Wokingham Community Hospital

Updated 31 October 2019

Wokingham Community Hospital is the registered location for Westcall GP Out of Hours (OOH) service. The service is provided by Berkshire Healthcare Foundation NHS Trust. The service provides OOH primary medical services to over 550,000 registered patients and those requiring immediate (but not emergency) treatment from the Berkshire West area when GP practices are closed. The service had 75,000 patient contacts a year. West Berkshire includes the towns and surrounding villages of Wargrave, Wokingham, Reading, Newbury and Hungerford. There are many rural areas within the catchment area.

Patients can access the Westcall service by calling NHS 111. An appointment is made directly with the service or patient details are added to a queue for GP triage. Following triage, the GP determines if a face-to-face assessment, home visit or remote home care advice is required and makes the appropriate arrangements. If patients require a more urgent outcome, the service can contact the ambulance service or direct patients to other local healthcare services, including the Emergency Department.

A dedicated operations hub is available to take calls from external providers requiring direct access to Westcall (for example, if looking after a patient with an advanced care plan or on the end of life register). The operations hub will also contact patients if there are delays to a GP making a home visit or a return telephone call. In addition the hub allows direct access for patients with end of life care plans, prioritised access to 999 crews on scene and a general operations support function to our teams on the frontline.

The service is led by a Medical Director, the Head of Urgent Care, a Clinical Governance Lead, Matron and an Operations Manager. This leadership team is supported by Directors at both Divisional and Executive level across the Trust. There are nearly 19 whole time equivalent (WTE) GPs, four WTE nurse practitioners, two WTE paramedic practitioners and three health care assistants. The clinical team are further supported by drivers, receptionists, operations room staff and administration staff. The service is registered to provider the following regulated activities:

• Treatment of disorder, disease or injury
• Diagnostic and screening procedures

The service operations centre and referral hub is based at:

The Old Forge

2nd Floor

45-47 Peach Street

Wokingham

RG40 1XJ

Details of the provider and services offered can be accessed through their website: www.berkshirehealthcare.nhs.uk

The service has two locations where GP OOH services are provided from:

Reading Primary Care Centre

Maternity block

Ground Floor

Royal Berkshire Hospital

Craven Road

Reading

RG1 5AN

Newbury Primary Care Centre

West Berkshire Community Hospital

Benham Hill

Thatcham

Berkshire

RG18 3AS

We visited the two clinical sites and the operations hub as part of this inspection. The service was inspected in December 2015, April 2016 and July 2018. All the previous inspection reports can be found by selecting the “all reports” link for “Wokingham Community Hospital – Westcall Out of Hours” on our website at www.cqc.org.uk.

Updated 31 October 2019

This service is rated as Good overall. (Previous inspection July 2018 – Requires improvement)

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? – Good

We carried out an announced comprehensive inspection at Wokingham Community Hospital also referred to as Westcall Out of Hours on 10 and 11 September 2019. We undertook this inspection due to a previous rating of requires improvement from the inspection undertaken in July 2018. At the previous inspection we asked the provider to take actions due to breaches of regulation. We have issued a new rating as a result of this inspection.

At this inspection we found:

• The service had systems to identify and manage risks to patients and staff.
• The service routinely 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 patients in their care and treated people with compassion, kindness, dignity and respect.
• Patients were able to access care and treatment from the service within an appropriate timescale for their needs.
• Since the July 2018 inspection, the service had strengthened existing governance and quality frameworks to make improvements. These frameworks aligned to the strong focus on continuous learning and improvement at all levels of the organisation.

We saw an area of outstanding practice:

• There was a clear, systematic and proactive approach to seeking out and embedding new and innovative models of care within the out of hours care setting. This included processes to improve patient care and the operational performance. For example:

-The provider followed through on their own blood tests undertaken during OOHs care. They analysed and reviewed each patient who had a blood test within the service to ensure effective follow up and communication with GP practices. Point of care blood testing was also available.

-Sepsis pathway care was developed to provide initial treatment on OOHs sites prior to admittance to hospital where sepsis was identified as a potential condition. This was audited for effectiveness

-Advance care plan (ACP’s) templates were we placed on all GP practice computers in West Berkshire so that they could be uploaded via a shared record system. The service monitors monthly figures of deceased patients, assessed the relevant ACPs and report to the CCG so that they can monitor care planning effectiveness

-A flu prophylaxis service was initiated by Westcall OOHs for local care and nursing homes and has become a commissioned service after this proactive initiative.

The area where the provider should consider improvements:

• Continue to consider and how to meet the potential various communication needs of patients, including those with visual or hearing impairments.

Dr Rosie Benneyworth BM BS BMedSci MRCGP

Chief Inspector of Primary Medical Services and Integrated Care