Previously we carried out an announced comprehensive inspection at Brockhurst Medical Centre on 18 February 2019.

We served warning notices to the provider following a breach of regulation 12, Safe Care and Treatment, of the Health and Social Care Act 2008. We also issued a requirement notice in relation to regulation 17, Good Governance.

We carried out an announced focused follow-up inspection at Brockhurst Medical Centre on 13 May 2019 to confirm that the practice had met the legal requirements in relation to the warning notice served after our previous inspection in February 2019. This report covers our findings in relation to the warning notice only. This means the ratings from our inspection in February 2019 remain the same.

We based our judgement of the quality of care at this service on a combination of:

• what we found when we inspected
• information from our ongoing monitoring of data about services and
• information from the provider, patients, the public and other organisations.

At this inspection we found that the requirements of the warning notice had been met in relation to Regulation 12, Safe Care and Treatment. However, we identified a further breach of Regulation 12. We served a requirement notice in relation to this breach.

We found that:

• There were improvements in the Docman system including a written policy and procedure and instructions to staff.
• High Risk medicines were being appropriately monitored.
• The advanced nurse practitioner (ANP) was prescribing within her own competency.

However, we found that:

• There were a high number of documents requiring coding on the Docman system causing a significant delay in diagnoses being coded onto the system.
• In addition, there were errors identified which meant there was a delay for two patients receiving medicines prescribed in secondary care.

The areas where the provider must make improvements are:

• Establish effective systems and processes to ensure good governance in accordance with the fundamental standards of care.
• Ensure care and treatment is provided in a safe way.

The full report published on 26 April 2019 should be read in conjunction with this report. The practice remains rated a requires improvement until a full comprehensive inspection is carried out by the Care Quality Commission.

Details of our findings and the evidence supporting our ratings are set out in the evidence tables.

Rosie Benneyworth
Chief Inspector of General Practice BM BS BMedSci MRCGP

Letter from the Chief Inspector of General Practice

This was a comprehensive inspection of the Brockhurst Medical Centre which was carried out on 9 December 2014.

We rated this practice as good overall. The practice was well led by the senior GP partner and the practice manager who provided a caring, compassionate service.

Our key findings were as follows:

• The practice was visibly clean and there were systems in place to maintain an appropriate standard of cleanliness and hygiene.

• The practice was rated highly by patients for the respect they were shown and for the kindness and consideration shown by reception staff.

• The practice provided GP appointments at times that met the needs of their patients with same day appointments or telephone consultations. Some appointments were available until 7.30pm for patients who could not attend during working hours.

• The latest patient satisfaction survey showed that 90% of the patients that responded rated their overall experience of the practice as either good or excellent. The practice had recently been awarded GP practice of the year based on the positive comments that they received from patients registered at the practice

  .

• The practice GPs met with the school nurse and health visitor every six weeks to keep each other informed of any safeguarding issues or vulnerable patients.

However, there were areas of practice where the provider needs to make improvements.

The provider should:

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  ave a policy for the management, testing and investigation of Legionella.

• Have a system in place to record the Hepatitis B immune status of GPs and nurses.

Professor Steve Field CBE FRCP FFPH FRCGP 

Chief Inspector of General Practice

We carried out an announced comprehensive inspection at Brockhurst Medical Centre on 18 February 2019 as part of our inspection programme.

We based our judgement of the quality of care at this service on a combination of:

• what we found when we inspected
• information from our ongoing monitoring of data about services and
• information from the provider, patients, the public and other organisations.

We have rated this practice as Requires Improvement overall. However, we rated Safe as Inadequate. We rated Effective and Well Led as Requires Improvement and Caring and Responsive as Good.

We rated the practice as Inadequate for providing Safe services because:

• There was no system in place to ensure the timely review, by a GP, of test results and other patient information coming into the practice. On the day of the inspection there was a large backlog.
• The practice was unable to demonstrate that patients taking high risk medicines were receiving appropriate monitoring.
• There was no evidence that the advanced nurse practitioner’s (ANP) prescribing practice was within the Nursing and Midwifery Council (NMC) prescribing competencies. Although her prescribing practice for some medicines was safe, her competency to prescribe a wide range of medicines had not been assessed, reviewed or monitored to ensure it was safe for patients.

We rated the practice as Requires Improvement for Effective and Well Led services because:

• The practice were unable to provide evidence that the required training had been completed by staff.
• The practice nurse did not receive clinical supervision.
• Patients living with long term conditions did not have care plans in place.
• There was a challenging culture which, staff told us, impacted on how non clinical staff provided care and support to patients.
• Insufficient oversight of systems and a lack of documented protocols led to inadequate safe care.

We rated all population groups as Requires Improvement because:

• A lack of training and clinical supervision negatively impacted all population groups.
• However, the practice had been responsive in addressing the needs of each population group.

We rated the practice as Good for providing caring and responsive services because:

• Staff treated patients with kindness, respect and compassion.
• The practice respected patients’ privacy and dignity.
• The practice organised and delivered services to meet patient need.
• Patients could access care and treatment in a timely way.

The areas where the provider must make improvements are:

• Ensure care and treatment is provided in a safe way for patients including the proper and safe management of medicines.
• Ensure systems and processes are in place to support good governance

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

The areas where the provider should make improvements are:

• Take appropriate actions to reduce the backlog of patient note summarising.
• Review actions to improve staff morale.
• Continue to improve uptake of cervical screening.
• Continue to identify patients who are also carers to ensure their needs are met.
• Appoint and train fire marshals.
• The advanced nurse practitioner and the nurse practitioner should receive the appropriate level of safeguarding training to their role.

Details of our findings and the evidence supporting our ratings are set out in the evidence tables.

Dr Rosie Benneyworth BM BS BMedSci MRCGPChief Inspector of General Practice