The Care Quality Commission
  • Doctor
  • GP practice

Brune Medical Centre

Overall: Good read more about inspection ratings

10 Rowner Road, Gosport, Hampshire, PO13 0EW (023) 9258 3333

Provided and run by:
Hampshire and Isle of Wight Healthcare NHS Foundation Trust

All Inspections

During an assessment under our new approach

Brune Medical Centre is part of The Willow Group. The Willow Group was formed in April 2017 between Brune Medical Centre and three other practices. In April 2023, a fifth practice joined the Group. The Willow Group provide NHS services across five sites: Brune, Forton, Stoke Road, Gosport and Waterside Medical Centres. Brune Medical Centre is the main hub, registered to provide the relevant regulated activities and has a registered manager in place.

The Willow Group is a partnership with Hampshire and Isle of Wight Healthcare NHS Foundation Trust. The Willow Group and Hampshire and Isle of Wight Healthcare NHS Foundation Trust are both separately registered providers with the Care Quality Commission. Hampshire and Isle of Wight Healthcare NHS Foundation Trust are subcontracted to deliver the General Medical Services (GMS) contract. This is a unique arrangement designed to provide integrated pathways to patients. The Willow Group is responsible to overseeing the day to day management of the GP services, whilst Hampshire and Isle of Wight Healthcare NHS Foundation Trust provides clinical and information governance support including recruitment, training, systems and processes.

The practice is situated within the NHS Hampshire and Isle of Wight Integrated Care Board (ICB) and delivers services to a patient population of approximately 49,000. The National General Practice Profiles states that demographics are in line with local and national averages. Information published by Office for Health Improvement and Disparities shows that deprivation within the practice population group is in the 5th decile (5 of 10). The lower the decile, the more deprived the practice population is relative to others. This assessment considered the demographics of the people using the service, the local context and how this impacted service delivery. We inspected in response to the information we held about the service.

At this inspection we found, the practice did not have fully effective and embedded processes for monitoring patients’ health in relation to some high-risk medicines and patients with diabetes. Although the service had oversight of risks, systems and processes were not always effective to address all shortfalls in performance. This resulted in a breach of regulations in relation to safe care and treatment. We have asked the provider for an action plan in response to the concerns found at this inspection.

However, there were enough staff with the right skills, qualifications and experience. Managers ensured staff received training and regular appraisals to maintain high-quality care. Effective processes were in place for monitoring human resources, recruitment and staffing, including staff inductions, mandatory training compliance, and regular clinical supervision for non-medical prescribers with prescribing audits. There were areas of outstanding practice, in relation to contribution to clinical research, improved patient outcomes following 2-cycle audits as well as the continued support of clinical staff as a registered training practice.

5 February 2019

During an inspection looking at part of the service

At our inspection on 12 to14 December 2017 we rated the practice as good for providing Safe, Effective, Caring and Responsive services. However we rated Well Led as Requires Improvement. We carried out an announced focussed follow up inspection on 5 February 2019 to inspect Well Led.

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 at our last inspection. We rated Well Led as Good for this inspection. This means the practice remains rated as Good overall.

We rated the practice as Good for providing Well Led services because:

  • There was compassionate, inclusive and effective leadership at all levels
  • The practice had a culture which drove high quality sustainable care.
  • There were consistent evidence of systems and processes for learning, continuous improvement and innovation.

At our inspection in December 2017, we rated all population groups as Good.

We also rated the practice as Good for providing effective, caring, responsive and well-led services because:

  • There were systems to assess manage and monitor the risks to patient safety.
  • Staff had the skills, knowledge and experience to carry out their roles.
  • Staff understood patients’ social, cultural and religious needs.
  • The practice organised and delivered services to meet patient need.

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

Professor Steve Field CBE FRCP FFPH FRCGP
Chief Inspector of General Practice

12-14 December 2017

During a routine inspection

Letter from the Chief Inspector of General Practice

The key questions are rated as:

Are services safe? – Good

Are services effective? – Good

Are services caring? – Good

Are services responsive? – Good

Are services well-led? – Requires Improvement

As part of our inspection process, we also look at the quality of care for specific population groups. The population groups are rated as:

Older People – Good

People with long-term conditions – Good

Families, children and young people – Good

Working age people (including those recently retired and students – Good

People whose circumstances may make them vulnerable – Good

People experiencing poor mental health (including people with dementia) - Good

We carried out an announced comprehensive inspection at Brune Medical Centre and the three branch sites (Forton Medical Centre, Waterside Medical Centre and Stoke Road Medical Centre) on the 12, 13 and 14 December 2017 as part of our inspection programme.

At this inspection we found:

  • Southern Health NHS Foundation Trust had 4 locations registered as GP practices until April 2017 when Brune Medical Centre became the lead location and the other 3 practices became the branch sites. This was not updated on their CQC certificate until November 2017.

  • In addition Southern Health NHS Foundation Trust formed a contractual arrangement with The Willow Group who have the same location Brune Medical Centre and same branch sites. The two providers hold accountabilities for the provision of the primary care services for the same patients. Southern Health NHS Foundation Trust were responsible for recruitment, HR and overarching information and clinical governance structures. The Willow Group maintained oversight of the daily running of services. It was apparent throughout the inspection that the process of bringing this arrangement together was still in progress. For example, although there was now one governance structure with staff working across sites, there were still observable minor differences in the way that each site ran.

  • The structural reorganisation had been since April 2017 and the practice was still in the process of introducing and embedding new systems and processes. Staff were aware of the new governance structures and support in place.

  • The practice had systems in place to manage risk so that safety incidents were less likely to happen. When incidents did occur the practice learned from them and improved their processes. However, there had been at least one incident that at the time of inspection was still under review. Southern Health NHS Foundation Trust and The Willow Group were working with the Clinical Commissioning Group and NHS England as part of the investigation into the events.

  • At time of the inspection the location and the branches experienced staff shortages for both clinical and non-clinical staff. There was a backlog in scanning signed consent forms into the electronic system. The Trust and The Willow Group management teams were already aware of these risks and had taken action such as undertaking recruitment processes.

  • The practice reviewed the effectiveness and appropriateness of the care it provided. It ensured that care and treatment was delivered according to evidence- based guidelines.

  • Staff involved and treated patients with compassion, kindness, dignity and respect.

  • Infection control audits were completed at all but one branch site.

  • Patients were generally positive about the new system for appointments whereby they could access appointments at any one of the four GP sites. However all patients spoken to throughout the inspection were dissatisfied with the telephone system for booking appointments. The Trust and The Willow Group management teams were aware of this issue and had begun implementing a plan to resolve this issue and at the time of inspection had recently secured funding for the project.

The areas where the provider should make improvements are:

  • Continue with the implementation of the governance arrangements for all sites to work in a cohesive way; including for sharing information.

  • Continue to review and monitor staffing levels and skills.

  • Review the need for a formalised quality improvement programme.

  • Review systems and processes to ensure written consent forms are scanned into patient notes in a timely manner.

  • Continue to review systems to improve identification of patients who are also carers.

  • Consider ways to improve support for patients with hearing impairments when in the waiting room of Brune Medical Centre.

  • Continue to review waste management processes in line with policy.

Professor Steve Field (CBE FRCP FFPH FRCGP) 

Chief Inspector of General Practice