Archived: South Reading Surgery Also known as South Reading & Shinfield Group Medical Practice

Updated 10 May 2017

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

South Reading Surgery is located within a converted two-storey house in a residential area of Reading. It is one of the practices within South Reading Clinical Commissioning Group and provides GP services to over 5,000 patients. According to data from the Office for National Statistics, Reading population demographics show a medium level of economic deprivation with pockets of low deprivation within the practice boundary. There is a higher percentage of unemployed patients compared to local and national averages. Ethnicity based on demographics collected in the 2011 census shows the population of Reading is predominantly White British with 1 3% of the practice population composed of patients with an Asian background and 10% from other non-white ethnic backgrounds.

South Reading Surgery has a two-storey main building and a permanent portakabin behind it. The portakabin is only accessible from outside and has a ramp for disabled access. There is one consultation room and one treatment room on the ground floor of the main building and one consultation room and one treatment room in the portakabin. There are dedicated reception areas and toilet facilities available in both buildings. The practice also provides GP services to two local nursing homes, with approximately 120 patients being looked after by the practice.

There are two full time GP partners (both female) and three salaried GPs (one female, two male) offering a whole time equivalent (WTE) of 2.13 GPs. The nursing team consists of one full time practice nurse and a full time healthcare assistant (HCA) (both female). Both the nurse and HCA work across both practice sites with the nurse providing three days and HCA one day per week at South Reading Surgery. The day to day management of the practice is supported by a team of administration staff including an interim practice manager, an assistant practice manager, two medical secretaries, an operational assistant, an administrator and ten receptionists.

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 daily. Extended hours appointments for face-to-face consultations are offered on Monday evenings from 6.30pm to 7.30pm and alternate Saturdays from 8.30am until 11.30am. The practice have opted out of providing out of hours c over. This is provided by Westcall by calling the NHS 111 number.

All services are provided from:

South Reading Surgery, Whitley Wood Road, Reading, Berkshire, RG2 8LE

Patients can also access services at:

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

Updated 10 May 2017

Letter from the Chief Inspector of General Practice

We carried out an announced comprehensive inspection at South Reading Surgery on 11 January 2017. Specifically, we have rated the practice as inadequate for the provision of safe and well led services and requires improvement for the provision of caring and responsive services. The practice was rated good for providing effective services. The concerns which led to these ratings apply to all population groups using the practice. Overall the practice is rated as inadequate.

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

• Patients were at risk of harm because systems and processes were not in place to keep them safe. For example, electrical wiring and fire risk assessments identified high risk actions which had not been carried out in a timely way. In addition, the practice had not undertaken health and safety risk assessments, including legionella. Some aspects of the legislation regarding the control of substances hazardous to health (COSHH) were not being met.
• Monitoring arrangements for the administration of medicines had failed to identify that the appropriate legal requirements were not being followed when the health care assistant administered vaccinations.
• Provision of emergency medicines had not been reviewed and the process in place for checking emergency equipment was inconsistent with some out of date equipment found.
• Individuals in lead roles had not received training to enable them to carry out their work.
• The fridge temperature logs were completed inconsistently. Some identified cold chain breaches had no documented actions.
• Not all recruitment checks for new members of staff had been undertaken prior to their employment.
• Complaints were dealt with inconsistently and documentation did not accurately reflect actions taken or outcomes for learning.
• Information about services and how to complain was not on display and there was no feedback box available to offer patients the opportunity to complain anonymously.
• The majority of patients said they were treated with compassion, dignity and respect. However, not all felt cared for, supported and listened to.
• The practice had limited leadership capacity and informal governance arrangements.
• Practice policies and protocols were kept under review but updates were not always shared with staff.
• Staff had been trained to provide them with the skills, knowledge and experience to deliver effective care and treatment. However, we found many staff had undertaken large amounts of e-learning in a short space of time, which meant staff were unable to retain the information from the training.

There were, however, areas of good practice:

• Patients registered at the practice could also be seen at another nearby practice, managed by the same organisation, if this was more convenient for them.
• 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.
• There was 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.
• The practice had appropriate facilities and was well equipped to treat patients and meet their needs, despite the constraints of the premises.

The areas where the provider must make improvements are:

• Ensure systems to assess, monitor, manage and mitigate risks to the health and safety of service users are implemented. This includes the assessment and monitoring of infection control, medicines management and recruitment checks.
• Implement formal governance arrangements including systems for assessing and monitoring risks, including health and safety, electrical and fire safety, legionella and COSHH.
• Ensure the views of patients expressed in the national patient satisfaction survey are considered in order to improve the delivery of care and treatment.

The areas where the provider should make improvements are:

• Ensure arrangements are in place for patients diagnosed with a learning disability to receive an annual health check.
• Ensure updates in practice policies and protocols are shared with staff in a timely manner.
• Ensure learning from complaints is clearly identified and shared consistently with staff of all grades and disciplines.
• Ensure staff receive suitable training for lead roles.
• Review the identification of carers and improve support.
• Improve patient awareness of access to translation and bereavement services and consider installing a hearing loop.

I am placing this service in special measures. Services placed in special measures will be inspected again within six months. If insufficient improvements have been made such that there remains a rating of inadequate for any population group, key question or overall, we will take action in line with our enforcement procedures to begin the process of preventing the provider from operating the service. This will lead to cancelling their registration or to varying the terms of their registration within six months if they do not improve.

The service will be kept under review and if needed could be escalated to urgent enforcement action. Where necessary, another inspection will be conducted within a further six months, and if there is not enough improvement we will move to close the service by adopting our proposal to remove this location or cancel the provider’s registration.

Special measures will give people who use the service the reassurance that the care they get should improve.

Professor Steve Field (CBE FRCP FFPH FRCGP) 

Chief Inspector of General Practice

Updated 16 March 2017

The practice is rated as inadequate for the care of people with long-term conditions. The provider was rated as inadequate for safety and for well-led and requires improvement for caring and responsive services. The issues identified as inadequate overall affected all patients including this population group. There were, however, examples of good practice.

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

• 70% of patients with diabetes had a blood glucose test result of 64mmol or less in the preceding 12 months compared to the CCG average of 72% and national average of 78%.

• 93% of patients with chronic obstructive pulmonary disease (COPD – a lung condition) had received a review and assessment of breathlessness compared to the CCG average of 92% and national average of 90%.

• Longer appointments 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 16 March 2017

The practice is rated as inadequate for the care of families, children and young people. The provider was rated as inadequate for safety and for well-led and requires improvement for caring and responsive services. The issues identified as inadequate overall affected all patients including this population group. There were, however, examples of good practice.

• 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 were comparable to national target indicators for all standard childhood immunisations, with the exception of pneumococcal conjugate booster for children aged 2 which was below the national target of 90%.

• 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.

• 83% of women aged 25 to 64 years had a cervical screening test performed in the preceding five years compared to 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, health visitors and school nurses.

Updated 16 March 2017

The practice is rated as inadequate for the care of older people. The provider was rated as inadequate for safety and for well-led and requires improvement for caring and responsive services. The issues identified as inadequate overall affected all patients including this population group. There were, however, examples of good practice.

• 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.

• 83% of patients with hypertension (high blood pressure) had achieved a target blood pressure reading in the preceding 12 months compared to the clinical commissioning group (CCG) average of 82% and national average of 83%.

• The practice told us home visits were available but patient feedback on the day suggested some patients had difficulty accessing these.

Updated 16 March 2017

The practice is rated as inadequate for the care of working-age people (including those recently retired and students). The provider was rated as inadequate for safety and for well-led and requires improvement for caring and responsive services. The issues identified as inadequate overall affected all patients including this population group. There were, however, examples of good practice.

• 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.

• There was a mixed uptake for health checks and health screening. For example, 49% of patients aged 60 to 69 had been screened for bowel cancer in the preceding 30 months compared to the CCG average of 49% and national average of 58%.

Updated 16 March 2017

The practice is rated as inadequate for the care of people experiencing poor mental health (including people with dementia). The provider was rated as inadequate for safety and for well-led and requires improvement for caring and responsive services. The issues identified as inadequate overall affected all patients including this population group. There were, however, examples of good practice.

• 97% of patients diagnosed with dementia who had their care reviewed in a face to face meeting in the last 12 months, compared to the CCG average of 89% and national average of 84%.

• 98% of patients with a diagnosed mental health condition had an agreed care plan in the preceding 12 months compared to the CCG average of 91% 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 16 March 2017

The practice is rated as inadequate for the care of people whose circumstances may make them vulnerable. The provider was rated as inadequate for safety and for well-led and requires improvement for caring and responsive services. The issues identified as inadequate overall affected all patients including this population group. There were, however, examples of good practice.

• 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 the remaining 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.