The Care Quality Commission
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Archived: Peppard Road Surgery

Overall: Good read more about inspection ratings

45 Peppard Road, Caversham, Reading, Berkshire, RG4 8NR (0118) 946 2224

Provided and run by:
Peppard Road Surgery

All Inspections

02 July 2018

During an inspection looking at part of the service

At our previous comprehensive inspection at Peppard Road Surgery in Caversham, Berkshire in November 2017 we found a breach of regulations relating to the management of risks, specifically risks associated with the management of medicines and infection prevention control. Although the overall rating for the practice was good, the practice was rated requires improvement for the provision of safe services. The practice was rated good for the provision of effective, caring, responsive and well-led services. In addition, all population groups were also rated good.

The full comprehensive report on the November 2017 inspection can be found by selecting the ‘all reports’ link for Peppard Road Surgery on our website at www.cqc.org.uk.

This inspection was an announced focused inspection carried out on 2 July 2018 to confirm that the practice had carried out their plan to meet the legal requirements in relation to the breach in regulations that we identified in our previous inspection in November 2017. This report covers our findings in relation to those requirements and improvements made since our last inspection.

We found the practice had made improvements since our last inspection. At our inspection on the 2 July 2018 we found the practice was meeting the regulations that had previously been breached. We have amended the rating for this practice to reflect these changes. The practice is now rated good for the provision of safe, effective, caring, responsive and well led services. The overall rating remains good.

Our key findings were as follows:

  • Systems had been implemented and embedded which ensured safe care and treatment.
  • The practice had reviewed and strengthened existing arrangements for the management and storage of medicines.
  • We reviewed the practices storage of emergency medicines and found the practice now held all the recommended medicines to deal with medical emergencies,
  • The practice had reviewed guidance from Public Health England and purchased a validated suitable pharmaceutical refrigerator to store vaccines and medicines that required refrigeration.
  • The practice had strengthened existing infection prevention control processes and supporting policies to effectively and safely manage infection prevention.
  • The practice had continued to review outcomes and clinical performance, specifically diabetes outcomes. This review included additional diabetes related training for both GPs.
  • There was a greater awareness of the Accessible Information Standard (a requirement to make sure that patients and their carers can access and understand the information they are given).

Professor Steve Field CBE FRCP FFPH FRCGP

Chief Inspector of General Practice

21 and 30 November 2017

During a routine inspection

Letter from the Chief Inspector of General Practice

This practice is rated as Good overall.

At our previous inspection in November 2014 the practice had an overall rating as Requires Improvement. We carried out a desktop follow up inspection in August 2015 and March 2016 to ensure improvements had been made and to review if the service was meeting regulations. Following the March 2016 inspection, we found the practice had made improvements and as a result we updated the overall rating to Good.

Following the November 2017 inspection, the key questions are rated as:

  • Are services safe? – Requires improvement
  • Are services effective? – Good
  • Are services caring? – Good
  • Are services responsive? – Good
  • Are services well-led? – Good

As part of our inspection process, we also look at the quality of care for specific population groups. The population groups are rated as:

  • Older People – Good
  • People with long-term conditions – Good
  • Families, children and young people – Good
  • Working age people (including those recently retired and students – Good
  • People whose circumstances may make them vulnerable – Good
  • People experiencing poor mental health (including people with dementia) - Good

We carried out an announced comprehensive inspection at Peppard Road Surgery in Caversham, Berkshire on 21 November 2017. We carried out this inspection under Section 60 of the Health and Social Care Act 2008 as part of our regulatory functions. This inspection was planned to check whether Peppard Road Surgery was meeting the legal requirements and regulations associated with the Health and Social Care Act 2008.

At this inspection we found:

  • There was an effective system in place for reporting and recording significant events.
  • The practice had systems to manage risk so that safety incidents were less likely to happen. When incidents did happen, the practice learned from them and improved their processes.
  • The practice had defined systems, processes and practices to minimise risks to patient safety. However, we found these systems had not monitored some risks associated with the management of medicines or infection control.
  • Staff had received training appropriate to their roles and the population the practice served.
  • Our findings showed that systems were in place to ensure that all clinicians were up to date with both National Institute for Health and Care Excellence (NICE) guidelines and other locally agreed guidelines.
  • We received positive feedback from patients which accessed GP services from the practice. This feedback aligned to other feedback about the practice including feedback collated through the GP national patient survey.
  • The practice learned lessons from individual concerns and complaints and also from analysis of trends.
  • We saw a systematic approach to managing patient demand whilst there was an unprecedented amount of change within the local health services.
  • The practice had clear and visible clinical and managerial leadership and supporting governance arrangements. These arrangements had been strengthened over the last two years with a business manager joining the practice and supporting the two GPs.

We saw an area of outstanding practice:

  • The practice provided outstanding access to appointments. The national GP survey indicated 100% of patients found it easy to get through to the practice by telephone. This was significantly better when compared to the CCG average (74%) and national average (71%). Similarly, 91% of patients described their experience of making an appointment as good. This was significantly better when compared to the CCG average (74%) and the national average (73%). This was confirmed by the 70 comment cards and the six patients we spoke with. Continuity of care was provided by the practice through the availability and longevity of GPs and staff. This enabled the GPs to have acquired extensive knowledge about patients changing health care needs and social circumstances. Feedback from patients indicated this information was used during regular consultations to provide meaningful emotional support and personalised care.

The areas where the provider must make improvements are:

  • Ensure care and treatment is provided in a safe way to patients and assess the risks to the health and safety of service users receiving care and treatment; for example risks associated with medical emergencies, medicines management and infection prevention control.

The areas where the provider should make improvements are:

  • Review practice procedures to ensure that the outcomes for patients with long term conditions are improved, specifically for patients with diabetes.
  • Undertake a full review of the requirements of the Accessible Information Standard.

Professor Steve Field CBE FRCP FFPH FRCGP

Chief Inspector of General Practice

9 March 2016

During a routine inspection

Letter from the Chief Inspector of General Practice

Our previous follow up inspection in August 2015 found breaches of regulations relating to the safe and well-led delivery of services. We found the practice required improvement for the provision of safe and well-led services, and was rated good for providing effective, caring and responsive services. Consequently we rated all population groups as requiring improvement.

Our previous comprehensive inspection in November 2014 found breaches of regulations relating to the safe, effective and well-led delivery of services.

This desk based review was undertaken to check the practice was meeting regulations that were in breach from the last inspection. For this reason we have only rated the location for the key questions to which these relate. This report should be read in conjunction with the full inspection report of 6 November 2014 and follow up inspection report of August 2015.

At our inspection on the 9 March 2016 we found the practice was meeting all the conditions of regulations that had previously been breached.

Specifically we found:

  • The practice had developed a formal risk assessment to demonstrate why the standard DBS was sufficient for reception and administration staff taking part in chaperoning process.
  • The practice had written infection control policy in place and was following infection control assurance framework. The practice had taken steps to prevent, detect and control the spread of infections. Staff had completed infection control training.
  • The practice had written policy in place for the management of legionella. The practice had carried out regular checks for the management of legionella.
  • The practice had not collected constructive feedback through patient participation group (PPG).

The areas where the provider should make improvements are:

  • Ensure feedback from patients is sought and acted upon. For example, through a patient participation group (PPG).

We have amended the rating for this practice to reflect these changes. The practice is now rated good for the provision of safe, effective, caring, responsive and well led services. Consequently we have rated all population groups as good.

Professor Steve Field (CBE FRCP FFPH FRCGP) 

Chief Inspector of General Practice

13 August 2015

During a routine inspection

Letter from the Chief Inspector of General Practice

Our previous inspection in November 2014 found breaches of regulations relating to the safe, effective and well-led delivery of services.

We found the practice required improvement for the provision of safe, effective and well-led services, and was rated good for providing caring and responsive services. Consequently we rated all population groups as requiring improvement.

This inspection was undertaken to check the practice was meeting regulations that were in breach from the last inspection. For this reason we have only rated the location for the key questions to which these relate. This report should be read in conjunction with the full inspection report of 6 November 2014.

We found the practice had made some improvements since our last inspection. At our inspection on the 13 August 2015 we found the practice was meeting the regulations that had previously been breached. However, there were areas of practice where the provider needs to make improvements.

Specifically we found:

  • The practice was operating safe systems of recruitment. This included pre-employment checks and criminal records checks through the Disclosure and Barring Service (DBS).
  • Staff were supported through performance reviews and were receiving appropriate training, for example in basic life support, safeguarding children and vulnerable adults, health and safety, equality and diversity, and fire and risk assessment.
  • Complaints information was accessible to patients.
  • Systems were put in place for the management of legionella after we had announced the inspection.
  • The practice had not have written infection control policy in place and was not following infection control assurance framework. The practice had not taken steps to prevent, detect and control the spread of infections.
  • The practice had not collected constructive feedback through patient participation group (PPG).

The areas where the provider must make improvements are:

  • Ensure the practice assesses the risk of, and takes steps to prevent, detect and control the spread of infections, including taking action to resolve identified actions without delay.

In addition the provider should:

  • Ensure a risk assessment is in place to explain why the standard DBS is sufficient for reception and administration staff taking part in chaperoning process.
  • Ensure feedback from patients is sought and acted upon. For example, through a patient participation group (PPG).

We have amended the rating for this practice to reflect these changes. The practice is now rated require improvement for the provision of safe and well led services. It is good for the provision of effective, caring and responsive services. Consequently we have rated all population groups as requiring improvement.

Professor Steve Field (CBE FRCP FFPH FRCGP) 

Chief Inspector of General Practice

06/11/2014

During a routine inspection

Letter from the Chief Inspector of General Practice

Peppard Road Surgery is located in an urban area of Berkshire. It provides primary medical services to approximately 2200 registered patients.

We carried out an announced, comprehensive inspection on 6 November 2014.

We visited the practice location at 45 Peppard Road, Caversham, Reading, Berkshire,RG4 8NR

Peppard Road Surgery is rated as requires improvement overall.

Our key findings were as follows:

  • The practice is rated as requires improvement for safe. We identified areas of concern regarding aspects of staff training, for example, safeguarding children and vulnerable adults and an inadequate recruitment process, including lack of Disclosure and Barring service checks for staff.
  • The practice is rated as requires improvement for effective. We identified one area of concern regarding lack appraisals for all staff. The GPs had a thorough understanding of patients’ healthcare needs and provided care in line with local and national guidance. However, Quality and Outcomes Framework data showed patient outcomes were variable with the practice performing better in some areas than others.
  • The practice is rated as good for caring. Feedback from patients and survey data showed the practice performed above the clinical commissioning group (CCG) and national averages on most aspects of patient satisfaction. We heard many examples of compassionate care from patients.
  • The practice is rated as good for responsive. The practice performed significantly better than the CCG average for access to appointments. The practice did not have an accessible complaints policy in place.
  • The practice is rated as requires improvement for well-led. We identified areas of concern regarding the lack of regular performance reviews for staff. The practice did not proactively seek feedback from patients through a patient participation group.

There were areas of practice where the provider needs to make improvements.

Importantly, the provider must

  • Ensure that criminal records checks through the Disclosure and Barring Service or risk assessments are carried out.

  • Ensure staff are supported through appraisals to identify training and development needs

  • Ensure staff receive appropriate regular training, for example in basic life support, safeguarding children and vulnerable adults and health and safety

We have issued two compliance actions for the regulations relating to Requirements relating to workers and Supporting workers.

In addition the provider should:

  • Ensure that all the recruitment checks are carried out and recorded as part of the staff recruitment process
  • Ensure  systems are in place for the management of legionella
  • Ensure complaints information is accessible to patients
  • Ensure feedback is sought from patients, for example, through a patient participation group.

Professor Steve Field (CBE FRCP FFPH FRCGP) 

Chief Inspector of General Practice