The Care Quality Commission
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  • GP practice

Archived: Eldon Road Surgery

Overall: Good read more about inspection ratings

10 Eldon Road, Reading, Berkshire, RG1 4DH (0118) 939 1919

Provided and run by:
Dr Ramnath Narayan

All Inspections

12 April 2017

During an inspection looking at part of the service

Letter from the Chief Inspector of General Practice

We carried out an announced comprehensive follow up inspection at Eldon Road Surgery on 19 August 2016. The overall rating for the practice was good but requires improvement for provision of effective services because we identified a breach of regulation. The breach of regulation relating to effective provision of services had also led to a rating of requires improvement for two population groups, people with long term conditions and people experiencing poor mental health (including people with dementia). The full report on the August 2016 inspection can be found by selecting the ‘all reports’ link for Eldon Road Surgery on our website at www.cqc.org.uk.

This inspection was an announced focused inspection carried out on 12 April 2017 to confirm that the practice had carried out their plan to meet the legal requirements in relation to the breach in regulation that we identified in our previous inspection on 19 August 2016. This report covers our findings in relation to that requirement and also additional improvements made since our last inspection.

Overall the practice remains rated as good and we have updated the rating for provision of effective services to good.

Our key findings were as follows:

  • Outcomes for people with long term conditions were similar to both local and national averages from the previous year.
  • There had been an increase in screening rates for both cervical and breast cancer.
  • Care plans had been updated to ensure those patients that needed such plans had them in place. Care plans were agreed with the patient.
  • Audits had been undertaken to ensure that patients with long term medical conditions were called for regular reviews. For example, audit of medicines used in the care of patients with diabetes had taken place resulting in an increase of 14 patients on the diabetes recall programme.
  • The practice had increased GP availability from 1.1 whole time GPs to 1.4 thus giving better access to GP appointments.
  • There was a sharper focus on improving the health of patients and promoting healthy lifestyles.

We saw one area of outstanding practice:

  • Care plans for patients whose first language was not English had been translated into Nepalese and Hindi. Patients were given a copy of their plan. The translation assisted them and their relatives or carers to follow the agreed actions. Approximately 35% of patients registered at the practice were identified from ethnic groups other than white British.

At our previous inspection on 19 August 2016, we rated the practice as requires improvement for providing effective services as the practice had breached the regulation relating to safe care and treatment. At this inspection we found that sufficient improvement had been achieved to update the rating for provision of effective services to good. The practice had addressed the breach of regulation and was now compliant with all regulations.

Professor Steve Field (CBE FRCP FFPH FRCGP) 

Chief Inspector of General Practice

19 August 2016

During an inspection looking at part of the service

Letter from the Chief Inspector of General Practice

We first inspected Eldon Road Surgery on 7 January 2016. At that time evidence showed the practice not to be meeting regulations and the practice was rated inadequate. It was subsequently placed into special measures.

Consequently we carried out an announced comprehensive inspection at Eldon Road Surgery on 19 August 2016. This second comprehensive inspection was undertaken to check whether the practice had completed the actions the practice told us they would take to comply with regulations. Our inspection findings have resulted in the practice achieving a revised rating of good overall. However, the practice has been rated as requires improvement for the delivery of effective services because further improvement is needed in outcomes for patients with long term medical conditions and in disease prevention.

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. This had improved since our inspection in January 2016 when we found that recording of significant events was not always completed in detail.
  • 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 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.
  • Environmental risks were assessed and mitigating action taken to address any risks identified. A risk management culture had been adopted.
  • The practice had taken action to comply with fire safety regulations.
  • Information for patients was more readily available via a new website. This provided patients with the opportunity to access services online.
  • There was a clear plan to improve outcomes for patients with long term conditions and those with complex health needs.
  • Action had been taken to provide more accessible information for patients from ethnic groups.
  • Improvements had been made to make services more accessible to patients with disabilities.

However,

  • Outcomes for patients with long term conditions remained below average.

  • Performance in disease prevention activities was also below average.

The areas where the provider must make improvement are:

  • Maintaining systems that ensure outcomes for patients with long term conditions continue to be improved.

  • Ensuring performance in delivering disease prevention programmes is improved, particularly promoting the benefits of stopping smoking.

  • Ensure care plans are appropriately recorded and are fit for purpose.

I am taking this service out of special measures. This recognises the significant improvements made to the quality of care provided by this service.

Professor Steve Field (CBE FRCP FFPH FRCGP) 

Chief Inspector of General Practice

7 January 2016

During a routine inspection

Letter from the Chief Inspector of General Practice

We carried out an announced comprehensive inspection at Eldon Road Surgery on 7 January 2016. The practice is rated good for delivering caring services. However, it is rated as inadequate for the delivery of safe effective and well led services and requires improvement for the delivery of responsive services. This leads to an overall rating of inadequate which affects the rating for all population groups.

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

  • Staff understood and fulfilled their responsibilities to raise concerns, and to report incidents and near misses.
  • Safeguarding systems and procedures were in place and staff were well trained in safeguarding procedures.
  • Audit had been carried out and we saw this was driving improvement in the care of patients diagnosed with diabetes.
  • Patients said they were treated with compassion, dignity and respect and we saw staff delivering a compassionate and supportive service.
  • Urgent appointments were available on the day they were requested.
  • The practice had proactively sought feedback from patients and acted upon feedback. A patient participation group had been formed and was developing its role.
  • The practice was inclusive and staff meetings involved all disciplines at all times.

However,

  • Health and safety risks to patients were either assessed inconsistently, or not assessed at all. The processes for addressing issues identified from risk assessments were weak.
  • Data showed patient outcomes were low compared to the locality and nationally. Some care of patients with long term conditions had either not been undertaken or had not been recorded in patient’s records.

  • Information about services was available but not everybody would be able to understand or access it. For example, there were no information leaflets available in Nepalese despite there being a large number of Nepalese patients registered with the practice.

  • The practice had a number of policies and procedures to govern activity. But governance systems were not effective in taking action when weaknesses in systems or risk had been identified.
  • Reasonable adjustments had not been made to the practice premises to support the needs of patients with a disability.

There are areas where the provider must make improvements and these are:

  • Review the fire safety risks and take appropriate and reasonable action to improve the safety of patients prior to the fire service enforcement notice being served.

  • Take immediate action to address the concerns identified in the enforcement notice to be issued by the fire and rescue authority.

  • Complete a full range of appropriate risk assessments. Including an assessment of the risks of evacuation of a patient from clinical room in event of a medical emergency.

  • Undertake an environmental assessment on the suitability of the premises to accommodate patients with a disability.

  • Implement checks on emergency equipment. This includes the recording of these checks.

  • Ensure the requirement for emergency medicines is risk assessed and action taken in response to the findings.

  • Increase the take up of cervical screening.

  • Ensure all medical equipment is subject to annual maintenance and calibration.

  • Ensure the practice appraisal system is operated consistently.

  • Improve care and treatment for patients with long term medical conditions. Ensure the improvements are sustainable. Accurately record treatments and tests for this group of patients.

  • Improve performance in the public health targets. Data showed the practice was a below average performer in four out of six domains.

  • Ensure the diagnosis of cancer is recorded in patient records and the care and treatment for these patients is also undertaken and recorded.

In addition the provider should:

  • Provide practice information in appropriate languages and formats.
  • Provide a practice website that enables patients to access practice services on line and offers up to date information about practice services and performance.
  • Improve the recording of learning arising from significant events.

I am placing this practice in special measures. Practices placed in special measures will be inspected again within six months. If insufficient improvements have been made so a rating of inadequate remains 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 practice 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.

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

Professor Steve Field (CBE FRCP FFPH FRCGP) 

Chief Inspector of General Practice