Letter from the Chief Inspector of General Practice

We carried out an announced comprehensive inspection at Boundary House Surgery (Extended Hours Service) on 2 March 2017. The overall rating for the service was requires improvement. Specifically, we found the service to be good for providing safe, caring and responsive services and requires improvement for effective and well led services. The full comprehensive report on the March 2017 inspection can be found by selecting the ‘all reports’ link for Boundary House (Extended Hours Service) on our website at www.cqc.org.uk.

This inspection was an announced focused inspection carried out on 24 January 2018 to confirm that the service had carried out their plan to meet the legal requirements in relation to the breaches in regulations that we identified in our previous inspection on 2 March 2017. This report covers our findings in relation to those requirements and also additional improvements made since our last inspection.

Overall the service is now rated as Good.

Our key findings were as follows:

• The service had instigated a system for tracking blank prescriptions.
• We saw calibration records for medical devices including in the GPs bags.
• Staff appraisals had been carried out and an appraisal programme was in place.
• Clinical audits had been undertaken to improve quality of care and patient outcomes.
• Governance processes had been improved to review, assess and monitor quality improvements and safety of services.

Professor Steve Field (CBE FRCP FFPH FRCGP) 

Chief Inspector of General Practice

Letter from the Chief Inspector of General Practice

We carried out an announced comprehensive inspection at Boundary House Surgery (Extended Hours Service) on 2 March 2017. The service operates from a single base at the local host practice. We visited the base during this inspection. Overall the service is rated as requires improvement.

Specifically, we found the service to require improvements for the provision of effective and well led services. The service is rated good for providing safe, caring and responsive services.

Our key findings across all the areas we inspected were as follows:

• This service was the GP Federation for the 15 practices in Bracknell and Ascot Clinical Commissioning Group (CCG). It was commissioned by CCG in December 2015 to run the local extended hours GP service for all 15 local practices.
• There was an effective system for reporting and recording significant events. Staff understood and fulfilled their responsibilities to raise concerns, and to report incidents and near misses.
• The provider had systems in place to identify, assess and manage risk but the systems were operated inconsistently. Some risks associated with managing blank prescriptions and calibration of medical devices in the doctor’s bags had not been identified within monitoring and governance processes.
• There was a monitoring system in place which required improvement to assure that appropriate checks had been undertaken regularly to maintain fire safety, emergency medicines and emergency equipment at the premises.
• Staff assessed patients’ needs and delivered care in line with current evidence based guidance. The Key Performance Indicators (KPIs) and Quality Requirements were monitored and reviewed and improvements implemented.
• Most staff had been trained to provide them with the skills, knowledge and experience to deliver effective care and treatment. However, some staff had not undertaken update training relevant to their role and the provider did not effectively monitor and keep records of staff training. Not all staff had received an annual appraisal.
• There were safeguarding systems in place for both children and adults at risk of harm or abuse.
• The provider had carried out some clinical audits. However, not all clinical audits were of full or repeat cycles. There were limited processes to ensure clinical improvement. The provider informed us this was due to the service only being in existence for the last 15 months.
• There was a system in place that enabled staff to access patient records, for example the local GP, with information following contact with patients as was appropriate.
• The service proactively sought feedback from staff and patients, which it acted on.
• Patients said they were treated with compassion, dignity and respect and they were involved in their care and decisions about their treatment.
• Patients said they found it easy to make an appointment and data showed the service managed patients’ care and treatment in a timely way.
• The service offered 15 minutes long pre-bookable appointments with GPs, practice nurses and health care assistants during extended hours, which could be booked up to six weeks in advance.
• The service had good facilities and was well equipped to treat patients and meet their needs.
• Information about services and how to complain was available.
• There was a clear leadership structure. Communication channels were open and staff felt supported by management.
• The provider was aware of and complied with the requirements of the duty of candour.

The areas where the provider must make improvements are:

• The provider must review, assess and monitor the governance arrangements in place to ensure and improve the quality and safety of the services provided. For example:
• Ensure and improve the management and tracking of blank prescription forms to use in printers, to ensure this is in accordance with national guidance.
• Ensuring calibration and checking of medical devices in doctors bags are carried out in accordance with the manufacturer’s specification at all times.
• Ensure all staff have received annual appraisals and undertake all training and relevant updates including health and safety, infection control, mental capacity act and equality and diversity awareness. Ensure effective monitoring of staff training records.
• Continue to establish a system of clinical audit cycles and identify processes for clinical improvement.

Professor Steve Field (CBE FRCP FFPH FRCGP) 

Chief Inspector of General Practice