Archived: NICS at The Red Practice

Updated 8 June 2020

North West Surrey Integrated Care Services Ltd (NICS) is a formal alliance of 38 General Practices which deliver a range of services for the local population. Services include first contact physiotherapy assessments and a GP improved access service which includes face to face appointments with GPs on weekday evenings and Saturday mornings, Saturday morning cervical cytology, wound care and phlebotomy and an online e-consultation service with appointments seven days a week. Patients stay registered with their own GP practice but are able to access the improved access services online and through hubs in five locations. Appointments at the hub locations are booked through the patients’ registered GP surgery. This is not a walk-in service.

This service is registered with CQC under the Health and Social Care Act 2008 in respect of some, but not all, of the services it provides. There are some exemptions from regulation by CQC which relate to particular types of regulated activities and services and these are set out in and of The Health and Social Care Act 2008 (Regulated Activities) Regulations 2014. NICS provides first contact physiotherapy assessments which, as a standalone treatment service run by physiotherapists, are not within CQC scope of registration. Therefore, we did not inspect or report on this service.

The 38 practices which form the federation are:

Chertsey Health Centre – KT16 8HZ

Crouch Oak Family Practice - KT15 2BH

The Ottershaw Surgery - KT16 0JX

Rowan Tree Practice - KT13 8DW

Church Street Practice - KT13 8DW

Hersham Surgery - KT12 4HT

Fort House Surgery - KT12 1UX

Ashley Medical Practice - KT12 2QY

Yellow Practice - KT12 3LB

Red Practice - KT12 3LB

White Practice - KT12 3LB

Parishes Bridge - KT14 6DH

Wey Family Practice - KT14 6DH

Madeira Medical - KT14 6DH

Upper Halliford - TW17 8SY

Sunbury Health Centre - TW16 6RH

Studholme Medical Practice - TW15 2TU

Shepperton Medical Practice - TW17 8EJ

Fordbridge Medical Practice - TW15 2S

Knowle Green Medical - TW18 1XD

Orchard Surgery - TW15 1HE

Grove Medical Centre - TW20 9QN

Packers Surgery - GU25 4RL

St Davids Family Practice - TW19 7HE

Hythe Medical Centre - TW18 3HX

Staines Health Group - TW18 1XD

Stanwell Road Surgery - TW15 3EA

The Family Practice - GU21 8TD

Chobham & West End Medical Practice - GU24 8NA

Pirbright Surgery - GU24 0JE

College Road Surgery - GU22 8BT

Hillview Medical Centre - GU22 7QP

Maybury Surgery - GU22 8HF

Southview Medical Practice - GU22 7RR

Sunny Meed Surgery - GU22 7EY

Heathcot Medical Practice - GU22 7XL

Goldsworth Medical Practice - GU22 7XL

Sheerwater Health Centre - GU21 5QJ

During this inspection we visited all five of the locations where patients can attend appointments:

The Bedser Hub

Woking Community Hospital, Heathside Road, Woking, GU22 7HS

Monday to Friday evenings 6pm to 9pm

Saturday 8.30am to 12.30pm

Studholme Medical Centre

50 Church Road, Ashford, TW15 2TU

Monday and Wednesday evenings 6pm to 9pm

Saturday 9am to 12pm

Sunbury Health Centre

Green Street, Sunbury-on-Thames, TW16 6RH

Tuesday and Thursday evenings 6pm to 9pm

Saturday morning 9am to 12pm

Chertsey Health Centre

Stepgates, Chertsey, KT16 8HZ

Tuesday and Thursday evenings 6pm to 9pm

Saturday morning 9am to 12pm

Red Practice

Walton Health Centre, Rodney Road, Walton-on-Thames, KT12 3LB

Monday and Wednesday evenings 6pm to 9pm

Saturday morning 9am to 12pm

This service is registered with the Care Quality Commission (CQC) under the Health and Social Care Act 2008 and provides the following regulated activities:

• Diagnostic and screening
• Family planning services
• Treatment of disease, disorder or injury

The provider has a Board of Directors which includes a Chief Executive Officer, Medical Director, and six non-Executive Directors. The provider has centralised governance for its services which are co-ordinated by the Chief Executive Officer, Medical Director, Chief Operating Officer and three administrative staff.

The Chief Executive Officer is the registered manager. A registered manager is a person who is registered with the Care Quality Commission to manage the service. Like registered providers, they are ‘registered persons’.

Registered persons have legal responsibility for meeting the requirements in the Health and Social Care Act 2008 and associated Regulations about how the practice is run.

As part of our inspection we asked for CQC comment cards to be completed by clients prior to our inspection visit. In total, across the five locations we visited, we received 97 comment cards which were mainly positive about the service and nature of staff. Five comment cards contained negative comments and four comment cards contained both positive and negative comments. We received 26 comment cards for The Red Practice, 22 of which were positive and four contained positive and negative comments. Other forms of feedback, including patient surveys carried out by the provider, were positive.

Updated 8 June 2020

This service is rated as Requires Improvement overall.

The key questions are rated as:

Are services safe? – Requires Improvement

Are services effective? – Requires Improvement

Are services caring? – Good

Are services responsive? – Good

Are services well-led? – Inadequate

We carried out an announced comprehensive inspection at North West Surrey Integrated Care Services NICS Ltd as part of our inspection programme. This was the first inspection of this improved access service. Our inspection included visits to offices where some of the service administrative staff were based and the five locations where the service operated. This report relates to our findings of the service as a whole and the specific findings relating to The Red Practice location.

Our key findings were:

• Patients were supported and treated with dignity and respect. Services were offered weekday evenings and Saturday mornings from five hub locations across the area covered by the 38 practices of the federation, ensuring the service was accessible to all patients.
• Patients were able to access care and treatment from the service within an appropriate timescale for their needs.
• Care and treatment was delivered according to evidence-based guidelines.
• Patients found the appointment system easy to use and reported they were able to access care when they needed it.
• The federation had reviewed the needs of their local population and ensured that additional services were offered. For example, cervical cytology screening, wound care and phlebotomy services.

However, we also found that:

• The service had not ensured care and treatment was always provided in a safe way to patients.
• The service was unable to assure themselves that people received effective care and treatment.
• The leadership and governance of the service did not ensure the delivery of high-quality care.
• The service could not evidence that all the checks required to employ staff appropriately were in place.
• We found that policies and procedures were not always written and shared with staff to govern activity and ensure staff were adhering to the same processes.
• The service did not have systems and processes to give assurance that staff would raise, share and record all significant events. There was a lack of evidence to demonstrate that any identified learning was shared with the whole service team.
• The service did not always have sufficient oversight of the premises from where they delivered services. For example, the service had not reviewed premises management information sent from the host sites and had not followed up areas of non-compliance, so were unaware if the host sites had rectified problems found.

The areas where the provider must make improvements, as they are in breach of regulations, 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.
• Ensure staff who are suitably qualified, competent, skilled and experienced persons, are deployed to meet the fundamental standards of care and treatment.
• Ensure recruitment procedures are established and operated effectively to ensure only fit and proper persons are employed.

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

The areas where the provider should make improvements:

• Review and improve the documentation of verbal complaints.

Dr Rosie Benneyworth BM BS BMedSci MRCGP Chief

Inspector of Primary Medical Services and Integrated Care