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Inspection carried out on 16 and 17 December 2019

During a routine inspection

We previously carried out an announced comprehensive inspection at Vine Medical Group on 14 and 15 November 2018 as part of our inspection programme. The practice was rated as requires improvement for safe, effective and caring, and for all population groups. This meant the practice was rated requires improvement overall. We issued two requirement notices for Regulation 18: Staffing and Regulation 19: Fit and proper persons employed.

This inspection on 16 and 17 December 2019 was an announced comprehensive inspection to follow up on the breaches of regulation and as part of our inspection schedule where services rated as requires improvement are subject to re-inspection within 12 months.

This inspection looked at the following key questions:

  • Are services safe?
  • Are services effective?
  • Are services caring?
  • Are services responsive?
  • Are services well-led?

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 overall. During our previous inspection we rated responsive and well led as Good. During this inspection we rated safe, effective, caring and responsive as Good. We rated all population groups as Good apart from older people which we rated as Outstanding and long term conditions which we rated at Requires Improvement. We rated well led as Outstanding.

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

  • Comprehensive and successful leadership strategies were in place to ensure delivery and to sustain and build upon the desired culture.
  • There was compassionate and inclusive leadership.
  • Throughout every key question we found the practice had not just addressed an identified issue but had implemented further improvements, putting patients at the heart of every they did, whilst appreciating and valuing their staff.
  • There was a strong quality improvement culture. Staff reported they worked in a supportive environment where they were encouraged to develop and take ownership of new ideas and projects.
  • The consistency of systems and processes across sites was evident through all aspects of the inspection and contributed to the ‘one team one goal’ culture. This had been achieved with a large number of staff working across multiple sites.
  • Rigorous and constructive challenge from the public, staff and other stakeholders was welcomed and seen as a vital way of holding services to account.

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

  • The practice had clear systems, practices and processes to keep people safe and safeguarded from abuse.
  • The practice had systems for the appropriate and safe use of medicines, including medicines optimisation
  • The practice learned and made improvements when things went wrong.
  • Patients’ needs were assessed, and care and treatment was delivered in line with current legislation, standards and evidence-based guidance supported by clear pathways and tools.
  • The practice had a comprehensive programme of quality improvement activity and routinely reviewed the effectiveness and appropriateness of the care provided.
  • The practice was able to demonstrate that staff had the skills, knowledge and experience to carry out their roles.
  • Staff worked together and with other organisations to deliver effective care and treatment.
  • The practice respected patients’ privacy and dignity.
  • The practice organised and delivered services to meet patients’ needs
  • People were able to access care and treatment in a timely way.

The areas where the provider should make improvements are:

  • Implement infection control audit measures across all sites and infection control risk assessments at the Westbrook site.
  • Continue to find ways of reducing exception reporting for long term conditions and cervical screening.
  • Improve the availability of information material for patients in languages other then English.

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 General Practice

Inspection carried out on 14 Nov to 15 Nov 2018

During a routine inspection

This practice is rated as Requires Improvement overall. (Previous rating May 2016 – Good)

The key questions at this inspection are rated as:

Are services safe? – Requires Improvement

Are services effective? – Requires Improvement

Are services caring? – Requires Improvement

Are services responsive? – Good

Are services well-led? - Good

We carried out an announced comprehensive inspection at Vine Medical Group on 14 and 15 November 2018 as part of our inspection programme.

At this inspection we found:

  • The practice had successfully undertaken and completed a second merger since their last inspection and were now a four-site practice.
  • The practice had clear systems to manage risk so that safety incidents were less likely to happen. When incidents did happen, the practice learned from them and improved their processes.
  • The practice routinely reviewed the effectiveness and appropriateness of the care it provided. It ensured that care and treatment was delivered according to evidence-based guidelines.
  • Staff involved and treated patients with compassion, kindness, dignity and respect; however, the practice’s National GP patient survey results did not reflect this.
  • Patients reported the appointment system was easy to use and reported that they were able to access care when they needed it.
  • There was a clear management and leadership structure in place.
  • The practice created and implemented numerous innovations in their practice to improve patient outcomes and to support staff.
  • There was a strong focus on continuous learning and improvement at all levels of the organisation.

The areas where the provider must make improvement 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 specified information is available regarding each person employed.

The areas where the provider should make improvements are:

  • Review how high-risk medicines are monitored in line with national guidance.
  • Review how risk assessments for emergency medicine stocks are recorded.
  • Continue to improve the uptake for cervical screening to achieve the national target of 80%.
  • Review policies to ensure they reflect practice procedures appropriately.
  • Continue to review patient feedback with regards to access to appointments, contacting the practice via the telephone and overall patient experience received at the practice.

Professor Steve Field CBE FRCP FFPH FRCGP
Chief Inspector of General Practice

Please refer to the detailed report and the evidence tables for further information.

Inspection carried out on 16 May 2016

During an inspection looking at part of the service

Letter from the Chief Inspector of General Practice

We carried out an announced focused inspection of Forest End Surgery, Forest End, Waterlooville, Hampshire, PO7 7AH on 16 May 2016. This inspection was undertaken to check the practice was meeting regulations.

At our previous inspection on 14 July 2015 we found breaches of regulations relating to the safe delivery of services. The practice was rated good for providing effective, caring, responsive and well-led services and requires improvement for safe.

At our inspection on 16 May 2016, we found the practice was meeting the regulations that had previously been breached.

The practice had reviewed and implemented changes to their medicines fridge temperature monitoring procedures and escalation processes in the event of temperatures recorded outside the recommended range of two degrees Celsius to eight degrees Celsuis.

We have amended 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.

Professor Steve Field

CBE FRCP FFPH FRCGPChief Inspector of General Practice

Inspection carried out on 14th July 2015

During a routine inspection

Letter from the Chief Inspector of General Practice

We carried out an announced comprehensive inspection at Forest End Surgery on 14th July 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. Information about safety was recorded, monitored, appropriately reviewed and addressed.
  • Risks to patients were assessed and well managed, with the exception of those relating to medicine fridges.
  • Patients’ needs were assessed and care was planned and delivered following best practice guidance. Staff had received training appropriate to their roles and any further training needs had been identified and planned.
  • Patients said they were treated with compassion, dignity and respect and they were involved in their care and decisions about their treatment.
  • Information about services and how to complain was available and easy to understand.
  • The practice had good facilities and was well equipped to treat patients and meet their needs.
  • There was a clear leadership structure and staff felt supported by management. The practice proactively sought feedback from staff and patients, which it acted on.

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

Importantly the provider must:

  • Ensure action is taken when the medicine fridge temperatures are outside of the appropriate range.

Professor Steve Field CBE FRCP FFPH FRCGP

Chief Inspector of General Practice