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Forest Health Group Requires improvement

Reports


Inspection carried out on 1 May 2019

During a routine inspection

We carried out an announced comprehensive inspection of Forest End Medical Centre on 1 May 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 have rated Safe, Effective and Well led as requires improvement and Caring and Responsive as good. We have rated all the population groups as requires improvement.

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

  • The practice did not have oversight of safety risk assessments at one of the sites (including fire, legionella and infection control). They had not completed their own risk assessment for legionella at one site and had not undertaken any precautionary checks for legionella at the main site.
  • Emergency medicines stock at all sites had not been risk assessed to identify any gaps in provision (or mitigate the need for them).
  • Staff had not been assessed for any medical conditions, that may affect their work, so reasonable adjustments could be made.
  • Non clinical staff had limited knowledge of significant events identification or escalation processes.

We rated the practice as requires improvement for providing effective services because:

  • Staff had not received regular appraisals to identify learning needs and review performance and there were gaps in staff training including safeguarding, infection control and fire safety.
  • There were no formal arrangements in place for continuing clinical supervision of non-medical prescribers.

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

  • Governance arrangements required a review as these were inconsistently applied. Risks and areas of concern were not always identified or effectively managed.
  • Staff told us the merger had been challenging and they did not feel involved in decisions about the practice.
  • Not all staff were clear about lead roles or who to approach for support and information.

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

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

  • 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. Most patients could access care and treatment in a timely way.

The areas where the provider must make improvements 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.
  • 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:

  • Review the recommendations of the “green book” in relation to staff immunisation status and consider if non-clinical staff should have their status assessed and documented.
  • Continue to review and monitor QOF achievement and exception reporting for diabetes indicators.
  • Consider the risks of the sit and wait service in relation to assessing urgent patient needs and staff training for recognising serious illness (including sepsis).
  • Review and monitor cervical screening uptake rates and continue to encourage eligible women to attend for screening.
  • Improve the identification of carers to enable this group of patients to access the care and support they need.
  • Review the arrangements for updating staff across all sites about changes in staffing and leadership.

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 16 July 2015

During an inspection to make sure that the improvements required had been made

Letter from the Chief Inspector of General Practice

Forest End Medical Centre is located in a purpose built medical centre in the Ringmead area of Bracknell in Berkshire. Patients from the practice can also visit the branch site called the Balfron Practice. There are approximately 12,000 patients registered at the practice. We carried out an announced comprehensive inspection on 23 October 2014 at Forest End Medical Centre. We found the practice did not undertake all the recruitment checks required to ensure staff were safe to work alone with patients. Not all training required was delivered to staff. Following the inspection we issued requirement notices and the practice sent us an action plan detailing how they would address the concerns we identified. We also found concerns which did not lead to regulatory action, but we reported that the practice should consider these. The concerns related to the checking of water for a bacteria called legionella, the checking of patients on long term medicines or with long term conditions, patient feedback regarding appointments and concerns regarding the checking of diabetic patients during health checks. The practice was rated as requiring improvement for providing safe, responsive and well-led services. It was rated as good for the provision of effective and caring services.

We undertook a focussed inspection at Forest End Medical Centre on 16 July 2015 to check improvements to the service had been made. Our findings were as follows:

  • Criminal background checks with the Disclosure and Barring Service (DBS) had been undertaken on all relevant staff.
  • A training programme was in place and staff had received training related to their roles.
  • A legionella risk assessment had been undertaken
  • Additional appointment capacity and changes to the appointment system had been implemented, aimed at improving access to the practice
  • Changes to the reviewing of patients on long term medicines and those with long term conditions had improved the outcomes for patients according to data used to monitor these outcomes.

We have amended the practice’s ratings to reflect these changes. The practice is now rated at good for the provision of safe, effective, caring, responsive and well-led services.

Professor Steve Field (CBE FRCP FFPH FRCGP) 

Chief Inspector of General Practice

Inspection carried out on 23 October 2014

During a routine inspection

Letter from the Chief Inspector of General Practice

Forest End Medical Centre is located in a purpose built medical centre in the Ringmead area of Bracknell in Berkshire. Patients from the practice can also visit the branch site called the Balfron Practice. There are approximately 12,000 patients registered at the practice. We carried out an announced comprehensive inspection on 23 October 2014 at Forest End Medical Centre. During this visit we did not inspect the Balfron Practice. This was the first inspection of the practice since registration with the CQC.

The practice merged with Balfron Practice in 2009 and the patient population has increased significantly since. Since the merger, the practice has made changes to the appointment system in response to patient feedback about the difficulty in making appointments. Despite these changes patients reported in the national and practice surveys and directly to us that they were still finding it very difficult to make appointments. The practice was accessible to patients with limited mobility.

We spoke with eight patients during the inspection. We met with the chair of the patient participation group, two GPs, a trainee GP, three nurses and administration staff.

Forest End Medical Centre practice was rated requires improvement overall.

Our key findings were as follows:

Patients experienced difficulties in booking appointments. Although the practice was aware of the patient concerns and had taken measures to alleviate the problems, not all reasonable steps had been considered to deal with the access problems. Patients were mostly positive about the care they received from GPs and nurses. Some patients were concerned about the continuity of care they received due to seeing different nurses or GPs at different appointments for ongoing treatment or care. Patients told us staff were usually very caring and supportive. The practice had systems to keep patients safe including safeguarding procedures and means of sharing information about patients who were vulnerable. Forest End Medical Centre was hygienic and infection control was monitored. However, we found concerns with the storage and disposal of clinical waste.

The practice was failing to meet regulations on Requirements Relating to Workers and Supporting Workers.

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

Importantly, the provider must:

  • provide all nurses with Disclosure and Barring Service (DBS) checks and administration staff undertaking chaperone duties
  • identify and deliver training and awareness to staff that they require to deliver care safely and to an appropriate standard, including the Mental Capacity Act (2005) and chaperone training.

In addition the provider should:

  • introduce a legionella risk assessment and related management schedule
  • review staff protocols for diabetic reviews to ensure they are undertaken appropriately

  • ensure that medicine reviews for patients on long term medications include patients who may be at risk of not taking medicines they require.
  • review, consider and take appropriate action in response to patient feedback regarding access to appointments. This should include a long term strategy to ensure patient demands are managed and met.

                                     

Professor Steve Field (CBE FRCP FFPH FRCGP) 

Chief Inspector of General Practice