Letter from the Chief Inspector of General Practice

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? – Requires Improvement

As part of our inspection process, we also look at the quality of care for specific population groups. The population groups are rated as:

Older People – Good

People with long-term conditions – Good

Families, children and young people – Good

Working age people (including those recently retired and students – Good

People whose circumstances may make them vulnerable – Good

People experiencing poor mental health (including people with dementia) - Good

We carried out an announced comprehensive inspection at Brune Medical Centre and the three branch sites (Forton Medical Centre, Waterside Medical Centre and Stoke Road Medical Centre) on the 12, 13 and 14 December 2017 as part of our inspection programme.

At this inspection we found:

• Southern Health NHS Foundation Trust had 4 locations registered as GP practices until April 2017 when Brune Medical Centre became the lead location and the other 3 practices became the branch sites. This was not updated on their CQC certificate until November 2017.

• In addition Southern Health NHS Foundation Trust formed a contractual arrangement with The Willow Group who have the same location Brune Medical Centre and same branch sites. The two providers hold accountabilities for the provision of the primary care services for the same patients. Southern Health NHS Foundation Trust were responsible for recruitment, HR and overarching information and clinical governance structures. The Willow Group maintained oversight of the daily running of services. It was apparent throughout the inspection that the process of bringing this arrangement together was still in progress. For example, although there was now one governance structure with staff working across sites, there were still observable minor differences in the way that each site ran.

• The structural reorganisation had been since April 2017 and the practice was still in the process of introducing and embedding new systems and processes. Staff were aware of the new governance structures and support in place.

• The practice had systems in place to manage risk so that safety incidents were less likely to happen. When incidents did occur the practice learned from them and improved their processes. However, there had been at least one incident that at the time of inspection was still under review. Southern Health NHS Foundation Trust and The Willow Group were working with the Clinical Commissioning Group and NHS England as part of the investigation into the events.

• At time of the inspection the location and the branches experienced staff shortages for both clinical and non-clinical staff. There was a backlog in scanning signed consent forms into the electronic system. The Trust and The Willow Group management teams were already aware of these risks and had taken action such as undertaking recruitment processes.

• The practice 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 patients with compassion, kindness, dignity and respect.

• Infection control audits were completed at all but one branch site.

• Patients were generally positive about the new system for appointments whereby they could access appointments at any one of the four GP sites. However all patients spoken to throughout the inspection were dissatisfied with the telephone system for booking appointments. The Trust and The Willow Group management teams were aware of this issue and had begun implementing a plan to resolve this issue and at the time of inspection had recently secured funding for the project.

The areas where the provider should make improvements are:

• Continue with the implementation of the governance arrangements for all sites to work in a cohesive way; including for sharing information.

• Continue to review and monitor staffing levels and skills.

• Review the need for a formalised quality improvement programme.

• Review systems and processes to ensure written consent forms are scanned into patient notes in a timely manner.

• Continue to review systems to improve identification of patients who are also carers.

• Consider ways to improve support for patients with hearing impairments when in the waiting room of Brune Medical Centre.

• Continue to review waste management processes in line with policy.

Professor Steve Field (CBE FRCP FFPH FRCGP) 

Chief Inspector of General Practice