Swallowfield Medical Practice

Updated 3 August 2016

Swallowfield Medical Practice, Shinfield branch Surgery and Arborfield branch Surgery offer primary medical services to over 11,500 patients in the Swallowfield, Shinfield and Arborfield areas of Wokingham. The practice area has an estimated low level of socio-economic deprivation, meaning few patients are affected by deprivation locally. The practice offers GP and nursing consultations from three sites. Patients are given the option to be seen at any practice and staff work across all sites. The practice look after one nursing home and one residential home for elderly patients. They are also responsible for four residential homes for patients with severe learning disabilities.

The practice has three GP partners (all male) and four salaried GPs (three female, one male). The nursing team consists of four practice nurses (all female), two healthcare assistants (both female) and two phlebotomists. The practice dispensary at Swallowfield has a dispensary manager and eight dispensers. The practice is supported by a large organisational and administration team, consisting of a practice manager, a deputy practice manager, an IT manager, five administration staff, a reception manager and eight receptionists.

Swallowfield Medical Practice (the main practice) is located in a purpose built building in a semi-rural area. There is ample parking available and designated disabled parking spaces. The entranceway has push button opening doors which lead to the reception and waiting room area. There are six GP consultation rooms and two nurse 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.

Swallowfield Medical Practice is open between 8am and 6.30pm Monday to Friday. Appointments vary daily depending on the GP available. Morning appointments start from 8.15am to 8.30am and finish between 11.20am and 11.50am Afternoon appointments commence between 1.30pm and 2.10pm and finish between 5.10pm and 5.15pm daily. Extended hours appointments at Swallowfield are offered on Monday evenings until 8pm, Wednesday mornings from 7.30am, Thursday evenings until 7.15pm and every alternate Saturday from 8am to 12pm.

Shinfield branch surgery is located approximately 3 miles from the main practice. Opening times are Monday from 8am to 6.30pm and Tuesday to Friday 8am to 1pm. Appointments are from 8am or 8.30am until 11.50am in the morning and on Monday afternoons between 2pm and 5.20pm.

Arborfield branch surgery is located 3.5 miles from the main practice at Swallowfield. It is closed on Mondays, open from 8am to 1pm Tuesdays and Wednesdays and 8am to 6.30pm Thursdays and Fridays. Appointments are from 8.30am to 11.20am in the mornings and 2.30pm to 4.40pm on the two afternoons it is open. Extended hours are offered on a Friday evening until 8pm.The practice have opted out of offering out of hours services. Out of hours cover is provided via the NHS 111 telephone service.

All services are provided from:

Swallowfield Medical Practice, The Street, Swallowfield, Reading, Berkshire, RG7 1QY

and

Shinfield branch surgery, Millworth Lane, Shinfield, Berkshire, RG2 9EN

and

Arborfield branch surgery, Arborfield Village Hall, Eversley Road, Arborfield Cross, Berkshire, RG2 9PQ

We visited the main practice site at Swallowfield during this inspection. The practice has not been inspected by the CQC prior to this visit.

Updated 3 August 2016

Letter from the Chief Inspector of General Practice

We carried out an announced comprehensive inspection at Swallowfield Medical Practice on 8 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.

The areas where the provider should make improvement are:

• Consider the location of emergency medicines.

• Ensure all high risk actions regarding legionella are completed.

Professor Steve Field (CBE FRCP FFPH FRCGP) 

Chief Inspector of General Practice

Updated 3 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.

• One of the GP partners had an interest in cardiology (heart health) and had successfully introduced 24 hour blood pressure and electrocardiogram (ECG – a recording of the electrical activity of the heart) monitoring. This reduced patients need to go to hospital for diagnosis of some coronary conditions.

• The practice had commenced a ‘house of care’ model for diabetes care and had achieved positive outcomes. ( The house of care takes a whole system approach to long term conditions management. It makes the patient central to care). The practice was planning to offer the same for patients with chronic lung problems.

• 76% of patients with diabetes had achieved a target blood level compared to the CCG average of 74% and national average of 78%.

• 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 3 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 people 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 people were treated in an age-appropriate way and were recognised as individuals, and we saw evidence to confirm this.

• One of the GPs was developing a course for young school children to promote GP services and reduce fear of going to the practice for examinations and vaccines.

• 87% of females aged 25 to 64 had received a cervical screening test in the preceding five years compared to the CCG average of 84% 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.

Updated 3 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 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.

• The practice offers a voluntary transport service to patients over the age of 65 who require assistance with attending appointments. This initiative is organised in association with the patient participation group.

• All patients over the age of 75 are contacted by a healthcare assistant within two days of being discharged from hospital. Any concerns are raised with the named GP who arranges a home visit or urgent appointment.

• The practice looked after patients from one nursing home and one residential home. Both homes received a regular ward round for reviewing all patients and were able to book home visits quickly when urgent care was required.

Updated 3 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.

• The practice had a self-check blood pressure machine for patients use so patients could take a reading at a time that was convenient for them.

• The practice newsletter included health education articles and practice information updates for patients who did not attend the practice very often.

Updated 3 August 2016

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

• 75% 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 78% and national average of 84%. The practice had increased this to 80% in the most recent QOF year (2015/16) and had initiated system alerts to highlight patients attending who could be opportunistically reviewed during a routine appointment.

• 90% of patients with a diagnosed psychiatric condition had a comprehensive, agreed care plan documented in the record in the preceding 12 months compared to the CCG average of 95% 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 looked after residents from two nursing homes who assisted patients with dementia. Both the homes were able to access GP home visits in a timely way and felt supported by the practice. Staff told us the named GP would attend when required with very few exceptions and they always treated the patients with dignity and respect.

• 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 3 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 looked after three residential homes for patients with severe learning disabilities. Each home had a named GP who attended regularly for reviews and check-ups.

• 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.

• The practice regularly hosted the citizen’s advice bureau and had commenced the services of a community navigator (a volunteer who advises patients on voluntary organisations and sources of help and support).