Archived: Shinfield Health Centre Also known as South Reading and Shinfield Group Medical Practice

Updated 6 March 2017

Shinfield Health Centre is one of two surgeries managed by South Reading and Shinfield Group Medical Practice. Shinfield Health Centre has a different contract arrangement to South Reading Surgery but shares policies and procedures and staff work across both sites. Patients registered at Shinfield Health Centre can be seen at South Reading Surgery if they prefer or if an earlier appointment is available.

Shinfield Health Centre is located within a purpose built health facility. The building is shared with a dental practice and other health related clinics. Shinfield village is a ward of Wokingham in Berkshire and has close links to Reading. The village is expanding with significant housing developments under construction close to the practice.

There are approximately 3,300 patients registered at the practice and these are predominantly in younger age groups. There are significantly fewer than average patients registered over the age of 65. Nationally reported data shows that income deprivation within the registered population is at six on a 10 point national scale (one being areas of highest deprivation and 10 the lowest).

The practice holds an Alternative Provider Medical Services (APMS) contract (An APMS contract is a locally negotiated contract open to both NHS practices, voluntary sector and private providers).

Most staff work at both Shinfield Health Centre and South Reading Surgery. The five GPs (three female and two male) share their time between the practices and offer 13 sessions at Shinfield. This is equivalent to approximately 1.6 whole time GPs. The practice nurse works the equivalent of two days at Shinfield Health Centre and the HCA works four days each week. The locum practice manager is supported in the day to day running of the practice by a team of nine administration and reception staff.

The practice is open between 8am and 6.30pm Monday to Friday. Appointments are from 8.30am to 11.30am every morning and 3.50pm to 5.50pm. Extended hours appointments are offered on a Monday and Thursday evening with the last appointment at 7.20pm. Extended hours were also offered on alternate Saturday mornings.

Services are provided from:

Shinfield Health Centre, School Green, Shinfield, Reading, Berkshire, RG2 9EH

The practice has applied to alter their registration with CQC. It is currently incorrectly registered as managed by an individual and has applied to become registered as a partnership. The partnership has been in existence since 2013.

Updated 6 March 2017

Letter from the Chief Inspector of General Practice

We carried out an announced comprehensive inspection at Shinfield Health Centre on 11 January 2017. Overall the practice is rated as requires improvement. Specifically the practice is rated good for the provision of effective services and requires improvement for the provision of safe, caring, responsive and well-led services.

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

• The practice was managed by partners of another practice nearby. Data and feedback from patients was combined across both practice locations. Patients registered at the practice could also be seen at the nearby practice if this was more convenient for them.

• There was an open and transparent approach to safety and an effective system in place for reporting and recording significant events.
• Staff assessed patients’ needs and delivered care in line with current evidence based guidance. Staff had been trained to provide them with the skills, knowledge and experience to deliver effective care and treatment. However, at the time of inspection the lead for infection control had not received training relevant to this responsibility. The practice has since inspection made relevant training available.
• Most patients said they were treated with compassion, dignity and respect. However, feedback relating to involvement in their care and decisions about their treatment was below average.
• Patients said they could obtain urgent appointments on the same day and received continuity of care. The practice had reviewed appointment systems and was introducing a revised more flexible appointment system within two weeks of this inspection.
• The practice had good facilities and was well equipped to treat patients and meet their needs.
• There was a clear leadership structure and staff felt supported by management. The practice proactively sought feedback from staff and patients. However, the response to patient feedback was inconsistent.
• Most risks to patients were assessed and well managed. However, some aspects of the legislation regarding control of substances hazardous to health (COSHH) were not being met. The practice has, since inspection, dealt with these matters. Some recruitment checks had not been recorded.
• Information about services and how to complain was limited in availability. The system for ensuring improvements were made to the quality of care as a result of complaints and concerns was managed inconsistently. Communication of learning from complaints was not always effective.
• Staff understood and fulfilled their responsibilities to raise concerns, and to report incidents and near misses.
• Monitoring arrangements for the administration of medicines had not identified that the appropriate legal requirements were not being followed when the health care assistant administered vaccinations.
• Health checks were offered to a wide range of patients with long term conditions but arrangements to deliver annual health checks for patients diagnosed with a learning disability were not in place.
• Information leaflets were available but these were not held in languages other than English. A significant number of patients were registered from Southern Asia whose first language was not English.

The areas where the provider must make improvements are:

• Ensure recruitment arrangements include all necessary employment checks for all staff.

• Ensure arrangements to identify, assess and manage risk are operated consistently. For example in complying with COSHH regulations and making relevant training in control of infection available.

• Ensuring the views of patients expressed in the national patient satisfaction survey are considered when delivering care and treatment. Also ensure that when changes in service delivery are made, in response to feedback, they are monitored and evaluated.

• Ensure medicines are administered in accordance with national guidance and legislation at all times.

• Ensure learning from complaints is communicated consistently.

In addition the provider should:

• Ensure arrangements are in place for patients diagnosed with a learning disability to receive an annual health check and encourage patients to take part in the national breast and bowel cancer screening programmes.

• Provide practice information in appropriate languages and formats.
• Ensure updates in practice policies and protocols are shared with staff in a timely manner.

.

Professor Steve Field

CBE FRCP FFPH FRCGPChief Inspector of General Practice

Updated 6 March 2017

The practice is rated as requires improvement for provision of safe, caring, responsive and well led services. These ratings apply to all patient groups although there were areas of good practice for this population group

• Nursing staff had lead roles in chronic disease management and patients at risk of hospital admission were identified as a priority.

• The practice achieved 85% of the indicators for care of patients diagnosed with diabetes. This was above the clinical commissioning group (CCG) average of 78% but below the national average of 90%.

• Longer appointments and home visits were available when needed.

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

Updated 6 March 2017

The practice is rated as requires improvement for provision of safe, caring, responsive and well led services. These ratings apply to all patient groups although there were areas of good practice for this population group

• 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 A&E attendances.

• Immunisation rates for the standard childhood immunisations were mixed. For example, whilst the practice had achieved the 90% target for three of the four immunisations offered to children aged under 24 months only 82% had received the pneumococcal booster immunisation.

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

• The practice’s uptake for the cervical screening programme was 83%, which was above the CCG average of 78% and national average of 82%

• Appointments were available outside of school hours and the premises were suitable for children and babies.

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

• Nursing staff were not clear in their understanding of national legislation relating to consent from patients under 16 years of age.

Updated 6 March 2017

The practice is rated as requires improvement for provision of safe, caring, responsive and well led services. These ratings apply to all patient groups although there were areas of good practice for this population group

• The number of registered patients aged over 50 was significantly below national average. Incidence of diseases commonly experienced by older people was therefore lower than average.

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

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

• Data showed the practice had ensured a scan to diagnose osteoporosis (a condition that weakens bones) had been undertaken for 100% of patients who were being treated with a bone sparing medicine. This was above the clinical commissioning group average of 81% and national average of 78%.

Updated 6 March 2017

The practice is rated as requires improvement for provision of safe, caring, responsive and well led services. These ratings apply to all patient groups although there were areas of good practice for this population group

• 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.

• 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.

• The practice offered extended hours appointments on two evenings per week and patients were able to attend alternative Saturday morning clinics at a different local GP practice. Telephone appointments were available for patients who found it difficult to attend the practice during working hours.

Updated 6 March 2017

The practice is rated as requires improvement for provision of safe, caring, responsive and well led services. These ratings apply to all patient groups although there were areas of good practice for this population group

• Due to the lower than average number of patients registered over the age of 50 the incidence of dementia was also lower than average. 97

• The practice had agreed a care plan in the last year with 97% of patients diagnosed with a long term mental health problem. This was above the CCG and national average of 89%.

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

• The practice 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.

• The practice 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 patients with mental health needs and dementia.

Updated 6 March 2017

The practice is rated as requires improvement for provision of safe, caring, responsive and well led services. These ratings apply to all patient groups although there were areas of good practice for this population group

• The practice held a register of patients living in vulnerable circumstances including homeless people, travellers and those with a learning disability. There were 59 patients diagnosed with a learning disability. A total of 29 had received a physical health check in the last year and the practice had not made arrangements for these health checks to be undertaken.

• The practice offered longer appointments for patients with a learning disability.

• The practice regularly worked with other health care professionals in the case management of vulnerable patients.

• The practice informed vulnerable patients about 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.