The Care Quality Commission
  • Doctor
  • GP practice

Forest Health Group

Overall: Good read more about inspection ratings

Ringmead, Birch Hill, Bracknell, Berkshire, RG12 7PG (01344) 421364

Provided and run by:
Forest Health Group

All Inspections

6 July 2023

During a monthly review of our data

We carried out a review of the data available to us about Forest Health Group on 6 July 2023. We have not found evidence that we need to carry out an inspection or reassess our rating at this stage.

This could change at any time if we receive new information. We will continue to monitor data about this service.

If you have concerns about Forest Health Group, you can give feedback on this service.

14 April 2022

During an inspection looking at part of the service

We carried out an announced focused follow up inspection at Forest Health Group on 14 April 2022 to identify if improvements had been made following our previous inspection in October 2021. The 2021 inspection led to a rating of good overall but a rating of requires improvement in the provision of safe services and we identified a breach of regulation. We issued the provider with a requirement notice in order for the service to make improvements. This inspection was to ensure the breach of regulation had been met and provide a new rating in the single domain of safe.

Ratings:

Overall Rating – Good

Safe - Good

The full reports for previous inspections can be found by selecting the ‘all reports’ link for Forest Health Group on our website at www.cqc.org.uk

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.

The inspection included:

  • Requesting evidence from the provider in advance of the inspection visit
  • A site visit at the practice.

Our findings

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 for providing safe services.

At our previous inspection in 2021 we identified areas the provider should make improvements. Paper prescription security was not adequate and fire risks that had been identified by the provider were still in the process of being mitigated.

During this inspection we found that:

  • Safety systems had been improved and processes were operated effectively to protect patients from risks associated with inappropriate use of paper prescriptions.
  • Fire risks were identified, assessed and mitigated.

At our previous inspection in 2021 we identified areas the provider should make improvements. We told the provider to continue to progress action plans to ensure wherever possible, eligible patients receive cervical screening and to ensure patients with learning disabilities receive their annual health checks. As a result, the provider has taken the following action:

  • The practice had continued to recall patients eligible for cervical screening and started text messaging patients who had not attended when initially invited. The practice had achieved 76% of screening for patients eligible who were 25 to 49 years old and 78% of patients between 50 and 64 years old in the previous 12 months up to 31 March 2022. This indicated an increase in uptake since the previous inspection.
  • The practice had continued to recall patients with a learning disability for an annual health check. Data showed 42 out of 68 patients had received a health check up to 31 March 2022 and we saw evidence there were planned reviews and recalls for the remaining patients to receive health checks. This indicated the action plan had successfully increased uptake of the health checks planned in October 2021.
  • In addition, we saw evidence the practice had continued to improve the recall and increase the reviews of patients with diabetes.

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 October 2021

During a routine inspection

We carried out an announced focused follow up inspection at Forest Health Group on 26 October 2021 to identify if improvements had been made following our previous inspection in May 2019. The 2019 inspection led to a rating of Requires Improvement and found breaches of regulation. We issued the provider with requirement notices in order for the service to make improvements. This inspection was to provide a new rating to the service and ensure the breaches of regulation had been met.

Ratings:

Safe – Requires Improvement

Effective - Good

Well-led - Good

The full reports for previous inspections can be found by selecting the ‘all reports’ link for Forest Health Group on our website at www.cqc.org.uk

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

The inspection included:

  • Conducting staff interviews using video conferencing
  • Completing clinical searches on the practice’s patient records system and discussing findings with the provider
  • Reviewing patient records to identify issues and clarify actions taken by the provider
  • Requesting evidence from the provider
  • A site visit at the practice.

Our findings

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 Requires Improvement for providing safe services.

We found that:

  • Safety systems had been improved and processes were operated to protect patients from risks. However, we found paper prescription security was not adequate. Action was taken immediately to begin rectifying this finding. Identified fire risks were still in the process of being mitigated.

  • Patients were prescribed medicines safely.
  • Patients’ needs were assessed and their care planned and delivered in line with national guidance.
  • Staff were supported and trained to ensure they could access guidance and had the skills and knowledge required to deliver effective and safe care.
  • Patients’ rights were protected.
  • Patients reported being well supported overall in the feedback we received and reviewed.
  • There were systems to consider patients’ views in relation to the delivery and design of the service.
  • Governance processes were clear and had improved since the previous inspection in May 2019.
  • The monitoring of staff training had improved.
  • There was a process for staff to receive role specific inductions.

The provider must:

  • Ensure care and treatment is delivered in a safe way.

In addition, the provider should:

  • Continue to progress actions plans to ensure wherever possible eligible patients receive cervical screening and patients with learning disabilities receive their annual health checks.

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

1 May 2019

During a routine inspection

We carried out an announced comprehensive inspection of Forest End Medical Centre on 1 May 2019 as part of our inspection programme.

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 requires improvement overall. We have rated Safe, Effective and Well led as requires improvement and Caring and Responsive as good. We have rated all the population groups as requires improvement.

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

  • The practice did not have oversight of safety risk assessments at one of the sites (including fire, legionella and infection control). They had not completed their own risk assessment for legionella at one site and had not undertaken any precautionary checks for legionella at the main site.
  • Emergency medicines stock at all sites had not been risk assessed to identify any gaps in provision (or mitigate the need for them).
  • Staff had not been assessed for any medical conditions, that may affect their work, so reasonable adjustments could be made.
  • Non clinical staff had limited knowledge of significant events identification or escalation processes.

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

  • Staff had not received regular appraisals to identify learning needs and review performance and there were gaps in staff training including safeguarding, infection control and fire safety.
  • There were no formal arrangements in place for continuing clinical supervision of non-medical prescribers.

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

  • Governance arrangements required a review as these were inconsistently applied. Risks and areas of concern were not always identified or effectively managed.
  • Staff told us the merger had been challenging and they did not feel involved in decisions about the practice.
  • Not all staff were clear about lead roles or who to approach for support and information.

These requires improvement areas impacted all population groups and so we rated all population groups as requires improvement.

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

  • 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. Most patients could access care and treatment in a timely way.

The areas where the provider must make improvements are:

  • 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.
  • 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 recommendations of the “green book” in relation to staff immunisation status and consider if non-clinical staff should have their status assessed and documented.
  • Continue to review and monitor QOF achievement and exception reporting for diabetes indicators.
  • Consider the risks of the sit and wait service in relation to assessing urgent patient needs and staff training for recognising serious illness (including sepsis).
  • Review and monitor cervical screening uptake rates and continue to encourage eligible women to attend for screening.
  • Improve the identification of carers to enable this group of patients to access the care and support they need.
  • Review the arrangements for updating staff across all sites about changes in staffing and leadership.

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

16 July 2015

During an inspection looking at part of the service

Letter from the Chief Inspector of General Practice

Forest End Medical Centre is located in a purpose built medical centre in the Ringmead area of Bracknell in Berkshire. Patients from the practice can also visit the branch site called the Balfron Practice. There are approximately 12,000 patients registered at the practice. We carried out an announced comprehensive inspection on 23 October 2014 at Forest End Medical Centre. We found the practice did not undertake all the recruitment checks required to ensure staff were safe to work alone with patients. Not all training required was delivered to staff. Following the inspection we issued requirement notices and the practice sent us an action plan detailing how they would address the concerns we identified. We also found concerns which did not lead to regulatory action, but we reported that the practice should consider these. The concerns related to the checking of water for a bacteria called legionella, the checking of patients on long term medicines or with long term conditions, patient feedback regarding appointments and concerns regarding the checking of diabetic patients during health checks. The practice was rated as requiring improvement for providing safe, responsive and well-led services. It was rated as good for the provision of effective and caring services.

We undertook a focussed inspection at Forest End Medical Centre on 16 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.
  • A training programme was in place and staff had received training related to their roles.
  • A legionella risk assessment had been undertaken
  • Additional appointment capacity and changes to the appointment system had been implemented, aimed at improving access to the practice
  • Changes to the reviewing of patients on long term medicines and those with long term conditions had improved the outcomes for patients according to data used to monitor these outcomes.

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

23 October 2014

During a routine inspection

Letter from the Chief Inspector of General Practice

Forest End Medical Centre is located in a purpose built medical centre in the Ringmead area of Bracknell in Berkshire. Patients from the practice can also visit the branch site called the Balfron Practice. There are approximately 12,000 patients registered at the practice. We carried out an announced comprehensive inspection on 23 October 2014 at Forest End Medical Centre. During this visit we did not inspect the Balfron Practice. This was the first inspection of the practice since registration with the CQC.

The practice merged with Balfron Practice in 2009 and the patient population has increased significantly since. Since the merger, the practice has made changes to the appointment system in response to patient feedback about the difficulty in making appointments. Despite these changes patients reported in the national and practice surveys and directly to us that they were still finding it very difficult to make appointments. The practice was accessible to patients with limited mobility.

We spoke with eight patients during the inspection. We met with the chair of the patient participation group, two GPs, a trainee GP, three nurses and administration staff.

Forest End Medical Centre practice was rated requires improvement overall.

Our key findings were as follows:

Patients experienced difficulties in booking appointments. Although the practice was aware of the patient concerns and had taken measures to alleviate the problems, not all reasonable steps had been considered to deal with the access problems. Patients were mostly positive about the care they received from GPs and nurses. Some patients were concerned about the continuity of care they received due to seeing different nurses or GPs at different appointments for ongoing treatment or care. Patients told us staff were usually very caring and supportive. The practice had systems to keep patients safe including safeguarding procedures and means of sharing information about patients who were vulnerable. Forest End Medical Centre was hygienic and infection control was monitored. However, we found concerns with the storage and disposal of clinical waste.

The practice was failing to meet regulations on Requirements Relating to Workers and Supporting Workers.

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

Importantly, the provider must:

  • provide all nurses with Disclosure and Barring Service (DBS) checks and administration staff undertaking chaperone duties
  • identify and deliver training and awareness to staff that they require to deliver care safely and to an appropriate standard, including the Mental Capacity Act (2005) and chaperone training.

In addition the provider should:

  • introduce a legionella risk assessment and related management schedule
  • review staff protocols for diabetic reviews to ensure they are undertaken appropriately
  • ensure that medicine reviews for patients on long term medications include patients who may be at risk of not taking medicines they require.
  • review, consider and take appropriate action in response to patient feedback regarding access to appointments. This should include a long term strategy to ensure patient demands are managed and met.

                                     

Professor Steve Field (CBE FRCP FFPH FRCGP) 

Chief Inspector of General Practice