Archived: Melrose Surgery - Dr Fab Williams & Partner

Updated 19 November 2015

Melrose Surgery - Dr Fab Williams & Partner is located in a converted building in Reading and has a population of approximately 1650 patients. The practice population has some economic deprivation although the proportion of patients affected by deprivation is higher among children and older patients. There are a higher proportion of patients aged 35 to 50 registered with the practice than the national average.

At the time of the inspection a locum GP provided appointments four days a week and a partner provided appointments one morning per week. Both GPs were female. There was one practice nurse. Patient services were located on the first floor and basement. There was no patient participation group (PPG).

The practice was open between 8.00am and 6.30pm Monday to Friday. Appointments were available Monday to Friday. There are no extended hours appointments available.

The practice underwent a comprehensive inspection on 21 January 2015 and as a result was placed into special measures. The practice was due to close on the 9 October 2015.

Melrose Surgery - Dr Fab Williams & Partner has a General Medical Services (GMS) contract. GMS contracts are negotiated between NHS England and the practice.

This was a comprehensive inspection of the surgery at

Melrose Surgery, 73 London Road, Reading, RG1 5BS

The practice has opted out of providing out of hours services to their patients. There are arrangements in place for services to be provided when the surgery is closed and these are displayed at the practice and on the website. Out of hours services are provided by West Call.

Updated 19 November 2015

Letter from the Chief Inspector of General Practice

We carried out an announced comprehensive inspection at Melrose Surgery Dr FAB Williams and Partner on 18 September 2015. This inspection covered areas of concern we identified at our last comprehensive inspection in January 2015, after a six month period of the practice being in special measures. On the date of inspection visit several staff members were absent and access to information we needed was limited. Some information we requested was not sent to us. Therefore some sections of the report do not have the range of evidence we would usually gather.

At this inspection our key findings across all the areas we inspected were as follows:

• The practice was due to close on the 9th October 2015 and the patients registered at Melrose Surgery Dr FAB Williams and Partner were to be transferred to the neighbouring GP provider.
• Risks to patients were often not identified, assessed or well managed.
• Staff were not always provided with the protocols and awareness they needed to respond to emergencies.
• Medical equipment and drugs were available but emergencies were not appropriately planned for.
• Infection control and hygiene of clinical areas was not effectively monitored.
• Medicines were not monitored appropriately
• Patients had not been informed via signs in the practice or on the website that the practice had a rating of inadequate given following the inspection in January 2015.

• Staff had processes to follow in order to raise concerns, and to report incidents and near misses. Information about safety was recorded, and reviewed.
• Patients’ medical needs were being assessed and care was planned and delivered following national guidance
• Patients said they were treated with compassion, dignity and respect and they were involved in their care and decisions about their treatment.

• The practice was mostly clean but we found areas of dust in treatment rooms. Maintenance had improved since our inspection in January 2015.
• There was monitoring of patient care but this was not in the form of a cohesive programme of clinical audit. The practice had prioritised resources in the identification of patients overdue medical and long term condition reviews to ensure their care was effective and safe, over recent months.
• Information about services and how to complain was not easily available.
• Access to appointments was good. Appointments were available the same day.
• Accessibility for disabled patients had been improved but it was still not appropriately assessed despite the concerns being raised in January 2015.
• Meetings had been introduced for staff communication but staff did not always feel supported by the leadership team.

• The practice did not communicate effectively with patients to advise them of the closure of the practice. Some patients reported being very concerned at the lack of communication.

There were areas of practice where the provider must make improvements:

• Improve infection control procedures including the monitoring of cleaning
• Fully prepare the service for medical and other emergencies by ensuring staff have the correct drugs, training and awareness of how to respond to emergencies which may occur.
• Monitor medicines to ensure they are safe and effective.
• Put in place a full programme of clinical audit including responsive audits where data suggested that improvements to the service can be made.
• Ensure patients with limited mobility can access the service safely and where possible independently.
• Improve communication with patients specifically in regards to the transfer of patients to another practice.
• Review systems of governance to reflect the needs of the practice and to support staff in their roles.
• Display the practices rating of its performance by the Commission following an inspection.

The practice has been rated as inadequate overall after the inspection in September 2015, which followed the practice being placed into special measures in January 2015. The provider will be cancelling their own registration and a new NHS England contract, with a new provider, commenced on 9 October 2015.

Professor Steve Field (CBE FRCP FFPH FRCGP) 

Chief Inspector of General Practice

Updated 19 November 2015

The practice is rated as inadequate for the care of people with long-term conditions. There were concerns which led to ratings of requires improvement in the effective, caring and responsive domains and to ratings of inadequate for safety and well-led. These concerns related to all the population groups. The nurse led the reviews of patients with chronic disease. Longer appointments and home visits were available when needed. A locum GP was providing the majority of appointments and the remaining GP partner provided appointments once a week. Multi-disciplinary working took place where necessary. There was improved monitoring of long term conditions since the inspection undertaken in April 2015. However, there was no programme of clinical audit to identify and embed improvements for this group of patients.

Updated 19 November 2015

The practice is rated as inadequate for the care of families, children and young people. There were concerns which led to ratings of requires improvement in the effective, caring and responsive domains and to ratings of inadequate for safety and well-led. These concerns related to all the population groups. 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 close to the national average for all standard childhood immunisations. Child immunisations had been suspended in July 2015 and August 2015 meaning the numbers of these completed for the year so far were lower than expected. Pre and post-natal appointments with a GP were undertaken at a nearby practice in Reading. A midwife also saw patients in the practice. Facilities including access for buggies and prams had not been improved significantly since our inspection in January 2015.

Updated 19 November 2015

The practice is rated as inadequate for the care of older people. There were concerns which led to ratings of in the effective, caring and responsive domains and to ratings of inadequate for safety and well-led. These concerns related to all the population groups. Nationally reported data showed that outcomes for patients were good for conditions commonly found in older people. The practice provided reviews of conditions often associated with aging such as dementia and screening for such conditions was offered to patients. Home visits were offered by an external GP and same day appointments were also available.

Updated 19 November 2015

The practice is rated as inadequate for the care of working age people (including those recently retired and students). There were concerns which led to ratings of requires improvement in the effective, caring and responsive domains and to ratings of inadequate for safety and well-led. These concerns related to all the population groups. No extended hours appointments were available which potentially affected this group of patients the most. Access during normal working hours was good. Phone access to the practice was rated highly by patients. This was particularly useful for patients calling at peak times for appointments such as those who work full time.

Updated 19 November 2015

The practice is rated as inadequate for the care of people experiencing poor mental health (including people with dementia). There were concerns which led to ratings of requires improvement in the effective, caring and responsive domains and to ratings of inadequate for safe and well-led. These concerns related to all the population groups. Dementia screening was offered to patients deemed at risk of the condition. Care plans were developed for some patients with poor mental health. The practice had told patients experiencing poor mental health about how to access various support groups and voluntary organisations. Records showed that monitoring of medication for patients on anti-depressants took place.

Updated 19 November 2015

The practice is rated as inadequate for the care of people whose circumstances may make them vulnerable. There were concerns which led to ratings of requires improvement in the effective, caring and responsive domains and to ratings of inadequate for safety and well-led. These concerns related to all the population groups. The practice held a register of patients living in vulnerable circumstances including those with a learning disability. It offered annual health checks and longer appointments for people with a learning disability. Phone translation services were available for patients who did not have English as a first language. The practice regularly worked with multi-disciplinary teams in the case management of vulnerable people. It had told vulnerable patients about how to access various support groups and voluntary organisations.