All inspections: Brambles - Care Quality Commission

We carried out a review of the data available to us about Brambles on 6 July 2023. We have not found evidence that we need to carry out an inspection or reassess our rating at this stage.

This could change at any time if we receive new information. We will continue to monitor data about this service.

If you have concerns about Brambles, you can give feedback on this service.

This service is rated as Good overall. At the previous inspection on 9 December 2019, the service was rated Requires Improvement overall.

The key questions are rated as:

Are services safe? – Good

Are services effective? – Good

Are services well-led? – Good

We carried out a comprehensive inspection of Brambles on 9 December 2019. We identified breaches of regulation 12 (Safe care and treatment) of the Health and Social Care Act 2008 (Regulated Activities) Regulations 2014 and issued a requirement notice. The service was rated as requires improvement for providing safe and effective services and good for providing caring, responsive and well-led services. The service was rated as requires improvement overall.

We carried out this announced focused inspection of Brambles on 30 November 2021 under Section 60 of the Health and Social Care Act 2008. This inspection was planned to check whether the service was meeting the legal requirements and regulations associated with the Health and Social Care Act 2008. At this inspection we checked that the service was providing safe, effective and well-led services.

Throughout the COVID-19 pandemic the Care Quality Commission (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.

This included:

• Speaking with staff in person and using video conferencing.

• Requesting documentary evidence from the provider.

• A site visit.

We carried out an announced site visit to the service on 30 November 2021. Prior to our visit we requested documentary evidence electronically from the provider and we spoke to staff by telephone and using video conferencing.

Brambles is the name of the location which Accountable Care Enterprises Ltd (ACE) use to deliver extended hours access to eight GP practices in Brentwood. ACE is owned by the eight GP practices in Brentwood and each of the practices has a representative on the board, and a role within the governance structure of the organisation.

This service is registered with CQC under the Health and Social Care Act 2008 to provide the regulated activity, Treatment of Disease, Disorder or Injury.

At the time of our inspection, Brambles was in the process of registering a new 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.

Our key findings were:

Staff had received training in key areas. There was a clear record of training for staff.
There were processes in place for performance review and monitoring of clinical staff. Staff employed by the service had undergone appraisals.
There were effective systems and processes to assess monitor and control the spread of infection.
There were safeguarding systems and processes to keep people safe. Staff had received training in the safeguarding of adults and children.
There were appropriate arrangements to manage medical emergencies and suitable emergency medicines and equipment in place.
There was evidence of clinical audit and review of patient treatment outcomes.
Staff found leaders approachable and supportive and felt they provided an individual service to patients.
There was frequent and open communication amongst the staff team which was well documented.
Complaints were managed appropriately.

The following areas were identified at the previous inspection where the provider was advised that improvements should be made:

Implement a protocol for wound dressings.
Implement a system for periodically checking the registration status of staff.
Implement a system so that where other providers have completed risk assessments, routine maintenance or other actions, the service have copies of these.
Review how they identify to patients how to access the complaints system, when not at service location.

At this inspection, we found that all of these concerns had been adequately addressed.

The following areas were identified at the previous inspection where the provider was advised that improvements must be made:

Ensure care and treatment is provided in a safe way to patients, in particular:

There were no records of immunisation status for some staff, including administration staff.
There were gaps within proof of identity checks for new staff.
There was no system in place to appraise staff or review that they were working within their competencies.
There was no evidence of patient specific directions, being attached to the electronic record, for the sample of patient records viewed.

At this inspection, we found that all of these concerns had been adequately addressed.

Dr Rosie Benneyworth BM BS BMedSci MRCGP
Chief Inspector of Primary Medical Services and Integrated Care

We carried out an announced comprehensive at Brambles extended hours service as part of our inspection programme.

GP extended hours access service is provided by Accountable Care Enterprise Ltd (ACE) which is owned by the eight GP practices in Brentwood. Each of the practices has a representative on the board, with a role within the governance structure of the organisation.

At the time of our inspection the provider’s registered manager had just left and they were in the process of completing forms for the new 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.

We received feedback about the service from 16 people. People told us that staff were caring, helpful and professional. They felt they were listened to and treated with dignity and respect. People were positive about the service experienced from both GPs and nursing staff. They told us the service was efficient and ran to time.

Our key findings were:

There was a safeguarding system in place.
Records were kept relating to some identity checks, qualifications and training of staff, however this did not include the immunisation status of all staff and identify checks for some staff.
There were systems in place for the management of medicines and prescription stationery.
Emergency medicines and equipment were kept and monitored.
There were arrangements in place for risk assessment and maintenance of facilities and equipment. Where this had been completed by an external provider they did not always have a copy of the assessment and outcome. This was remedied following our inspection.
Although staff had access to clinicians and managers whilst working, they had received no appraisals, or had their work reviewed to check they were working within their competencies.
There was no evidence of written instructions for the administration of B12 treatments for named patients, for a sample of patients viewed.
Care and treatment was provided in line with best practice guidelines.
There were policies and procedures in place for staff. For one clinical activity, there was no protocol in place to promote consistency of care.
The practice had completed some audits. They used these and other information to review and improve the service provided.
Patient’s felt treated with dignity and respect. They were positive about the attitude of staff.
There was a system in place for complaints, but there was no signposting for patients on how to access this.
Staff told us they felt supported by managers and GPs.
There was a clear leadership and governance structure.

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

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

The areas where the provider should make improvements are:

Implement a protocol for wound dressings.
Implement a system for periodically checking the registration status of staff.
Implement a system so that where other providers have completed risk assessments, routine maintenance or other actions, the service have copies of these.
Review how they identify to patients how to access the complaints system, when not at service location.

Dr Rosie Benneyworth BM BS BMedSci MRCGP
Chief Inspector of Primary Medical Services and Integrated Care

Brambles Also known as Brambles Surgery

All Inspections

6 July 2023

During a monthly review of our data

30 November 2021

During an inspection looking at part of the service

9 December 2019

During a routine inspection