The Symons Medical Centre

Updated 17 August 2018

The Symons Medical Centre is located in an urban area of Maidenhead. There are approximately 12,300 patients registered with the practice. The practice population shows a higher than average number of patients aged over 80 years old (approximately 800). There are a lower than average number of patients aged between 15 and 34 registered at the practice. Services are provided to approximately 300 patients that live in local care homes. According to data from the Office for National Statistics, this part of Berkshire has high levels of affluence and low levels of deprivation.

There are six permanent GPs working at the practice (5.5 WTEs) with additional locum cover available if and when required.  The practice employs two practice nurses and three health care assistants. The practice manager is supported by a team of reception and administration staff.

All services are provided from: The Symons Medical Centre, 25 All Saints Avenue, Maidenhead, Berkshire, SL6 6EL. Further information about the practice can be obtained from their website at  and via the EMIS Patient Access Service.  

The practice also works closely with district nurses, midwives and health visitors. Outside normal surgery hours patients are able to access emergency care from East Berkshire Out of Hours Service and routine out of hours GP appointments via the Windsor, Ascot and Maidenhead Prime Minister's Challenge Fund service with which the practice is affiliated - this provides routine consultations on weekday evenings and weekends. Information on how to access medical care outside surgery hours was available on the practice leaflet, website and waiting area.

The practice is registered with the Care Quality Commission to provide the following regulated activities:

• Treatment of disease, disorder and injury
• Family planning
• Maternity and midwifery and
• Diagnostic and screening procedures

Updated 17 August 2018

This practice remains rated as Good overall. (First rated in November 2017)

The key question at this inspection is rated as:

Are services well-led? - Good

We carried out a focused inspection at The Symons Medical Centre on 17 July 2018. This inspection was undertaken to follow up a breach of regulation identified at the comprehensive inspection carried out in November 2017. At that time we identified that some management processes were not operated consistently. Specifically we found the practice did not:

• Operate a process for dealing with safety alerts that clearly identified who should action relevant alerts and confirm that action had been completed.
• Have a system in place to effectively offer physical health checks for patients diagnosed with a learning disability.
• Effectively promote the benefits of registering as a carer to enable appropriate support to be offered or given.
• Ensure that nursing staff were always given appropriate authorisation to administer vaccines.
• Maintain operational and clinical policies that were up to date and relevant to the day to day work of the practice.

Whilst the practice was rated good overall we rated provision of well led services as requires improvement.

At this inspection we found the practice had made significant improvements including:

• The practice had reviewed all operational policies to ensure they were relevant to the current provision of services.
• Implementing a revised system to call patients with a learning disability for a review of their physical health and had carried out 21 out of 46 such reviews in three months since April 2018.
• Ensured nurses had appropriate authorisation to administer vaccines.
• Promoting the benefits of registering as a carer resulting in a 46% increase in registered carers.
• Updated the process for dealing with safety alerts that were relevant to the practice to provide reassurance that these were seen and acted upon.

The area where the provider should make improvement is:

• Continue to monitor the effectiveness of promoting the benefits of registering as a carer.

Consequently the practice is now rated good for provision of well led services and remains rated good overall.

Professor Steve Field CBE FRCP FFPH FRCGP
Chief Inspector of General Practice

Please refer to the detailed report and the evidence tables for further information.

Updated 14 May 2015

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. Longer appointments and home visits were available when needed. All these patients had a named GP and a structured annual review to check that their health and medication needs were being met. For those people with the most complex needs, the named GP worked with relevant health and care professionals to deliver a multidisciplinary package of care.

The practice offered services such as spirometry, phlebotomy and ECGs on site, which meant patient had greater flexibility to use these services. The practice worked closely with district nursing team and held monthly palliative care meetings. The practice had access to local retinal screening and dietetics services, and made appropriate referrals for patients when required.

Updated 14 May 2015

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.

The community midwife held regular antenatal and post natal clinics onsite. The practice offered obstetric care to all pregnant women. This involved, routine 10 days post-partum contact and a dedicated liaison midwife. 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. Appointments were available outside of school hours and the premises were suitable for children and babies. We saw good examples of joint working with midwives, health visitors and school nurses. 

Updated 14 May 2015

The practice is rated as good for the care of older people. Nationally reported data showed that outcomes for patients were good for conditions commonly found in older people. The practice offered proactive, personalised care to meet the needs of the older people in its population and had a range of enhanced services, for example, in dementia and end of life care. It was responsive to the needs of older people, and offered home visits and rapid access appointments for those with enhanced needs. All patients over 75 had a named GP. The premises and services had been adapted to meet the needs of people with mobility problems. We saw that the waiting area and treatment rooms were able to accommodate patients with wheelchairs. Accessible toilet facilities were available. Patients had access to onsite pharmacy. The practice offered to deliver patients medicine delivered to them.

Updated 14 May 2015

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 14 May 2015

The practice is rated as good for the care of people experiencing poor mental health (including people with dementia). The practice regularly worked with multi-disciplinary teams in the case management of people experiencing poor mental health, including those with dementia. It carried out advance care planning for patients with dementia. Planned reviews were carried out for all patients with mental health needs.

The practice had told patients experiencing poor mental health about how to access various support groups and voluntary organisations including talking therapies, counselling and psychiatry. It had a system in place to follow up patients who had attended accident and emergency (A&E) where they may have been experiencing poor mental health. Staff had received training on how to care for people with mental health needs and dementia.

Updated 14 May 2015

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 had a high proportion of patients with learning disability. For these patients they offered home visits to deal with medical needs and for influenza vaccinations. It had carried out annual health checks for people with a learning disability. It offered longer appointments for people with a learning disability.

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. 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.

Weekly health reviews were offered to patients who were alcohol and drug dependent. These patients prescribed on weekly basis to ensure safe prescribing. The practice worked closely with agencies such as local SMART team.