Letter from the Chief Inspector of General Practice

Our previous comprehensive inspection at Reading Walk-in Health Centre in April 2016 found breaches of regulations related to the effective and responsive domains. We issued a requirement notice for regulation 12 safe care and treatment and regulation 18 staffing. We rated the service as requires improvement in providing effective and responsive services and good for providing safe, caring and well-led services. Overall we rated the service requires improvement. Consequently we rated all population groups as requires improvement. The full comprehensive report from the April 2016 inspection can be found by selecting the ‘all reports’ link for Reading Walk-in Health Centre on our website at www.cqc.org.uk.

This inspection was an announced focused inspection carried out on 7 February 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 April 2016. This report covers our findings in relation to those requirements since our last inspection.

We found the practice had made improvements since our last inspection. Overall the service is rated as good. However, there were still concerns with the effective domain and the provider is still in breach of regulations. Therefore we have issued a warning notice instructing the provider to meet regulatory requirements. We have amended the rating for this practice to reflect these changes.

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

• Registered patient feedback from comment cards and the services own survey indicated they could make appointments with a GP when needed.
• We saw from audit data that the number of appointments available in relation to the patient list size had increased since April 2016.
• The care for patients with long term conditions was not always monitored properly to ensure it was delivered in line with current evidence based guidance.
• Medicine reviews were not being undertaken as frequently as required to ensure patients received effective medicines for their conditions.
• Work had been undertaken to improve child immunisation rates.
• Carers’ registration forms had been introduced to registration paperwork and carer information was available on new notice boards in waiting areas which had been installed to try and increase the numbers of carers identified.

The areas where the provider must make improvement are:

• Ensure systems and processes are in place to assess, monitor, manage and mitigate risks to the health and safety of service users. The provider was not routinely and consistently monitoring patients with long term conditions based on national guidance to ensure improved patient outcomes; did not have a process to ensure the cervical screening programme was implemented effectively so patients had timely access to screening procedures and they had not ensured medicine reviews were undertaken to make sure patients received their medicines safely and they remained effective in supporting the patients’ health condition.

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 Reading Walk-in Health Centre (the service is provided by Assura Reading LLP) on 20 April 2016. Overall The service is rated as requires improvement. We had previously inspected in January 2015 and found the service was breaching regulations, specifically good governance and was rated requires improvement overall. We rated the service requires improvement in providing effective and responsive services and good for providing safe, caring and well-led services. Overall we rated the service requires improvement. Since that inspection some improvements have been made, but the service must continue to make further adjustments to ensure it meets the needs of its patients.

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

• There was a system in place for reporting and recording significant events.
• Risks to patients were assessed and well managed.
• The management of medicines, including repeat prescriptions was appropriate.
• The necessary support and procedures were not available to nursing staff to assess patients with long term conditions ongoing needs. Managing long term conditions training was not provided to all nurses.
• Registered patients said they found it difficult to make an appointment with a named GP and there was not always continuity of care. There was action planned to improve the amount of appointments available.
• GP care was delivered in line with current evidence based guidance.
• Staff had most training to provide them with the skills, knowledge and experience to deliver effective care and treatment.
• The walk-in service provided patients with the care and treatment they needed in a timely way.
• 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. Improvements were made to the quality of care as a result of complaints and concerns, but there was no revisiting of old complaints to ensure improvements were embedded.
• The service 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 service proactively sought feedback from staff and patients..
• The provider was aware of and complied with the requirements of the duty of candour.

The areas where the provider must make improvement are:

• Support staff to follow national guidance in the management of patients with long term health conditions, specifically with templates and training, and provide appropriate care to these patients when required.
• Improve the access to appointments and provide adequate levels of trained staff to ensure registered patients receive effective, consistent and safe provision of care and treatment.

The areas where the provider should make improvement are:

• The service should improve uptake of childhood immunisation rates.
• Review the performance of diabetes against national standards and identify improvements to managing ongoing diabetes care.
• Review the processes used to identify and register carers in order to provide any necessary support to this group of patients.

Professor Steve Field (CBE FRCP FFPH FRCGP) 

Chief Inspector of General Practice

Letter from the Chief Inspector of General Practice

We inspected Reading Walk-in Health Centre on 28 January 2015. This was a comprehensive inspection. The service has a registered population as well as providing a walk in service seven days a week to the local population.

We have rated the practice as requires improvement because improvements in the effectiveness and responsiveness are required.

Our key findings were as follows:

The practice provided good care and treatment to their patients. National data showed the practice performed similarly to the national average in managing long term conditions. Patient feedback showed the opening hours were popular with patients and they liked the flexibility this provided. Patients were less positive about their overall ability to make appointments due to phone access and the availability of bookable appointments.

The practice population was expanding rapidly. The practice used tools to monitor and assess the allocation of staff and had made changes to meet the demands on appointments from registered patients. A robust strategic plan was not in place to meet the increasing demands or alleviate the pressure from the registered population. The walk-in access and availability of appointments was monitored regularly and alterations were made to try and improve access. For example, providing less phone consultations to free up more appointment slots. The practice was clean, well maintained and safe. The premises were accessible for patients with limited mobility.

There was a leadership team with clear responsibilities and the day to day management of the service was clearly delegated to enable staff to fulfil their roles. Medicines were checked and stored safely. Staff were aware of the diverse nature of their patients and went to great effort to meet the needs of minority and vulnerable groups. The practice had worked with some specific sections of the local population, such as the Nepalese community. However, not all sections of the local community were considered in the planning of the service. An open and inclusive culture encouraged staff to participate in the running of the practice. The practice has established a patient participation group and three meetings were held in 2014 however the attendance was not good despite posters advertising the meeting being displayed in the waiting areas of the service. The local population was very transient and this may have made creating a PPG difficult. The practice should consider different forms of PPG to help develop this.

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

Importantly, the provider must:

• Continue to assess and monitor the quality of the service, to ensure that patients can access services and there is capacity to meet the demands of the registered patient population and walk-in service, notably the appointment system.
• Address the care, treatment and communication needs of the non-English speaking population.
• Review the system for monitoring referrals before patients are sent to external services and supervise the referrals made by the nurse practitioners.
• Review the repeat prescribing protocol to ensure patients receive medicines they require safely.

In addition the practice should:

• Determine whether improvements can be made at the reception desk to ensure confidentiality is maintained

Professor Steve Field (CBE FRCP FFPH FRCGP) 

Chief Inspector of General Practice

In this report the name of one registered manager appears who was not in post and not managing the regulated activities at this location at the time of the inspection. Their name appears because they were still a registered manager on our register at the time of this inspection. We have advised the provider of what they need to do to remove the individual's name from our register.

During the period of writing our inspection report, the provider requested to change the location name from "Assura Reading LLP" to "Reading Walk-in Health Centre". Throughout this report we have used the latter location name. However, please note at the date of our inspection the former location name was the legal title and therefore page 1 of our report reflects this.

People were able to provide feedback to the service using a variety of methods. We found the provider used the feedback to make improvements to the quality of the service. For example, the provider addressed the length of time people had to wait for a consultation after this was highlighted as an issue by people who use the service.

People who use the service were protected against abuse because the provider had a robust system in place to prevent and identify it. Staff had received training in safeguarding vulnerable adults and children and one staff member had taken on the role of safeguarding lead at the location.

The provider had taken steps to make the premises as accessible as possible and had complied with the provisions of the Equality Act 2010. For example, this included extra wide doorways, corridors, reception desks and bathrooms that were suitable for people using a wheelchair.

Appropriate checks were undertaken before staff commenced work for the provider. Recruitment and selection processes utilised by the provider ensured that only skilled and experienced staff carried out and managed the regulated activities.

There was an effective complaints management system in place at Reading Walk-in Health Centre. Complaints were acknowledged, investigated and responded to within the provider's stipulated timeframes.

Patients we spoke with told us they came to the walk-in clinic to get immediate medical advice and treatment. They said their need for immediate support was met and they were treated by caring and professional staff. People particularly commented on the level of professionalism and understanding with which they were treated. One person said they were "surprised at how knowledgeable the doctor was about a range of things I wasn't expecting." Another person told us "the nurse was so kind and she didn't judge me."

We found that people using the service were provided with appropriate care to meet their needs. National clinical guidelines and recommendations were understood and implemented. Infection prevention and control measures were in place. There were systems in place for monitoring the quality and safety of services provided to people.

In this report the name of a registered manager appears who was not in post and not managing the regulated activities at this location at the time of the inspection. Their name appears because they were still a registered manager on our register at the time of this inspection. We have advised the provider of what they need to do to remove the individual's name from our register.

Letter from the Chief Inspector of General Practice

Our previous focussed follow up inspection at Reading Walk-in Health Centre on 7 February 2017 found breaches of regulations related to the effective domain. We issued a warning notice as this was a continued breach following our last comprehensive inspection in April 2016. We rated the service as requires improvement in providing effective services. Overall the service was rated as good following our last inspection, as improvements in other domains led to change in the overall rating. The full comprehensive report on the April 2016 inspection and the focussed inspection report from February 2017 can be found by selecting the ‘all reports’ link for Reading Walk-in Health Centre on our website at www.cqc.org.uk.

This inspection was a desk based review (we have not visited the centre as part of the inspection but requested specific information related to the previous breach of regulation) carried out on 11 May 2017 to confirm that the practice had completed their plan to meet the legal requirements in relation to the breaches in regulations that we identified in our previous inspection in February 2017. This report covers our findings in relation to those requirements since our last inspection.

We found the practice had made improvements since our last inspection. The service is rated as good for providing effective services.

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

• The care and monitoring of patients with long term conditions had improved since our last inspection and was now closer to local and national achievements in national data.
• The process for recording and monitoring medicine reviews had been improved and this was reflected in data we received regarding the number of reviews undertaken within appropriate timescales.
• Data from the Quality and Outcomes Framework (QOF) showed that by the end of March 2017 the centre had achieved a significantly improved QOF performance compared to 2016.
• There was an increased uptake in cervical screening for eligible patients and therefore greater opportunity for an interventions required to be implemented in a timely way.

Areas the provider should make improvements:

• Continue to improve the cervical screening rates among eligible patients.

Professor Steve Field (CBE FRCP FFPH FRCGP) 

Chief Inspector of General Practice