Archived: London Road Surgery

Updated 30 August 2016

Letter from the Chief Inspector of General Practice

We carried out an announced comprehensive inspection at London Road Surgery, Reading on 17 November 2015. Overall the practice is rated as good.

Our key findings across all the areas we inspected were as follows:

• There was an open and transparent approach to safety and an effective system in place for reporting and recording significant events.
• Risks to patients were assessed and well managed and recruitment checks were completed.
• Staff assessed patients’ needs and delivered care in line with current evidence based guidance.
• There were gaps within staff training and development, including elements of mandatory training and the Mental Capacity Act 2005.
• Patients said they were treated with compassion, dignity and respect and they were involved in their care and decisions about their treatment.
• Information about how to complain was available and easy to understand.
• Information about services was available but not everybody would be able to understand or access it as only a few posters and leaflets were in another language (the practice recognised that they had a high number of their practice population whose first language was not English).
• Urgent appointments were usually available on the day they were requested, although patient feedback suggested this was not always the case.
• There was a clear leadership structure and staff felt supported by management. The practice proactively sought feedback from staff and patients, which it acted on.
• The provider was aware of and complied with the requirements of the Duty of Candour.

We saw one area of outstanding practice:

The practice had been recognised by the Clinical Commissioning Group (CCG) for their work on improving sexually transmitted disease screening targets. The 2013/14 figures indicated that the surgery was performing poorly for the locality, being forth from the bottom in a performance table of 54 practices. The figures for October 2015 showed improvement, with the practice being third from the top and increasing their screening percentage from 0.6% to 4.3%. Only two other practices had achieved the CCG target of more than 5% of the eligible population group being screened.

The areas where the provider must make improvements are:

• To provide the appropriate training and updates in essential skills such as basic life support and the Mental Capacity Act 2005 to all staff at the required level. In addition, the practice must complete the induction programme for newly appointed staff and ensure an ongoing timetable of training requirements for all staff is implemented.

• The practice must implement a protocol in line with their risk assessment relating to medical emergency response times and consider their preparedness for a cardiac emergency with the provision of an automated external defibrillator as recommended by the UK Resuscitation Council.

The areas where the provider should make improvements are:

• Provide practice information, including the complaints procedure, in appropriate languages and formats.
• Ensure services are accessible to those with hearing or speech difficulties. For example, by installing a hearing loop and offering British sign language as part of their translation services.

Professor Steve Field (CBE FRCP FFPH FRCGP) 

Chief Inspector of General Practice

Updated 21 January 2016

The practice is rated as good for the care of people with long-term conditions.

• Quality and outcomes framework (QOF) indicators for diabetes care showed the practice had obtained 87.2% which was higher than the Clinical Commissioning Group average (80%) and comparable with the national average (89%).

• Longer appointments and home visits were available when needed.

• All these patients had a named GP and a structured annual review to check that their health and medicines needs were being met. For those people with the most complex needs, the named GP worked with relevant health and care professionals to deliver a multidisciplinary package of care.

• Patients approaching the last days of life had access to a GP’s personal mobile number to ensure continuity and efficiency of palliative (end of life) care.

Updated 21 January 2016

The practice is rated as good for the care of families, children and young people.

• There were systems in place to identify and follow up children living in disadvantaged circumstances and who were at risk, for example, children and young people who had a high number of accident and emergency attendances. Immunisation rates were relatively high for all standard childhood immunisations.

• Patients told us that children and young people were treated in an age-appropriate way and were recognised as individuals, and we saw evidence to confirm this.

• 88.25% of women aged between 25-64 have had cervical screening in the last five years. This was greater than the CCG average of 82.55% and national average of 81.88%.

• Appointments were available outside of school hours and the premises were suitable for children and babies. The practice offered same day appointments for under five year olds as standard practice.

• We saw good examples of joint working with midwives and health visitors.

The practice sent a congratulations letter to new mothers with an appointment for their six week post-natal check.

Updated 21 January 2016

The practice is rated as good for the care of older people.

• The practice offered proactive, personalised care to meet the needs of the older people in its population.

• It was responsive to the needs of older people, and offered home visits and urgent appointments for those with enhanced needs.

• A staff member had asked the practice about improving elderly care through the provision of an elderly care pack. This has recently been implemented and contains useful contact numbers, information on claiming benefits and social services entitlement as well as leaflets from local and national charity organisations.

• The percentage of people aged 65 or over who received a seasonal flu vaccination (77.7%) was greater than the national average (72.99%).

Updated 21 January 2016

The practice is rated as good for the care of working-age people (including those recently retired and students).

• The needs of the working age population, those recently retired and students had been identified and the practice had adjusted the services it offered to ensure these were accessible, flexible and offered continuity of care.

• Early morning appointments had just been implemented on Friday mornings with a plan to review this in three months.

• The practice had an agreement with two other surgeries to provide a Saturday morning surgery rota, providing GP services by pre-bookable appointment.

• The practice was proactive in offering online services as well as a full range of health promotion and screening that reflects the needs for this age group.

• There was a recent increase in screening for sexually transmitted diseases (STD’s) following a performance table result showing the practice forth from bottom of 54 practices. The improvement had been recognised by the CCG with the practice now third from the top, with an increase from 0.6% to 4.3%. Only two practices in the locality had successfully achieved the CCG target of over 5%.

Updated 21 January 2016

The practice is rated as good for the care of people experiencing poor mental health (including people with dementia).

• 100% of patients with schizophrenia, bipolar affective disorder and other psychoses disorder have a comprehensive, agreed care plan documented in the record in the preceding 12 months

• The practice regularly worked with multi-disciplinary teams in the case management of people experiencing poor mental health, including those with dementia.

• It carried out advance care planning for patients with dementia.

• The practice had told patients experiencing poor mental health about how to access various support groups and voluntary organisations.

• It had a system in place to follow up patients who had attended accident and emergency where they may have been experiencing poor mental health.

• Staff had a good understanding of how to support people with mental health needs and dementia.

Updated 21 January 2016

The practice is rated as good for the care of people whose circumstances may make them vulnerable.

• There were no registered patients identified as homeless or from the travelling community but a policy was in place to allow people with no fixed address to register or be seen at the practice.

• Longer appointments were available for people with a learning disability.

• The practice regularly worked with multi-disciplinary teams in the case management of vulnerable people.

• Vulnerable patients were advised how to access various support groups and voluntary organisations.

Staff knew how to recognise signs of abuse in vulnerable adults and children. Staff were aware of their responsibilities regarding information sharing, documentation of safeguarding concerns and how to contact relevant agencies in normal working hours and out of hours.