Letter from the Chief Inspector of General Practice

In December 2015, we found concerns related to the management of medicines during a comprehensive inspection of Wokingham Community Hospital- Westcall Out of Hours, Wokingham, Berkshire. The service was rated as good overall with a requires improvement in the safe domain. Following the inspection the provider sent us an action plan detailing how they would improve the areas of concern. The previous inspection in December 2015 had found one breach of the regulations relating to the safe delivery of services.

We carried out an focussed inspection at Wokingham Community Hospital in April 2016. This is the registered location of Westcall Out of Hours Service. This inspection was to follow up on concerns with the safety and management of prescriptions at the previous inspection December 2015. 

Following the improvements made since our last inspection in December 2015; the practice was now meeting the regulations that had previously been breached. The practice is rated as good overall.

Specifically the practice was:

• Operating safe systems in relation to management of medicines. This included clear and robust processes relating to the security of prescriptions had been implemented since our inspection in December 2015.

Professor Steve Field (CBE FRCP FFPH FRCGP) 

Chief Inspector of General Practice

We inspected the two in patient wards of the hospital. We spoke with ten people who used the service, senior management staff, ward staff and completed a formal observation (SOFI).The observation took place in one of the six bedded bays over a one hour and ten minute period.

We found that people were involved in their treatment and care planning. They told us that no decisions were taken without their involvement and they were consulted ''every step of the way''. People told us that they had witnessed people with dementia being treated with ''great respect and dignity''.

We found that people were appropriately cared for. People told us that they were ‘’very, very well looked after’’ and it ''was the best hospital experience'' they'd had.

We found that staff were appropriately trained and were knowledgeable about how to keep people safe. People told us that they felt ''very safe'' in the hospital and never had any concerns about the way they or others were treated.

We found that medicines were managed safely and people were given their medication appropriately.

We found that there were enough appropriately qualified staff on duty. People said that they felt there were ’’plenty’’ of staff to meet their needs. They told us that ‘’ there’s always a nurse there to help you when you need them’’.

We found that the provider had ways of continually checking the quality of the care they offered. People were involved in the quality checks.

This service is rated as Requires improvement overall. (Previous inspection December 2015 – Good with requires improvement for Safe. Follow up inspection in October 2016 - Good)

The key questions are rated as:

Are services safe? – Requires improvement

Are services effective? – Requires improvement

Are services caring? – Good

Are services responsive? – Good

Are services well-led? – Requires improvement

We carried out an announced comprehensive inspection at the registered location (Wokingham Community Hospital, locally known as Westcall) on 5, 12 & 20 July 2018. This inspection was planned to coincide with the provider Trust (Berkshire Healthcare NHS Foundation Trust) inspection as part of our inspection programme.

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 found not all incidents or events had been reported in line with service policy.
• Evidence of safeguarding training had not been collected for all GPs and some staff had not received safeguarding children training to the appropriate level for their role.
• Infection control audits were not available for all service sites and we found dusty surfaces at two of the premises used by Westcall.
• Care and treatment was delivered according to evidence- based guidelines.
• Clinical audits were limited and did not drive quality improvement.
• 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 governance processes were inconsistently applied and leaders did not have oversight of all the information required to safely deliver the service.
• There was a strong focus on continuous learning and improvement at all levels of the organisation.

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.
• 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.

The areas where the provider should make improvements are:

• Review and maintain oversight of emergency trolley checking procedures at all sites.

Professor Steve Field CBE FRCP FFPH FRCGP

Chief Inspector of General Practice