Agenda item

To review the action being taken by the Clinical Commissioning Group and OneMedicalGroup on the criticisms of the Care Quality Commission (CQC), arising from their inspection of the Urgent Care Centre (UCC).

The Urgent Care Centre is commissioned by the Bracknell and Ascot Clinical Commissioning Group and operated by OneMedicalGroup.

Dr Tong from the CCG introduced Rachel Beverley – Stevenson, Chief Executive of the OneMedicalGroup, to the Panel.

Rachel thanked the Panel for inviting them to come and present the action that had been taken by the CCG and OneMedicalGroup as a result of the criticism received from the Care Quality Commission (CQC) following the October 2015 inspection of the Bracknell Urgent Care Centre.

Rachel also stated that they have worked closing with the CCG post the October inspection, which they had learnt from. They had made major improvements, they were proud of their achievements, and  a follow up inspection had taken place on 12 April 2016. Although the outcome of the follow up inspection won’t be available for a couple of months, the feedback that had been received on the day was very positive.

Luke Minshall, Head of Urgent Care at OneMedicalGroup, gave a presentation on the progress of Bracknell Urgent Care Centre since the inspection in October 2016.

The OneMedicalGroup had learnt from the CQC inspection and had redesigned the Urgent Care Centre around the Patient Journey. There had also been large stakeholder engagement to enable the changes, this had created a more stable team and working environment. Two Health Care Assistants had been employed to work as patient advisors and more Nurses had applied for positions within the Centre, even though there is a national shortage within the area.

There had been a lot of work undertaken to ensure safety and improve Clinical Care at the Bracknell Urgent Care Centre. There was now a stable, multi skilled staff team in place and they had instilled a learning and development culture. Communications and governance had now been improved; an example of this had been the introduction of significant event reporting. This was a new mechanism to be used to report issues via the intranet which sent alerts to managements mobiles, this ensured that all were aware of any significant issues at anytime.

It was also reported that despite a record month in March of 4000 patients, all KPIs had been attained since October 2015 and that the Quality Schedule had also been met in full.

A lot of collaborate working was also underway. OneMedicalGroup had been working with the Ambulance Service’s 111 service on a Peer Review, a good relationship had been built up with Mark Sanders of Healthwatch Bracknell Forest and work had been ongoing with the CCG to put a policy in place, focusing on process and safety, for Unscheduled Care appointments via Skype by July 2016. This was a policy that had been implemented in OneMedicalGroup’s Leeds Urgent Care Centre, and had positive feedback from the GPs and Patients.

Future Plans had already begun for Health Sessions, such as a Community Garden which would promote healthy eating. Another proposal was to publish the Urgent Care Centres current waiting times on their website and to be used on other community platforms. This had proved successful in the Derby Urgent Care Centre.

The Chair thanked Rachel & Luke for their very useful, informative and reassuring presentation.

Arising from the Panel’s questions, the following points were noted:

·         The culture of the UCC had improved due to the changes that had been made. It was felt that there was a good, strong platform to build on.

·         Changes to required policies had been made and were now more localised.

·         The response to risk is now immediate, learnings from risks are now logged and shared within the team and also shared with other OneMedicalGroup locations.

·         CCG confirmed that they visit the Bracknell UCC on regular occasions. They had previously issued a contract performance notice, and installed robust monitoring and have been meeting monthly to review reports and indicators. The CCG was comfortable about the UCC’s performance and supportive of the journey they were taking. The CCG regarded the UCC as providing better value for money than the former Minor Injuries Unit at Heatherwood hospital.

·         Locums and Agency staff were still used by the UCC. However they were now undertaking an induction and had been provided with their own equipment and logins.

·         The sharing information and joint log-in issue that had been reported in the October review had now been resolved due to the changes made with the access given to Locum & Agency staff.

·         There had been some frustrations with the landlord support provided by Royal Berkshire Hospital, particularly with the heat in the atrium. One outstanding issue had been the need to install a pod in the waiting area to enable more privacy.

·         It was reported that monitoring of time peaks had been undertaken from 1 January to 15 March 2016. In this period the time peaks had been at 4pm and 6pm. There had only been two 9pm finishes during this period.

·         Since October, waiting time KPI’s had improved. A child should wait only 15 minutes and an adult 30 minutes.

·         The main deliverable for the UCC was to divert patients away from Accident and Emergency. A&E ‘Minors’ had decreased, though A&E ‘Majors’ had increased. It was difficult to distinguish exactly how great an impact the UCC had had, at a time of increasing demand on A&E generally. It was also difficult to determine the impact of the UCC on non-elective hospital admissions, but the CCG was confident that the effect had been positive.

·         UCC had found it difficult to introduce a Patient User Group as their patients are not continuous. A volunteer had introduced “Knit and Natter” sessions and placements with students from Bracknell and Wokingham College had been confirmed.

·         Options for waiting area entertainment were being explored, with interactive books and tablets being looked at.

·         Emergency sexual contraception was available at the UCC but there was still work ongoing with the CCG regarding the introduction of the Deep Vein Thrombosis testing tool kits.

·         It was urged that any negative feedback should be reported at the time via feedback forms to ensure lessons are learnt.

·         The “One Stop Shop” model was still the overall goal, but this had proved very difficult in a building owned by someone else with multiple providers.

·         OneMedical would provide a written account of how they had acted on the improvements which the CQC said must or should be made.

·         The UCC had not committed to provide a Paediatrician led service, instead a GP with paediatric experience.

·         The UCC has become very popular, offering a service people need and drawing patients from unplanned areas. The cost of treating people resident outside Bracknell Forest and RB Windsor and Maidenhead is charged to the CCG concerned.