The Berkshire Medical Practice

We carried out an announced comprehensive inspection at The Berkshire Medical Practice on 4 February 2020 to follow up on a breach of regulation and to provide ratings for all key questions.

Care Quality Commission (CQC) inspected the service on 23 January 2019 and asked the provider to make improvements because although the care being provided was safe, effective, caring and responsive, it was not being provided in accordance with the relevant regulations relating to well-led care. Specifically, we found the provider had breached Regulation 17 (good governance) of the Health and Social Care Act 2008. This was because there were governance concerns over identifying and responding to risk, there was an absence of a system to monitor staff training requirements, there was no established programme of quality improvement activity and patient feedback had not been recorded or documented.

We checked these areas as part of this comprehensive inspection and found this had been resolved.

The Berkshire Medical Practice is a private GP service located in Maidenhead, Berkshire. They offer a variety of services including GP appointments, long term conditions management and monitoring, travel vaccinations, health checks/health screening and maternity care.

This service is registered with CQC under the Health and Social Care Act 2008 in respect of some, but not all, of the services it provides. There are some exemptions from regulation by CQC which relate to particular types of regulated activities and services and these are set out in Schedule 1 and Schedule 2 of The Health and Social Care Act 2008 (Regulated Activities) Regulations 2014. The Berkshire Medical Practice provides a range of non-surgical cosmetic interventions, for example anti-wrinkle treatments and Botox injections which are not within CQC scope of registration. In addition, they offer joint injections which is also not within CQC scope of registration. Therefore, we did not inspect or report on these services.

There are three GPs who founded the service and are jointly responsible for the day-to-day running and organisation of the service. All three GPs are the CQC registered managers. A registered manager is a person who is registered with the CQC to manage the service. Like registered providers, they are ‘registered persons’. Registered persons have legal responsibility for meeting the requirements in the Health and Social Care Act 2008 and associated Regulations about how the service is run.

As part of our inspection we asked for CQC comments cards to be completed by patients prior to our inspection. We received four cards which were all positive about the services provided, GPs and standard of care they received. There were no patients available to speak with during the inspection day.

Our key findings were:

• The service had clear systems to keep people safe and safeguarded from abuse.
• There were systems and processes in place to manage risk.
• When incidents did occur, the service learned from them and improved their processes.
• The service ensured that care and treatment was delivered according to evidence based research or guidelines.
• The service introduced a system to review and monitor the essential training needs of all GPs and could demonstrate all GPs had up to date training.
• There was a focus on quality improvement activity and we saw two clinical audits which demonstrated actions taken to improve quality.
• The service encouraged and monitored patient feedback with the introduction of an annual patient survey and by monitoring online reviews. Patient comment cards, online reviews and the provider patient survey were positive about the care and treatment provided at the service.
• The culture of the service encouraged candour, openness and honesty.
• There were effective systems and governance processes in place to identify and respond to risk.

The area where the provider should make improvements is:

• Consider implementing a system to document verbal compliments to further improve monitoring of patient feedback.

Dr Rosie Benneyworth BM BS BMedSci MRCGP

Chief Inspector of Primary Medical Services and Integrated Care

We carried out an announced comprehensive inspection of The Berkshire Medical Practice on 23 January 2019 to ask the service the following key questions; Are services safe, effective, caring, responsive and well-led?

Our findings were:

Are services safe?

We found that this service was providing safe care in accordance with the relevant regulations

Are services effective?

We found that this service was providing effective care in accordance with the relevant regulations

Are services caring?

We found that this service was providing caring services in accordance with the relevant regulations.

Are services responsive?

We found that this service was providing responsive care in accordance with the relevant regulations

Are services well-led?

We found that this service was not providing well-led care in accordance with the relevant regulations.

We carried out this inspection under Section 60 of the Health and Social Care Act 2008 as part of our regulatory functions. This inspection was planned to check whether the service was meeting the legal requirements and regulations associated with the Health and Social Care Act 2008.

The service registered with the Care Quality Commission (CQC) in February 2018 and has not been inspected previously.

The Berkshire Medical Practice is a private GP service located in Maidenhead, Berkshire. They offer a variety of services including GP appointments, long term conditions management and monitoring, travel vaccinations, health checks/health screening and maternity care.

This service is registered with CQC under the Health and Social Care Act 2008 in respect of some, but not all, of the services it provides. There are some exemptions from regulation by CQC which relate to particular types of regulated activities and services and these are set out in Schedule 1 and Schedule 2 of The Health and Social Care Act 2008 (Regulated Activities) Regulations 2014. The Berkshire Medical Practice provides a range of non-surgical cosmetic interventions, for example anti-wrinkle treatments and Botox injections which are not within CQC scope of registration. In addition, they offer joint injections which is also not within CQC scope of registration. Therefore, we did not inspect or report on these services.

There are three GPs who founded the service and are jointly responsible for the day-to-day running and organisation of the service. All three GPs are the CQC registered managers. A registered manager is a person who is registered with the CQC to manage the service. Like registered providers, they are ‘registered persons’. Registered persons have legal responsibility for meeting the requirements in the Health and Social Care Act 2008 and associated Regulations about how the service is run.

As part of our inspection we asked for CQC comments cards to be completed by patients prior to our inspection. We received six cards which were all positive about the standard of care they received. There were no patients available to speak with during the inspection day.

Our key findings were:

• There were systems and processes in place to manage risk, although not all risks had been appropriately identified in relation to infection control.
• When incidents did occur, the service learned from them and improved their processes.
• The service ensured that care and treatment was delivered according to evidence based research or guidelines.
• There was no established system to review the training needs of the GPs in relation to essential training, such as infection control, health and safety or fire safety.
• Quality improvement activity was not established or embedded into routine service reviews. We saw evidence of a clinical audit after the inspection which demonstrated actions to improve quality.
• Patients comment cards told us patients felt they were treated with dignity and respect.
• Patient feedback had been received by the service but not all had been logged or recorded.
• The culture of the service encouraged candour, openness and honesty.
• There were some governance concerns over identifying and responding to risk.
• There were established policies and protocols for a number of areas, including provisional issues.

We identified regulations that were not being met and the provider must:

• Establish effective systems and processes to ensure good governance in accordance with the fundamental standards of care.

You can see full details of the regulations not being met at the end of this report.

Professor Steve Field CBE FRCP FFPH FRCGP

Chief Inspector of General Practice