The Bucklebury Practice Also known as Chapel Row Surgery

Updated 23 August 2016

The Bucklebury Practice (also known as Chapel Row Surgery) offers primary medical services to over 7,600 patients in a 50 square mile area of rural and semi-rural West Berkshire. The practice area has an estimated low level of socio-economic deprivation, meaning few patients are affected by deprivation locally. There is a lower number of unemployed patients compared to local and national averages. The practice profile is mainly white British, with only 3% of the local population from ethnic minority backgrounds.

The practice has three GP partners (two male, one female) and two salaried GPs (both female). The GPs offer 35 sessions per week which offers a working time equivalent (WTE) of 4.38 full time GPs. The nursing team consists of five practice nurses (all female) who are all part time and make up 2.81full time WTE. In addition, there is one healthcare assistant/phlebotomist (female). The dispensary team includes a full time dispensary manager, an assistant dispensary manager, four qualified dispensers and two dispensary assistants. Day to day management of the practice is delivered by a full time practice manager, two medical secretaries, two administration staff, a summariser, a reception manager and seven receptionists. There are also two cleaners employed by the practice.

The Bucklebury Practice is a single storey purpose built building which has been extended in recent years. There is a large car park to the front and rear of the building with a small number of designated disabled parking spaces. The entranceway has wide doors which lead to a large lobby and reception area. There is a large waiting room with adequate space for wheelchairs and pushchairs. There are eight GP consultation rooms and three nurse/phlebotomist treatment rooms which are accessible from the waiting area. There are two patient toilet facilities including a disabled toilet with emergency pull cord. Baby change facilities are also available.

The practice is open between 8am and 6.30pm Monday to Friday. Appointments are offered from 8.30am to 12.45pm every morning and 2pm to 6.15pm daily. Extended hours clinics are offered on Monday and Wednesday evenings until 7.30pm and alternate Saturdays from 9am to 12pm.The practice have opted out of offering out of hours GP services. This cover is provided by Westcall via the NHS 111 telephone service.

All services are provided from:

The Bucklebury Practice, Chapel Row Surgery, The Avenue, Bucklebury, Reading, RG7 6NS.

The practice has not been inspected by CQC prior to this visit.

Updated 23 August 2016

Letter from the Chief Inspector of General Practice

We carried out an announced comprehensive inspection at The Bucklebury Practice on 15 June 2016. 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.
• 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.
• Patients said they were treated with compassion, dignity and respect and they were involved in their care and decisions about their treatment.
• Information about services and how to complain was available and easy to understand. Improvements were made to the quality of care as a result of complaints and concerns.
• Patients said they found it easy to make an appointment with a named GP and there was continuity of care, with urgent appointments available the same day.
• 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, which it acted on.
• The provider was aware of and complied with the requirements of the duty of candour.

However,

• The practice used patient group directions (PGDs) for some travel vaccines. We found two of these had expired in March 2016. The practice nursing team were unaware of the expiry date, they had not been informed by NHS England and there were no further updates or extensions to the existing ones. Once it was brought to their attention, one of the nurses completed a significant event record and initiated the use of a patient specific direction to cover the small number of patients requiring these vaccines. During a root cause analysis of the event, it transpired the GPs were signing the travel assessment form which prescribed the vaccine by default.

The areas where the provider should make improvements are:

• To ensure a system is in place for checking the patient group directions expiry dates for travel vaccines.

Professor Steve Field (CBE FRCP FFPH FRCGP) 

Chief Inspector of General Practice

Updated 23 August 2016

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

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

• Diabetic indicators showed the practice had achieved 90% compared to the CCG average of 86% and national average of 89%. For example, 86% of patients with diabetes had achieved a target cholesterol reading which was higher than the CCG average of 82% and national average of 81%.

• The practice held virtual clinics with a Community Diabetes Consultant and one of the GPs was the clinical commissioning group lead for diabetes care.

• The practice offered care planning for all diabetic patients and annual screening for pre-diabetic patients with health and lifestyle advice to reduce the risk of developing diabetes.

• 87% of patients with chronic obstructive pulmonary disease (a lung condition) had a review and an assessment of breathlessness compared to the CCG and national averages 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 23 August 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 patients who had a high number of A&E attendances. Immunisation rates were relatively high for all standard childhood immunisations.

• 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.

• 84% of women aged between 25 and 64 had a record of receiving a cervical smear test within the last five years compared to the CCG average of 87% 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 23 August 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 patients in its population.

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

• 85% of patients with chronic kidney disease had achieved a target blood pressure compared to the CCG average of 80% and national average of 81%.

Updated 23 August 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.

• 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.

Updated 23 August 2016

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

• 86% of patients diagnosed with dementia who had their care reviewed in a face to face meeting in the last 12 months, which was comparable to the CCG average of 87% and national average of 89%.
• 100% of patients with a diagnosed psychiatric condition had a comprehensive, agreed care plan in the last 12 months compared to the CCG average of 86% and national average of 88%.

• 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 23 August 2016

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

• The practice held a register of patients living in vulnerable circumstances including homeless people, travellers and those with a learning disability.

• 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.