The Care Quality Commission
  • Doctor
  • GP practice

Archived: Binfield Surgery Also known as Dr Koefman and Partners trading as Binfield Surgery

Overall: Good read more about inspection ratings

Terrace Road North, Binfield, Bracknell, Berkshire, RG42 5JG 0844 477 0932

Provided and run by:
Binfield Surgery

All Inspections

8 January 2020

During a routine inspection

We carried out an announced comprehensive inspection at Binfield Surgery on 8 January 2020 to follow up on concerns and breaches of regulation following our previous inspections in May 2019 and April 2018.

At the last inspection, in May 2019, we rated the practice as requires improvement overall. Specifically, we rated the practice as inadequate for providing well led services and requires improvement for providing safe and effective services. We also rated the population group ‘people experiencing poor mental health’ as inadequate and ‘people with long term conditions’ as requires improvement. We issued a warning notice for regulation 17: Good governance and two requirement notices for regulation 12: Safe care and treatment and regulation 18: Staffing.

We undertook a focused follow up inspection in September 2019, to follow up on the warning notice and check the practice had made improvements to their governance processes.

At this inspection (January 2020) we found that the provider had satisfactorily addressed our concerns.

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 and good for all population groups.

We found that:

  • The practice provided care in a way that kept patients safe and protected them from avoidable harm.
  • The provider had improved their dispensary processes and undertaken appropriate risk assessments to reduce risk.
  • The practice had improved the quality of care for patients with poor mental health and long term conditions. They had worked with external stakeholders to ensure changes made were effective and sustainable.
  • Staff dealt with patients with kindness and respect and involved them in decisions about their care.
  • The practice organised and delivered services to meet patients’ needs. Patients could access care and treatment in a timely way.
  • The practice had reviewed their governance processes and implemented an action plan to focus on specific areas of concern highlighted to them during the May 2019 inspection. There was improved oversight of patient care outcomes and effective management processes in place to reduce risk.

Whilst we found no breaches of regulations, the provider should:

  • Continue to monitor, review and recall patients taking novel oral anticoagulants to improve their care and treatment outcomes in line with guidance.
  • Complete the dispensary development plan to include a system for assessing competency for dispensary staff and audit tools to audit dispensary processes.
  • Introduce a process for monitoring consent seeking processes, to ensure patient consent is gained in accordance with legislation and guidance.
  • Review the use of translation services offered to patients who do not speak English as a first language. Encourage staff to use this facility.

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

Dr Rosie Benneyworth BM BS BMedSci MRCGP

Chief Inspector of Primary Medical Services and Integrated Care

26 September 2019

During an inspection looking at part of the service

We undertook a focussed follow up inspection at Binfield Surgery on 26 September 2019. This inspection was to determine whether action had been taken regarding significant risks identified at a comprehensive inspection on 15 May 2019. The previous inspection led to the CQC taking enforcement action against the provider and rating the practice requires improvement overall. We did not issue a rating as part of this inspection.

We based our judgement of the quality of care at this service on a combination of:

  • what we found when we inspected

At this inspection we found improvements had been made to meet the requirements of our enforcement action.

Our key findings were:

  • There had been improvements to the monitoring and recording of care for patients with mental health conditions.
  • The processes for monitoring repeat prescribing had been improved to mitigate risks we identified in May 2019.

We found one area where the provider should make improvements:

  • Implement the system proposed during the inspection for ensuring patients who are potentially vulnerable and rely on medicines are followed up when they do not request their repeat prescriptions.

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

Dr Rosie Benneyworth BM BS BMedSci MRCGP

Chief Inspector of Primary Medical Services and Integrated Care

15 May 2019

During a routine inspection

We carried out an announced comprehensive follow up inspection at Binfield Surgery on 15 May 2019 as part of our inspection programme. The practice’s last comprehensive inspection was in April 2018 and the Care Quality Commission (CQC) issued an overall rating of requires improvement and two requirement notices for breaches of regulations.

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.

Following the May 2019 inspection, we have rated this practice as requires improvement overall and inadequate for well led and for the population group ‘people experiencing poor mental health’.

We rated the practice as requires improvement for providing safe services because:

  • The practice did not have appropriate systems in place for the safe management of medicines and some risks had not been identified, such as assessing emergency medicine storage or security of blank prescription stationary.

We rated the practice as requires improvement for providing effective services because:

  • We have rated the Older people, Families, children and young people, Working age people (including those recently retired and students) and People whose circumstances may make them vulnerable as good. The population group People with long-term conditions has been rated as requires improvement. This was due to the issues with staff training and the issues in the dispensary that affects patients in these groups. The population group People experiencing poor mental health (including people with dementia) which we have rated as inadequate. This was due to the limited monitoring of the outcomes of care and treatment. For example, we found that the practice had not made sufficient improvement in relation to exception reporting since the previous inspection and some clinical indicators remained significantly above local and national averages.

We rated the practice as good for providing caring and responsive services because:

  • Staff treated patients with kindness and respect and involved them in decisions about their care.
  • The practice organised and delivered services to meet patients’ needs including the provision of services for people with caring responsibilities.
  • Complaints and patient feedback was listened and responded to and used to improve the quality of care.

We rated the practice as inadequate for providing well-led services because:

  • The arrangements for governance were not always operated effectively. For example, the lack of monitoring of controlled drugs prescribing meant that the practice could not be assured that controlled drugs were being prescribed safely and were not at risk of misuse.
  • There was not sufficient monitoring of patient outcomes and the provider had not identified gaps in recall process or higher than average exception reporting.
  • The practice had failed to act on previous feedback. For example, the provider submitted an action plan to the Commission for its previous breach of regulation 9 but has been unable to provide evidence to show that the actions were completed.
  • The provider systems and processes did not identify the lack of adherence to the repeat prescribing policy.

The areas where the provider must make improvements are:

  • Care and treatment must be provided in a safe way for service users.
  • Ensure persons employed in the provision of the regulated activity receive the appropriate support, training, professional development, supervision and appraisal necessary to enable them to carry out the duties.
  • Ensure that systems or processes are established and operated effectively to ensure compliance with the regulations.

The areas where the provider should make improvements are:

  • Review the process in place to monitor the emergency medicines and assess medicines which are not held in stock.
  • Review the process of recording and escalating concerns for the monitoring of storage temperatures of vaccines.
  • Take appropriate actions to ensure that conversations in consultation rooms could not be overheard whilst in the reception or corridor areas.
  • To continue to improve uptake of cervical screening to meet the 80% national target.

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

Dr Rosie Benneyworth BM BS BMedSci MRCGP

Chief Inspector of Primary Medical Services and Integrated Care

10 April to 11 April 2018

During a routine inspection

This practice is rated as Requires Improvement overall. (Previous comprehensive inspection October 2014 – Requires Improvement, previous focused inspection July 2015 – Good).

The key questions are rated as:

Are services safe? – Requires Improvement

Are services effective? – Requires Improvement

Are services caring? – Good

Are services responsive? – Good

Are services well-led? – Requires Improvement

We carried out an announced comprehensive inspection at Binfield Surgery on 10 April 2018 as part of our inspection programme.

At this inspection we found:

  • The practice had systems in place to review and manage risk so that safety incidents were less likely to happen, with the exception of some dispensary processes and some areas of medicines management. When incidents were identified, the practice learned from them and improved their processes.
  • The practice routinely reviewed the effectiveness and appropriateness of the care it provided, although they had not considered the needs of some of their population groups. The provider told us they provided care and treatment according to evidence-based guidelines, but we found this was not always the case.
  • Staff involved and treated patients with compassion, kindness, dignity and respect.
  • The majority of patients found appointments accessible and were able to arrange care when they needed it.
  • The practice had a governance structure and processes in place and all staff were aware of their roles and responsibilities. However, some processes were inconsistently applied such as staff training.

The areas where the provider must make improvements are:

  • Ensure the care and treatment of patients is appropriate, meets their needs and reflects their preferences.
  • Establish effective systems and processes to ensure good governance in accordance with the fundamental standards of care.

The areas where the provider should make improvements are:

  • Review the arrangements for storing emergency medicines to enable ease of access in an emergency.

Professor Steve Field CBE FRCP FFPH FRCGP

Chief Inspector of General Practice

21 July 2015

During an inspection looking at part of the service

Letter from the Chief Inspector of General Practice

We carried out an announced focussed inspection of the Binfield Surgery, Terrace Road North, Binfield, Bracknell on 21 July 2015. This inspection was undertaken to check the practice was meeting regulations following our previous inspection in October 2014. The practice was given and overall rating of requires improvement following the previous inspection.

Specifically we rated the practice as inadequate for providing safe services, requires improvement for providing effective, responsive and well-led services and good for providing caring services.

There were concerns regarding the management and dispensing of medicines which could have impacted on patient safety. The practice did not follow all of the requirements related employing and recruitment staff. We found that not all training required by staff was delivered to ensure that they could provide safe and effective care. We issued requirement notices to the practice.

Following the inspection the practice sent us an action plan detailing how they planned to meet the fundamental standards included in this report. In addition to improvements we told the provider they must make, we also suggested improvements the provider should consider. These included introducing a comprehensive infection control audit, ensuring that contingency plans for medical emergencies were in place and clearly communicated to the team, reviewing their appointments process due to concerns with nurse appointment availability and to review the planning and delivery of care provided to patients with learning disabilities and those with other complex needs.

We undertook the focussed inspection at Binfield Surgery on 21 July 2015 to check improvements to the service had been made. Our findings were as follows:

  • Criminal background checks with the Disclosure and Barring Service (DBS) had been undertaken on all relevant staff and other staff checks where necessary.
  • Changes to the storage and dispensing of medicines had been made to improve safety.
  • Emergency equipment was working and accessible and emergency medicines were available.
  • Training had been delivered to staff which related to their roles. For example, in the Mental Capacity Act and infection control.
  • Changes to nurse appointments had been implemented, aimed at improving access to nurses.
  • A hygiene and infection control audit had been implemented.
  • The practice had implemented appropriate monitoring of patients with learning disabilities.

We have amended the practice’s ratings to reflect these changes. The practice is now rated at good for the provision of safe, effective, caring, responsive and well-led services.

Professor Steve Field (CBE FRCP FFPH FRCGP) 

Chief Inspector of General Practice

1 October 2014

During a routine inspection

Letter from the Chief Inspector of General Practice

We undertook a comprehensive inspection of Binfield Surgery on 1 October 2014. We were also following up on concerns we found regarding protecting patients from abuse and monitoring of the service from January 2014. We visited Binfield Surgery, Terrace Road North, Binfield, Bracknell as part of the inspection. The practice is rated as Good. Although many aspects of the practice were good, improvements in safety are required.

Our key findings were as follows:

Patient feedback from surveys, comment cards and verbal feedback was overall positive. The majority of patients said they were treated with compassion, dignity and respect and they were involved in care and treatment decisions. The practice enabled patients to book appointments quickly. Patients with limited mobility were able to access the practice. The practice involved patients in the core strategy and day to day running of the practice. There were concerns regarding the management and dispensing of medicines which could have impacted on patient safety. The practice did not follow all of the requirements related employing and recruitment staff. Not all training required by staff was delivered to ensure that they could provide safe and effective care.

The practice had improved clinical governance arrangements since our last inspection. National guidance and best practice was reflected in the monitoring and delivery of patient care. Improvements to safeguarding procedures meant that staff were aware of their responsibilities in protecting patients from abuse.

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

Importantly, the provider must:

  • make changes to the processes for obtaining, storing and dispensing medicines.
  • ensure that all information required relating to staff checks, such as references, Disclosure and Barring Service (DBS) as per the DBS risk assessment (including a system to update and renew Criminal Record Bureau checks) and identification documents, are in place and available in staff records
  • must ensure hygiene and infection control training is provided to all relevant staff.
  • provide Mental Capacity Act 2005 awareness to all relevant staff.

We have issued three compliance actions for the regulations relating to Recruitment, Supporting Workers and Medicines management.

In addition the provider should:

  • introduce a comprehensive infection control audit.
  • ensure that contingency plans for medical emergencies are in place and clearly communicated to the team.
  • review their appointments process.
  • consider the planning and delivery of care provided to patients with learning disabilities and those with other complex needs.

Professor Steve Field CBE FRCP FFPH FRCGP

Chief Inspector of General Practice

8 January 2014

During a routine inspection

During this inspection we spoke with 10 patients, four staff members, the practice manager and staff from other services about the practice.

Patients told us the practice was caring and met their needs. One patient said "If I moved away from the area I would want to stay with this practice." They told us they were able to access appointments and were offered some flexibility when they needed to see a clinician. Staff ensured patient privacy and confidentiality was protected. Patients felt they were treated with respect and dignity.

We found the practice had systems to assess the quality of care it provided. This included gaining the views of patients and acting on them. The provider reviewed patients' care regularly to ensure their needs were being met. The practice was prepared for the event of a medical emergency.

Staff had some but not a full awareness in safeguarding children and vulnerable adults. There was a risk staff would not be able to identify and respond to potential abuse.

The practice was clean and hygienic. Staff were aware of appropriate guidance regarding hygiene and infection control. There were systems in place to reduce the risk of healthcare associated infection.