What is the Quality of Facilities at Bracknell Urgent Care Centre

Positive

"The maintenance issue had been resolved and the waiting area was in the original location in clear view of both the reception desk and nurse assessment area ensuring patients safety and wellbeing was continually monitored."

Positive

"• Where a patient’s mental capacity to consent to care or treatment was unclear the GP or nurse assessed the patient’s capacity and recorded the outcome of the assessment."

Positive

"At the time of our inspection we saw two offers of employment had been made to increase the nurse team to seven and the service was recruiting for additional GPs and nurses."

Positive

"The rationale was to provide insight into prescribing habits of both nurse prescribers and GP’s working during this period against an agreed criteria."

Neutral

"Patients did not need to book an appointment but could attend the centre and wait to see a nurse or GP."

Neutral

"• In most cases patients would then wait to see a nurse for initial clinical assessment."

Positive

"Although we noted there was often no nurse prescriber on duty the risks identified at the last inspection which related to the lack of nursing staff with the appropriate skills on duty had been reduced."

Positive

"A new lead nurse provided support for nurses."

Positive

"We reviewed the skill mix of nursing staff and saw that most shifts had a nurse on duty with training in dealing with minor illnesses."

Positive

"Nursing staff were positive about the appointment of a lead nurse and told us they believed nurses meetings were being planned."

Positive

"We found that a lead nurse had been employed at the centre and this had been received positively by the nursing team."

Neutral

"Consequently patients had to wait until the GP was available and the nurse was able to obtain a prescription or authorisation."

Neutral

"At the time of this inspection the provider was advertising nurse prescriber vacancies and they were also due to hold a recruitment open day a few days later."

Neutral

"This was carried out sensitively and enabled the GP or nurse to escort the patient to the treatment rooms."

Neutral

"Patients did not need to book an appointment but could attend the centre and wait to see a nurse or GP."

Neutral

"For example there was a new lead nurse and a business manager."

Neutral

"The nurse lead and business manager informed us that they had communicated openly and honestly with the provider and local CCG to inform them of the requirements to improve the service’s poor performance in terms of KPIs."

Positive

"We also saw that there was not always a nurse on duty with up to date training in dealing with minor illnesses."

Positive

"This training was not delivered and the lack of up to date experience in dealing with minor illnesses meant the GP was often called upon for advice or the patient had to wait to see a suitable qualified nurse or the GP."

Positive

"When a GP or nurse failed to attend for duty the local manager was not authorised to contact other staff or the locum agency to obtain prompt cover for the absent clinician."

Positive

"Medicine alerts were passed to GPs and nurse prescribers and action was taken to ensure medicines prescribed complied with the alerts."

Positive

"Responsibility for generating and signing prescriptions lay with the GP on duty when there was not a nurse prescriber working."

Neutral

"The team included a GP the CQC national nurse advisor a practice manager advisor and a second CQC inspector."

Neutral

"Following the inspections we spoke with three further members of staff including two nurse practitioners and another member of the reception team."

Neutral

"The nurse did not seek authorisation from the GP on duty."

Neutral

"We reviewed the company procedure for obtaining staff cover in the event of a GP or nurse not arriving for their duty."

Neutral

"This was carried out sensitively and enable the GP or nurse to escort the patient to the treatment room."

Neutral

"Appointments did not have a set time although there was a target of four patients to be seen per hour per nurse and GP."

Neutral

"The absence of a lead nurse regional medical director and a newly appointed business manager meant staff felt remote and at risk without senior manager support to carry out their day to day duties."

Neutral

"Clinical supervision for nursing staff was inconsistent with the absence of either a clinical nurse lead or regional medical director."

Positive

"• There was an increase in quality monitoring including clinical audit which demonstrated quality improvement."

Positive

"The service had responded positively to the report compiled by the commission where action was required for example staff communication monitoring patients in the waiting area and a review of the support and guidance available to staff particularly locums in regards to patient pathways."

Positive

"Management monitoring and improving outcomes for people The service produced monthly monitoring reports of the activity undertaken which were shared with the Clinical Commissioning Group CCG."

Positive

"• Procedures were in place for monitoring and managing risks to patient and staff safety."

Positive

"There was also minimal quality monitoring with a limited clinical audit programme."

Positive

"At the last inspection we saw there was minimal monitoring to identify areas for improvements for example limited numbers of completed clinical audits."

Neutral

"It is based on a combination of what we found when we inspected information from our ongoing monitoring of data about services and information given to us from the provider patients the public and other organisations."

Neutral

"We saw evidence of daily performance monitoring undertaken by the service including a day by day analysis and commentary."

Positive

"Management monitoring and improving outcomes for people The service produced monthly monitoring reports of the activity undertaken which were shared with the CCG."

Positive

"There was minimal quality monitoring such as clinical audit but contract monitoring did take place."

Positive

"There was minimal quality monitoring to identify improvements such as clinical audit."

Positive

"There was limited monitoring of clinical performance."

Neutral

"It is based on a combination of what we found when we inspected information from our ongoing monitoring of data about services and information given to us from the provider patients the public and other organisations."

Positive

"Management monitoring and improving outcomes for people Patient comments demonstrated that they were satisfied with the care and treatment received from the GPs and nurses at the service."

Positive

"Learning and improvement from safety incidents The service had a system in place for reporting recording and monitoring significant events."

Positive

"The service produced monthly monitoring reports of the activity undertaken which were shared with the CCG."

Neutral

"It is based on a combination of what we found when we inspected information from our ongoing monitoring of data about services and information given to us from the provider patients the public and other organisations."

Neutral

"The plan had defined sections including aligned work streams tasks activities assurances outcomes an owner and target completion date."

Positive

"We reviewed a range of policies and procedures the service used to govern their activities reviewed how medicines were kept and managed We reviewed staffing rosters logs of significant events and minutes of meetings."

Positive

"• There was an increase in quality monitoring including clinical audit which demonstrated quality improvement."

Positive

"There was also minimal quality monitoring with a limited clinical audit programme."

Neutral

"The inspection team followed up on the audit process during the day on inspection and noted: • The service had a system in place for completing a range of clinical audit cycles."

Positive

"• Review the need for a comprehensive programme of clinical audit as part of quality improvement."

Positive

"There was minimal quality monitoring such as clinical audit but contract monitoring did take place."

Positive

"This included ongoing support during sessions onetoone meetings appraisals coaching and mentoring clinical supervision and facilitation and support for revalidating GPs and nurses."

Neutral

"We did not see any evidence of clinical supervision taking place with either the GPs or the nurses."

Positive

"They had been signed by the senior GP before the nurses required to administer the medicine had confirmed they had read understood and were competent to administer the medicine the PGD related to."

Positive

"We checked medicines stored in the treatment rooms and medicine refrigerators and found they were stored securely and were only accessible to authorised staff."

Positive

"We noted that the service was not responsible for prescribing repeat or regular medicines and that any action arising from an alert related to avoidance in prescribing a new medicine for the patient."

Positive

"They had been signed by the senior GP before the nurses required to administer the medicine had confirmed they had read understood and were competent to administer the medicine the PGD related to."

Positive

"Medicines management We checked medicines kept in the medicines cupboard and medicine refrigerator and found they were stored securely and were only accessible to authorised staff."

Positive

"The service shares premises with other services including NHS Trust clinics an xray department and the local out of hour’s service."

Positive

"We saw recent audits for infection control sepsis xray prescribing and needle stick safety."

Positive

"The service shares premises with other services including NHS Trust clinics an xray department and the local out of hours service."

Neutral

"• There were procedures for following up on patient referrals such as xray results."

Neutral

"Daily tasks were being assigned to staff such as reviewing xray results."

Positive

"The areas where the provider should make improvement are: • Implement a system to review xray reports from radiologists and take appropriate action on the findings of the report."

Positive

"Action the service COULD take to improve • Implement a system to review xray reports from radiologists and take appropriate action on the findings of the report."

Positive

"Patients were at risk if the radiologist had found an issue of concern that the GPs and nurses had missed when they first reviewed the xray and made clinical decisions based on their own findings."

Positive

"The service shares premises with other services including NHS Trust clinics and xray department and the local out of hours service."

Neutral

"Working with colleagues and other services We noted the close working between the service and the xray department located in the same premises."

Neutral

"We were told that there was a reporting system which required the radiologists to review the xrays and provided a report to the service within two days after the xray had been taken."

Positive

"A receptionist would also complete a brief set of safety questions ruling out chest pain shortness of breath and heavy blood loss ensuring the patient was safe to wait to see an assessment nurse."

Positive

"We saw plans of Skype appointments a spoken conversation over the Internet using the software application Skype frequently also viewing by webcam strengthening relationships with ambulance services including peer reviews and further developments within the service including a community sensory garden proposal."

Neutral

"• There was automatic doors at the entrance to the building; there was a lift available the centre had clear obstacle free access and height adjustable couches were available in the treatment rooms."

Neutral

"• There was a lowered reception desk which enabled wheelchair users to access the service and speak directly to one of the reception team."

Positive

"• Findings were used by the centre to improve services and patient outcomes; one example was a review of antimicrobial prescribing habits within Bracknell Urgent Care Centre ensuring prescribing guidelines and clinical governance was being adhered."

Positive

"The minutes of the meetings we reviewed showed that significant events were discussed at clinical governance meetings."

Positive

"At the time of inspection there was no clinical lead at the centre but the new lead was due to start working in midOctober and part of their role would be attending clinical governance meetings."

Positive

"There was a health and safety policy available with a poster in the communication corridor leading to offices and kitchen facilities which identified local health and safety representatives."

Positive

"• Staff received training that included: health and safety fire procedures basic life support and information governance awareness."

Neutral

"It covered such topics as infection prevention and control fire safety health and safety and confidentiality."

Positive

"The service also had a health and safety policy."

Neutral

"The service had an induction programme for new members of staff that covered such topics as safeguarding fire safety health and safety and confidentiality."

Positive

"Induction training and the mandatory training package for staff covered various aspects of health and safety including fire safety control of substances hazardous to health COSSH and lone working."

Positive

"One described their induction as being given access to important policies and procedures being briefed on the health and safety procedures and being taught their job by other staff of a similar grade."

Positive

"Another member of staff said their induction comprised nine hours of being taken through the provider structure and essential health and safety procedures."

Neutral

"Staff received an induction that covered health and safety essentials including fire safety and maintaining confidentiality."

Neutral

"We saw that these staff had attended one half day of training organised by the CCG and had also completed the provider’s mandatory health and safety training."

Neutral

"It covered such topics as infection prevention and control fire safety health and safety and confidentiality."

Positive

"Although there was access to external clinical leadership and expertise with only locum GPs working at the centre there was a risk that staff did not have access to the support they may need."

Neutral

"We saw there were cleaning schedules in place and cleaning records were kept."

Positive

"There were cleaning schedules in place and the quality and frequency of cleaning was monitored on a daily basis."

Positive

"They also told us they had no difficulty parking and in gaining access to the service."

Neutral

"We saw that GPs were able to access clinical training and attend the local CCG training sessions."