involvement from the GP partners in the running of the practice.
  • Systems and processes in place to support good governance were not fully embedded, to demonstrate business resilience and ongoing improvement. Quality and sustainability were not routinely discussed with all relevant staff.
  • Staff were not fully involved in the running of the practice.
  • The information used to monitor performance and the delivery of quality care was not consistently accurate and useful. There were limited plans to address any identified weaknesses; action taken to address issues was reactive rather than proactive.

The areas where the provider must make improvements as they are in breach of regulations are:

  • Ensure persons employed in the provision of the regulated activity receive the appropriate support, training, professional development, supervision and appraisal necessary to enable them to carry out the duties.
  • Ensure recruitment procedures are established and operated effectively to ensure only fit and proper persons are employed.
  • Establish effective systems and processes to ensure good governance in accordance with the fundamental standards of care.

The areas where the provider should make improvements are:

  • Take action to improve communication of learning from significant events and safeguarding concerns to all relevant staff members.
  • Take action to develop a clear protocol on what the practice deems a significant event and communicate this to all relevant staff members.

Where a service is rated as inadequate for one of the five key questions or one of the six population groups, it will be re-inspected no longer than six months after the report is published. If, after re-inspection, the service has failed to make sufficient improvement, and is still rated as inadequate for any key question or population group or overall, we will place the service into special measures. Being placed into special measures represents a decision by CQC that a service has to improve within six months to avoid CQC taking steps to cancel the provider’s registration.

Professor Steve Field CBE FRCP FFPH FRCGP

Chief Inspector of General Practice

07/09/2016

During an inspection looking at part of the service

Letter from the Chief Inspector of General Practice


We carried out an inspection of The Alma Partnership on the 7 September 2016. This review was performed to check on the progress of actions taken following an inspection we made on 22 September 2015. Following that inspection the provider sent us an action plan which detailed the steps they would take to meet their breaches of regulation. During our latest inspection on 7 September 2016 we found the provider had made the necessary improvements.

This report covers our findings in relation to the requirements and should be read in conjunction with the report published on 28 January 2016. This can be done by selecting the 'all reports' link for The Alma Partnership on our website at www.cqc.org.uk

Our key findings at this inspection were as follows:

  • The practice ensured the health and safety of patients by improving the arrangements for managing infection control.

  • Patient safety had been improved by ensuring all equipment was tested and calibrated.

  • Improvements to fire safety information and checks had ensured patient safety.

    Patient safety had been improved by ensuring emergency medicines were available to all staff when undertaking a home visit.

  • Patient confidentiality had improved by ensuring all computer SMART cards were stored securely at all times.

Professor Steve Field (CBE FRCP FFPH FRCGP) 

Chief Inspector of General Practice

22 September 2015

During a routine inspection

Letter from the Chief Inspector of General Practice

We carried out an announced comprehensive inspection at The Alma Partnership on 22 September 2015. Overall the practice is rated as Good.

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

  • Staff understood and fulfilled their responsibilities to raise concerns, and to report incidents and near misses.
  • Risks to patients were assessed and well managed, with the exception of those relating to recruitment checks.
  • Data showed patient outcomes were average for the locality and the practice generated reports to improve outcomes for people. For example, the practice generated a report of patients who had not requested a repeat prescription in over 40 days so that they could be contacted.
  • Patients said they were treated with compassion, dignity and respect.
  • Information about services was available and the practice had a carer’s lead that was very proactive in supporting patients who were carers.
  • Whilst routine appointments were not easily available due to a shortage of GPs urgent appointments were available on the day they were requested.
  • The practice had a number of policies and procedures to govern activity and all had been reviewed within the past six months.
  • The practice had proactively sought feedback from patients and had an active patient participation group.
  • Data from the Quality and Outcomes Framework (QOF) identified that the practice had achieved 96% of the total points available compared to the National average of 94.2%

The areas where the provider must make improvements are:

  • Ensure that infection control procedures and systems are in place and include action plans following audit.
  • Ensure that all equipment is tested and calibrated.
  • Review fire safety information to ensure that it is consistent and appropriate and ensure that emergency lighting is tested and ensure that cupboards are locked where they may present a risk to patients and staff.
  • Ensure that emergency medicines are available to all staff conducting home visits.
  • Ensure that computer SMART cards are securely stored at all times.

In addition the provider should:

  • Improve the availability of non-urgent appointments.
  • Improve the procedures to ensure that all test results are recorded as reviewed in a timely manner.
  • Ensure that DBS risk assessments includes all staff roles.
  • Improve access for patients in wheelchairs by ensuring that hand hygiene facilities and toilet chains are accessible and in reach.

Professor Steve Field (CBE FRCP FFPH FRCGP) 

Chief Inspector of General Practice