Background to this inspection
Updated
14 November 2019
Our inspection team
Our inspection team was led by a CQC inspector. The team included a CQC specialist adviser.
Background to Brent GP Extended Access Service
The provider, Brent Care Limited, is a healthcare federation created by an amalgamation of 56 GP practices in Brent, West London. The service operates under a contract with Brent clinical commissioning group (CCG) and provides primary healthcare services which are open to all patients living in Brent. Brent Care Limited subcontracts the operation of the service to the three primary care networks currently covering Brent. The service operates the Wembley hub and has formal service level agreements with four ‘host’ GP practices from which the service is provided. Brent Care Limited maintains overall responsibility for the service.
The service provides appointments with a GP or practice nurse. All appointments are pre-booked either through a patient’s own GP practice, the NHS 111 service or the local urgent care centre and are available seven days a week. The service does not accommodate walk-in patients. The service is available to adults and children.
The service headquarters is located at Wembley Centre for Health and Care. The service itself is currently operated from five locations, known locally as hubs. These are:
Wembley Hub, Wembley Centre for Health and Care, 116 Chaplin Road, Wembley HA0 4UZ
Monday to Sunday 8am-8pm
Willesden Hub, Roundwood Park Medical Centre, Robson Avenue, London NW10 3RY
Monday to Friday 4pm-8pm, Saturday 12pm-4pm
Northern Hub, Jai Medical Centre (Brent), 82 Stag Lane, Edgware, Middlesex, HA8 5LP
Monday to Friday 4pm-8pm
Kilburn Hub, Staverton Surgery, 51 Staverton Road, London, NW2 5HA
Monday to Friday 4pm-8pm, Saturday 10am-2pm
Central Middlesex Hub, Park Royal Medical Practice, Acton Lane, London, NW10 7NS
Monday to Friday 4pm-8pm, Saturday 10am-2pm
The service directly employs a team of five clinical directors and is overseen by a non-executive board. The service also employs receptionists and managers at the Wembley hub. The receptionists at the other hubs are provided through a service level agreement with the host practices. A team of managers and administrative staff employed at primary care network level are in place to support the respective hubs. The service contracted with a pool of 35 local GPs and five nurses who provide sessions at the hubs.
The provider is registered to provide the following regulated activities: diagnostic and screening procedures; family planning; maternity and midwifery services; surgical procedures; and treatment of disease, disorder or injury.
How we inspected this service
Before the inspection we reviewed information from stakeholders, information provided by the service and information provided to us by patients.
During our inspection, we visited all five of the sites. We spoke with a range of staff, observed how patients were being cared for in the reception areas, reviewed comment cards where patients and members of the public shared their views and experiences of the service and looked at information the service used to deliver care and treatment plans.
To get to the heart of patients’ experiences of care and treatment, we always ask the following five questions:
- Is it safe?
- Is it effective?
- Is it caring?
- Is it responsive to people’s needs?
- Is it well-led?
These questions therefore formed the framework for the areas we looked at during the inspection.
Updated
14 November 2019
This service is rated as Good overall.
The key questions are rated as:
Are services safe? – Good
Are services effective? – Good
Are services caring? – Good
Are services responsive? – Good
Are services well-led? – Requires improvement
We carried out an announced, comprehensive inspection of the Brent GP Extended Access Service on 18, 19 and 22 July 2019. This was the first inspection of the provider’s extended hours service.
Our inspection included visits to the five locations (hubs) in Brent where the service operates. The service provides extended access appointments for patients of all practices within the Brent clinical commissioning group (CCG). The Wembley hub is open 8am to 8pm, seven days a week. The other sites are open during weekday evenings and on weekends. GP appointments are available at every site. Nurse appointments are also available at the Wembley hub.
One of the provider’s clinical directors 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 service is run.
As part of our inspection, 33 people provided feedback about the service at the Wembley hub. All of them were positive about the service. Patients frequently described the service as excellent and said they valued being able to access the service quickly when they needed it. Patients also commented on the efficiency of the appointment system and praised the GPs and nurses for their professionalism and caring manner.
Our key findings were:
- The service had systems to manage most risks so that safety incidents were less likely to happen.
- When incidents occurred, there were systems in place to learn from them and improve.
- Care and treatment were delivered according to evidence-based guidelines.
- Staff involved and treated people with compassion, kindness, dignity and respect.
- Patients were able to access care and treatment from the service within an appropriate timescale for their needs.
- Patient feedback about the service was consistently positive.
- Practice and patient needs were used to inform service development and improvements.
- The provider monitored its activity and there was also some focus on quality improvement.
- Managerial oversight arrangements were not always clearly documented however, and we found different practices in place at different hubs without a clear rationale.
- There was scope to improve the feedback mechanisms with the GPs and nurses on the rota pool.
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.
(Please see the specific details on action required at the end of this report).
The areas where the provider should make improvements are:
- The provider should review the information it provides to new and temporary clinicians to ensure they have the information they need to provide the service effectively and efficiently
- The provider should ensure that all sites are aware of available facilities to support patient access including translation services.
Dr Rosie Benneyworth BM BS BMedSci MRCGPChief Inspector of Primary Medical Services and Integrated Care