Letter from the Chief Inspector of General Practice

We carried out an announced focussed inspection of the Binfield Surgery, Terrace Road North, Binfield, Bracknell on 21 July 2015. This inspection was undertaken to check the practice was meeting regulations following our previous inspection in October 2014. The practice was given and overall rating of requires improvement following the previous inspection.

Specifically we rated the practice as inadequate for providing safe services, requires improvement for providing effective, responsive and well-led services and good for providing caring services.

There were concerns regarding the management and dispensing of medicines which could have impacted on patient safety. The practice did not follow all of the requirements related employing and recruitment staff. We found that not all training required by staff was delivered to ensure that they could provide safe and effective care. We issued requirement notices to the practice.

Following the inspection the practice sent us an action plan detailing how they planned to meet the fundamental standards included in this report. In addition to improvements we told the provider they must make, we also suggested improvements the provider should consider. These included introducing a comprehensive infection control audit, ensuring that contingency plans for medical emergencies were in place and clearly communicated to the team, reviewing their appointments process due to concerns with nurse appointment availability and to review the planning and delivery of care provided to patients with learning disabilities and those with other complex needs.

We undertook the focussed inspection at Binfield Surgery on 21 July 2015 to check improvements to the service had been made. Our findings were as follows:

• Criminal background checks with the Disclosure and Barring Service (DBS) had been undertaken on all relevant staff and other staff checks where necessary.
• Changes to the storage and dispensing of medicines had been made to improve safety.
• Emergency equipment was working and accessible and emergency medicines were available.
• Training had been delivered to staff which related to their roles. For example, in the Mental Capacity Act and infection control.
• Changes to nurse appointments had been implemented, aimed at improving access to nurses.
• A hygiene and infection control audit had been implemented.
• The practice had implemented appropriate monitoring of patients with learning disabilities.

We have amended the practice’s ratings to reflect these changes. The practice is now rated at good for the provision of safe, effective, caring, responsive and well-led services.

Professor Steve Field (CBE FRCP FFPH FRCGP) 

Chief Inspector of General Practice

Letter from the Chief Inspector of General Practice

We undertook a comprehensive inspection of Binfield Surgery on 1 October 2014. We were also following up on concerns we found regarding protecting patients from abuse and monitoring of the service from January 2014. We visited Binfield Surgery, Terrace Road North, Binfield, Bracknell as part of the inspection. The practice is rated as Good. Although many aspects of the practice were good, improvements in safety are required.

Our key findings were as follows:

Patient feedback from surveys, comment cards and verbal feedback was overall positive. The majority of patients said they were treated with compassion, dignity and respect and they were involved in care and treatment decisions. The practice enabled patients to book appointments quickly. Patients with limited mobility were able to access the practice. The practice involved patients in the core strategy and day to day running of the practice. There were concerns regarding the management and dispensing of medicines which could have impacted on patient safety. The practice did not follow all of the requirements related employing and recruitment staff. Not all training required by staff was delivered to ensure that they could provide safe and effective care.

The practice had improved clinical governance arrangements since our last inspection. National guidance and best practice was reflected in the monitoring and delivery of patient care. Improvements to safeguarding procedures meant that staff were aware of their responsibilities in protecting patients from abuse.

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

Importantly, the provider must:

• make changes to the processes for obtaining, storing and dispensing medicines.
• ensure that all information required relating to staff checks, such as references, Disclosure and Barring Service (DBS) as per the DBS risk assessment (including a system to update and renew Criminal Record Bureau checks) and identification documents, are in place and available in staff records
• must ensure hygiene and infection control training is provided to all relevant staff.
• provide Mental Capacity Act 2005 awareness to all relevant staff.

We have issued three compliance actions for the regulations relating to Recruitment, Supporting Workers and Medicines management.

In addition the provider should:

• introduce a comprehensive infection control audit.

• ensure that contingency plans for medical emergencies are in place and clearly communicated to the team.

• review their appointments process.

• consider the planning and delivery of care provided to patients with learning disabilities and those with other complex needs.

Professor Steve Field CBE FRCP FFPH FRCGP

Chief Inspector of General Practice

During this inspection we spoke with 10 patients, four staff members, the practice manager and staff from other services about the practice.

Patients told us the practice was caring and met their needs. One patient said "If I moved away from the area I would want to stay with this practice." They told us they were able to access appointments and were offered some flexibility when they needed to see a clinician. Staff ensured patient privacy and confidentiality was protected. Patients felt they were treated with respect and dignity.

We found the practice had systems to assess the quality of care it provided. This included gaining the views of patients and acting on them. The provider reviewed patients' care regularly to ensure their needs were being met. The practice was prepared for the event of a medical emergency.

Staff had some but not a full awareness in safeguarding children and vulnerable adults. There was a risk staff would not be able to identify and respond to potential abuse.

The practice was clean and hygienic. Staff were aware of appropriate guidance regarding hygiene and infection control. There were systems in place to reduce the risk of healthcare associated infection.

This practice is rated as Requires Improvement overall. (Previous comprehensive inspection October 2014 – Requires Improvement, previous focused inspection July 2015 – 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 Binfield Surgery on 10 April 2018 as part of our inspection programme.

At this inspection we found:

• The practice had systems in place to review and manage risk so that safety incidents were less likely to happen, with the exception of some dispensary processes and some areas of medicines management. When incidents were identified, the practice learned from them and improved their processes.
• The practice routinely reviewed the effectiveness and appropriateness of the care it provided, although they had not considered the needs of some of their population groups. The provider told us they provided care and treatment according to evidence-based guidelines, but we found this was not always the case.
• Staff involved and treated patients with compassion, kindness, dignity and respect.
• The majority of patients found appointments accessible and were able to arrange care when they needed it.
• The practice had a governance structure and processes in place and all staff were aware of their roles and responsibilities. However, some processes were inconsistently applied such as staff training.

The areas where the provider must make improvements are:

• Ensure the care and treatment of patients is appropriate, meets their needs and reflects their preferences.
• Establish effective systems and processes to ensure good governance in accordance with the fundamental standards of care.

The areas where the provider should make improvements are:

• Review the arrangements for storing emergency medicines to enable ease of access in an emergency.

Professor Steve Field CBE FRCP FFPH FRCGP

Chief Inspector of General Practice