At our inspection on 12 to14 December 2017 we rated the practice as good for providing Safe, Effective, Caring and Responsive services. However, we rated Well Led as Requires Improvement. We carried out an announced focussed follow up inspection on 5 February 2019 to inspect Well Led.

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 Good overall at our last inspection. We rated Well Led as Good for this inspection. This means the practice remains rated as Good overall.

We rated the practice as Good for providing Well Led services because:

• There was compassionate, inclusive and effective leadership at all levels
• The practice had a culture which drove high quality sustainable care.
• There were consistent evidence of systems and processes for learning, continuous improvement and innovation.

At our inspection in December 2017, we rated all population groups as Good.

We also rated the practice as Good for providing effective, caring, responsive and well-led services because:

• There were systems to assess manage and monitor the risks to patient safety.
• Staff had the skills, knowledge and experience to carry out their roles.
• Staff understood patients’ social, cultural and religious needs.
• The practice organised and delivered services to meet patient need.

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

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 at Brune Medical Centre on 19 May 2016 Overall the practice is rated as good.

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

• There was an open and transparent approach to safety and an effective system in place for reporting and recording significant events.
• Risks to patients were assessed and well managed.

• Staff assessed patients’ needs and delivered care in line with current evidence based guidance. Staff had been trained to provide them with the skills, knowledge and experience to deliver effective care and treatment.
• Patients said they were treated with compassion, dignity and respect and they were involved in their care and decisions about their treatment.
• Information about services and how to complain was available and easy to understand. Improvements were made to the quality of care as a result of complaints and concerns.
• Patients said they found it easy to make an appointment with a named GP and there was continuity of care, with urgent appointments available the same day.
• The practice had good facilities and was well equipped to treat patients and meet their needs.
• There was a clear leadership structure and staff felt supported by management. The practice proactively sought feedback from staff and patients, which it acted on.
• The provider was aware of and complied with the requirements of the duty of candour.

The areas where the provider must make improvement are:

• Ensure all medicines are stored securely, including vaccines kept in fridges.

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 at Brune Medical Centre on 19 May 2016. The overall rating for the practice was good; however, the safe key question was rated as requires improvement. The full comprehensive report on the May 2016 report can be found by selecting the ‘all reports’ link for Brune Medical Centre on our website at www.cqc.org.uk.

This inspection was an announced comprehensive follow up inspection carried out 12, 13 and 14 December 2017 to confirm that the practice had carried out their plan to meet the legal requirements in relation to the breaches in regulations that we identified in our previous inspection in May 2016. This report covers our findings in relation to those requirements and also additional improvements made since our last inspection. We visited the three branch sites attached to this location as part of this inspection (Forton Medical Centre, Waterside Medical Centre and Stoke Road Medical Centre) all the sites are collectively known as The Willow Group.

This practice is rated as Good overall.

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

Brune Medical Centre was rated as requires improvement for the well-led key question in relation to the changes required as part of the reorganisation and to reflect that whilst in place systems and process were not yet fully embedded. There were no breaches to regulations.

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

At this inspection we found:

• The Willow Group and Southern Health NHS Foundation Trust have a contractual arrangement between them and hold accountabilities for the provision of primary care services. The Willow Group maintained oversight of the daily running of services and Southern Health NHS Foundation Trust were responsible for recruitment, Human Resources and overarching information and clinical governance structures. 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 registered location of Brune Medical Centre expanded to include three branches and in September 2017 changed the provider name, through CQC, to The Willow Group. The structural reorganisation had begun in April 2017 and we found that at this inspection 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 the inspection that was still under review. The Willow Group and the Trust 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 Willow Group and the Trust management teams were already aware of these risks and had taken action including beginning the process of recruiting new staff.

• 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 Willow Group and the Trust management team 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 the location 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