Brambles Also known as Brambles Surgery

Updated 15 December 2021

This service is provided by Accountable Care Enterprise Ltd (ACE) at the Brambles Surgery, Geary Drive in Brentwood. The service provides an extended hours GP service to patients registered at all Brentwood practices. Appointments are booked through the patient’s usual GP practice. The service is provided from 6.30pm to 8.30pm Monday to Friday, 8am to 2pm on Saturdays and Sundays, 10am to 2pm on Bank Holidays. The premises are also used as a branch of a local practice prior to 6.30pm on some weekdays, but this service is separate to the extended hours service we inspected.

How we inspected this service

Throughout the pandemic CQC has continued to regulate and respond to risk. However, taking into account the circumstances arising as a result of the pandemic, and in order to reduce risk, we have conducted our inspections differently.

This inspection was carried out in a way which enabled us to spend a minimum amount of time on site. This was with consent from the provider and in line with all data protection and information governance requirements.

This included:

• Requesting evidence from the provider before the inspection.
• A short site visit, including interviews with staff.
• Reviewing patient feedback.

To get to the heart of patients’ experiences of care and treatment, we asked the following questions:

• Is it safe?
• Is it effective?
• Is it well-led?

These questions therefore formed the framework for the areas we looked at during the inspection.

Updated 15 December 2021

This service is rated as Good overall. At the previous inspection on 9 December 2019, the service was rated Requires Improvement overall.

The key questions are rated as:

Are services safe? – Good

Are services effective? – Good

Are services well-led? – Good

We carried out a comprehensive inspection of Brambles on 9 December 2019. We identified breaches of regulation 12 (Safe care and treatment) of the Health and Social Care Act 2008 (Regulated Activities) Regulations 2014 and issued a requirement notice. The service was rated as requires improvement for providing safe and effective services and good for providing caring, responsive and well-led services. The service was rated as requires improvement overall.

We carried out this announced focused inspection of Brambles on 30 November 2021 under Section 60 of the Health and Social Care Act 2008. 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. At this inspection we checked that the service was providing safe, effective and well-led services.

Throughout the COVID-19 pandemic the Care Quality Commission (CQC) has continued to regulate and respond to risk. However, taking into account the circumstances arising as a result of the pandemic, and in order to reduce risk, we have conducted our inspections differently.

This inspection was carried out in a way which enabled us to spend a minimum amount of time on site. This was with consent from the provider and in line with all data protection and information governance requirements.

This included:

• Speaking with staff in person and using video conferencing.

• Requesting documentary evidence from the provider.

• A site visit.

We carried out an announced site visit to the service on 30 November 2021. Prior to our visit we requested documentary evidence electronically from the provider and we spoke to staff by telephone and using video conferencing.

Brambles is the name of the location which Accountable Care Enterprises Ltd (ACE) use to deliver extended hours access to eight GP practices in Brentwood. ACE is owned by the eight GP practices in Brentwood and each of the practices has a representative on the board, and a role within the governance structure of the organisation.

This service is registered with CQC under the Health and Social Care Act 2008 to provide the regulated activity, Treatment of Disease, Disorder or Injury.

At the time of our inspection, Brambles was in the process of registering a new registered manager. A registered manager is a person who is registered with the Care Quality Commission 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.

Our key findings were:

• Staff had received training in key areas. There was a clear record of training for staff.
• There were processes in place for performance review and monitoring of clinical staff. Staff employed by the service had undergone appraisals.
• There were effective systems and processes to assess monitor and control the spread of infection.
• There were safeguarding systems and processes to keep people safe. Staff had received training in the safeguarding of adults and children.
• There were appropriate arrangements to manage medical emergencies and suitable emergency medicines and equipment in place.
• There was evidence of clinical audit and review of patient treatment outcomes.
• Staff found leaders approachable and supportive and felt they provided an individual service to patients.
• There was frequent and open communication amongst the staff team which was well documented.
• Complaints were managed appropriately.

The following areas were identified at the previous inspection where the provider was advised that improvements should be made:

• Implement a protocol for wound dressings.
• Implement a system for periodically checking the registration status of staff.
• Implement a system so that where other providers have completed risk assessments, routine maintenance or other actions, the service have copies of these.
• Review how they identify to patients how to access the complaints system, when not at service location.

At this inspection, we found that all of these concerns had been adequately addressed.

The following areas were identified at the previous inspection where the provider was advised that improvements must be made:

Ensure care and treatment is provided in a safe way to patients, in particular:

• There were no records of immunisation status for some staff, including administration staff.
• There were gaps within proof of identity checks for new staff.
• There was no system in place to appraise staff or review that they were working within their competencies.
• There was no evidence of patient specific directions, being attached to the electronic record, for the sample of patient records viewed.

At this inspection, we found that all of these concerns had been adequately addressed.

Dr Rosie Benneyworth BM BS BMedSci MRCGP
Chief Inspector of Primary Medical Services and Integrated Care