We carried out an announced comprehensive inspection at The Waterfield Practice on 6 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. We found the practice requires improvement for safe and well led and good for effective, caring and responsive. All the population groups were rated as good.

During this inspection we found:

• Systems and processes around safeguarding were well managed.
• Some risks had not been identified, such as control of substances hazardous to health or assessing emergency medicine provision and storage.
• Identifying and learning from significant events was inconsistent and the practice had recently reviewed their systems and processes but these were not yet embedded.
• The practice monitored patient care effectively and had achieved positive outcomes for their patients.
• Uptake of health checks for patients with learning disabilities was low.
• The majority of patients were positive about the care they received.
• The practice website had been developed with patient access in mind. It was utilised well and had reduced appointment requests and telephone calls to the practice.
• Governance arrangements required review as these were inconsistently applied. Risks and areas of concern were not always identified or effectively managed.
• Staff felt supported by management and enjoyed working at the practice.

The areas where the provider must make improvements are:

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

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

The areas where the provider should make improvements are:

• Review the arrangements for recall of female patients for the cervical screening programme to improve uptake.
• Review the processes for engaging with patients with a learning disability to improve uptake of annual health checks.
• Continue to consider the need for and review the effectiveness of, an effective patient participation group.

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 undertook a comprehensive inspection of The Waterfield practice on 15 October 2014. We visited The Waterfield practice, Ralph's Ride, Harmanswater, Bracknell, RG12 9LH. We did not visit the branch site at 1 County Lane, Warfield, Bracknell, RG42 3JP during this inspection. The practice is rated as requires improvement. Although many aspects of the practice were good, improvements in the domains of safe and well-led were required.

Our key findings were as follows:

Patient feedback from surveys, comment cards and verbal feedback was very positive. The majority of patients said they were treated with compassion, dignity and respect and they were involved in care and treatment decisions. The appointment system was robust and offered both online and telephone booking for patients. Appointments could also be booked in person. Patients with limited mobility were able to access the practice. There were concerns regarding the identifying and delivery of training required by staff. Some staff did not receive all the training they needed to provide safe and effective care.

The practice followed clinical guidelines. There were care planning arrangements for the management of different health conditions. There were arrangements to ensure vulnerable patients received the care and treatment they needed. There was evidence that the practice was extremely compassionate and caring. The practice had a clear leadership structure and an open and transparent culture. Staff were valued, supported and their views were considered in the running of the practice.

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

Importantly, the provider must:

• ensure that training and development needs are identified for all staff to deliver safe, effective and responsive care to patients. For example, equality and diversity, information governance training and Mental Capacity Act (2005)
• review its recruitment processes to ensure all information required including background checks is up to date.

• implement monitoring systems for hygiene and infection control, including a system of audit, identifying and assessing any risk of legionella and cleaning check system to ensure relevant guidance is followed by staff.

We have issued three compliance actions for the regulation relating to the Requirements of Relating to Workers, Supporting Workers and Hygiene and Infection Control.

In addition the provider should:

• provide health checks to new patients.
• review how all staff are involved in the management and clinical governance of the practice.

Professor Steve Field CBE FRCP FFPH FRCGP

Chief Inspector of General Practice

Letter from the Chief Inspector of General Practice

In October 2014 we found concerns related to the training of staff, the recruitment of staff and infection control during a comprehensive inspection of Waterfield Practice. Following the inspection the practice sent us an action plan detailing how they would revise the practice training programme, review recruitment undertaking necessary staff checks and complete infection control audits.

We carried out desktop review of the Waterfield Practice on 2 July 2015 to ensure these changes had been implemented and that the practice was meeting regulations. Our previous inspection in October 2014 had found breaches of regulations relating to the safe delivery of services and services being well-led. The ratings for the practice have been updated to reflect our findings.

We found the practice had made improvements since our last inspection on 15 October 2014 and they were meeting the regulation relating to the recruitment of staff that had previously been breached.

Specifically the practice was:

• Operating safe systems in relation to the recruitment of staff.

• Ensuring staff completed training appropriate to their roles and any further training needs had been identified and planned.

• Monitoring hygiene and infection control, including a system of audit, identifying and assessing any risk of legionella.

We have changed the rating for this practice to reflect these changes. The practice is now rated good for the provision of safe, effective, caring, responsive and well led services. Furthermore, the rating for all six population groups are now rated as good.

Professor Steve Field CBE FRCP FFPH FRCGP 

Chief Inspector of General Practice