This service is rated as Good overall. (Previous inspection April 2016 – Good)

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? – Good

We carried out an announced comprehensive inspection at Bracknell Urgent Care Centre on 31 October 2018. This inspection was planned and undertaken as part of our inspection programme and as part of a wider inspection of the provider (One Medicare Ltd). The provider had agreed to contribute to our Primary Care at Scale project.

At this inspection we found:

• The service had good systems to manage risk so that safety incidents were less likely to happen. When they did happen, the service learned from them and improved their processes. However, we noted some inconsistent reporting of significant events.
• The service 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 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.
• Some complaints had been managed inconsistently and not in line with the provider’s policy and guidance. Verbal complaints had not been documented which made it difficult for them to be included in any future reviews of themes and trends.
• There was a strong focus on continuous learning and improvement at all levels of the organisation.

The areas where the provider should make improvements are:

• Review and improve significant event reporting processes to enable all incidents to be managed consistently.
• Review and improve complaints processes locally to offer appropriate acknowledgement in line with the provider’s guidance. Consider how the service can monitor and record verbal complaints to offer oversight of all feedback offered to the service.

Professor Steve Field CBE FRCP FFPH FRCGP

Letter from the Chief Inspector of General Practice

Bracknell Urgent Care Centre had been inspected twice before in August 2015 and October 2015. On both previous inspections we found that the service provided by the centre was not meeting regulations associated with the Health and Social Care Act 2008.

The inspection on 7 October 2015 was a comprehensive inspection and we followed up on the concerns we identified in August 2015. As a result of the findings of the inspection in October 2015 we were able to remove the urgent conditions imposed following the August 2015 inspection as improvements had been made. However, we still found concerns specifically related to the effectiveness, safety and governance of the service. This led to an overall rating of requires improvement.

We carried out an announced comprehensive inspection at Bracknell Urgent Care Centre on 12 April 2016, to consider whether sufficient improvements had been made.

The provider had addressed the concerns we had at the previous inspection (October 2015). Overall the provider is rated as good following this inspection.

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

• The service had a clear vision that had improvement of service quality and safety as its top priority. The service and staff fully embraced the need to change, high standards were promoted and there was good evidence of team working.

• The service had an effective governance system in place, was well organised and actively sought to learn from previous Care Quality Commission inspections, performance data, complaints, incidents and feedback.

• There was an open and transparent approach to safety and an effective system in place for reporting and recording significant events.

• The service was monitored by Bracknell and Ascot Clinical Commissioning Group (CCG) and there were specific indicators the service worked to achieve. Since October 2015 the service had met all the key performance indicators in terms of performance. For example, in March 2016, 92% of children had a clinical contact within 15 minutes of booking at reception; this was 12% above the target.

• Procedures were in place for monitoring and managing risks to patient and staff safety.

• Feedback from patients about access to the service and treatment received was consistent and highly positive.

• The service understood the needs of the changing local population, increased demand on local health services and planned services to meet those needs.

• The centre had good facilities and was well equipped to treat patients and meet their needs.

However, there were areas where the service needs to make improvements. Importantly the provider should:

• Ensure all GPs have achieved, or are working towards, the appropriate level of training in safeguarding of children.

• Continue to engage with the patient participation group, proceed with planned meetings with the aim to seek feedback and views about the service from their patients.

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 on 7 October 2015. Overall the service is rated as requires improvement.

We undertook a focussed inspection on 17 and 24 August 2015 in response to concerns we had about the service. We imposed urgent conditions on the service as a result of the findings and issued a warning notice and a requirement notice. The inspection in October was a comprehensive inspection and we followed up on the concerns we identified in August. As a result of the findings of the inspection in October we were able to remove the urgent conditions as improvements had been made. However, we still found concerns specifically related to the effectiveness, safety and governance of the service. This has led to an overall rating of requires improvement.

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

• Incidents and accidents were being reported, investigated and reviewed. The outcomes were displayed for staff but no formal means of feedback was in place to ensure learning from such events.
• Some information about safety was recorded, monitored, appropriately reviewed and addressed.
• There was not always appropriate clinical cover for patients onsite after 8pm and those transferred to other services after 8pm
• Governance arrangements did not involve most staff at the centre who provided services in the way of meetings or other communication.
• The service was monitored by the local clinical commissioning group (CCG) and there were specific indicators the service worked to achieve. Since February 2015 the service had only met the waiting time target for adults in one month and had missed the 80% target for children in six consecutive months. The data we reviewed showed the targets for clinical assessment of patients over the six month period had been consistently missed. These had improved in September 2015 compared with previous months, but not all were met.
• No clinical audit was undertaken to identify improvements and learning related to clinical care
• There had been a significant improvement to staffing levels since August, meaning greater patient safety, capacity to see patients and support for nursing staff.
• There were procedures for following up on patient referrals such as x-ray results.
• Communication with GP practices was taking place appropriately. Records of assessment and treatment were passed onto a patients’ GP quickly.
• The service had a number of policies and procedures to govern activity, but locum staff did not have access to many of these and some were generic and not related directly to the centre.
• Staff were caring and considerate to patients’ needs.
• Most of the feedback from patients we spoke with was positive.
• The service had sought feedback from patients. However, it was not liaising effectively with local Healthwatch.

The areas where the provider must make improvements are:

• Ensure all staff are aware of the outcomes and learning from significant events, incidents and complaints
• Ensure locum GPs and agency nurses have access to the provider’s computer system where supporting information required to undertake their role is stored
• Review the monitoring of patients in the waiting area to ensure their safety and wellbeing
• Review the support and guidance available to staff, particularly locums, in regards to patient pathways.
• Review the need for a comprehensive programme of clinical audit as part of quality improvement.
• Provide staff with greater feedback and support through improved supervision and communication including meetings.
• Update the whistleblowing policy to ensure it contains information on the rights of whistleblowers and how they should escalate concerns externally

In addition the provider should:

• Review policies to ensure they reflect services provided and are relevant for staff
• Review the cover after 8pm to ensure there is a clear pathway for patients attending after 8pm to access the out of hours service.
• Make sure staff know there is a phone translation service available.
• Improve engagement with local Healthwatch to ensure that the views of the local community are considered and responded to in regard the provision 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 two unannounced focused inspections of Bracknell Urgent Care Centre on 17 and 24 August 2015. The inspections were carried out because we had received information of concern from whistleblowers and the local clinical commissioning group (CCG) in relation to patients being placed at risk. These concerns referred to insufficient staff or lack of experienced staff to deal with patient demand and meet safe waiting times. In addition there were concerns that prescribing of medicines was being delayed due to a lack of staff qualified to prescribe. We were also informed that staff turnover was high and the service was heavily reliant on locum staff. Both inspections were in response to information of concern.

We found the service was not meeting fundamental standards and had breached regulations.

Our key findings were as follows:

• Patients were placed at risk of harm because there were insufficient or inappropriately skilled staff on duty to carry out a robust assessment of patients’ needs. Patients were not being assessed and treated in a timely manner.
• Medicines were not always managed safely and in accordance with legal requirements.
• Local managers were not given authority to deploy staff in sufficient quantity or of appropriate experience to support safe and responsive delivery of patient care.
• Staff received inconsistent support and training to carry out their duties.
• Learning from reported incidents was not shared in a robust manner with staff to avoid recurrence.
• Staff were fearful of reporting incidents and concerns for fear of reprisal.
• Patients were positive about their interactions with staff and said they were treated with compassion and dignity.
• Patients were treated in a clean and tidy environment and their privacy was respected.
• The centre was open between 8am and 8pm every day offering a service to patients at times when their GP practice was closed.
• People working in Bracknell and surrounding areas were able to access a minor injury and illness service whilst away from their local GP.
• The service ran from a purpose built clinic that afforded easy access to patients with a disability.

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

Importantly, the provider must:

• Provide adequate support and training for all members of staff, which allows them to undertake their role and meet the demands of the service.

• Ensure that appropriate levels of staffing are maintained at all times to maintain the safe and effective delivery of services. A GP must be on duty at all times during service opening hours.

• Ensure systems and plans are in place to enable staff at the service to organise prompt cover in the absence of GP or a nurse.

• Ensure clinical advice from senior GPs can be obtained in a timely manner.

• Ensure medicines are managed and administered safely. Introduce patient group directions that follow legal requirements and instigate checks on all medicines to ensure they are in date and fit for use.

• Ensure a mechanism to encourage staff to report concerns and incidents is operated consistently and fairly is in place. Investigate and respond consistently to issues and concerns raised by staff.

• Improve the system of communicating learning from significant events to ensure all staff at the service are equipped to avoid recurrence of incidents that have placed patients at risk.

The areas where the provider should make improvement are:

• Implement a system to review x-ray reports from radiologists and take appropriate action on the findings of the report.

Professor Steve Field CBE FRCP FFPH FRCGP

Chief Inspector of General Practice