Archived: Circuit Lane Surgery

Updated 19 April 2018

Circuit Lane Surgery is located in the Southcote area of Reading. One Medicare Ltd took over the contract following a procurement exercise led by the local clinical commissioning group (CCG) in September 2016.

The practice has been through a challenging four years with three changes in provider and a number of GPs and managers leaving, which has caused instability in the practice.

At the time of the inspection the services was staffed by 2.9 whole time equivalent (WTE) salaried GPs, supported by locum GPs, and 3.1 WTE nurses, supported by agency nurses. In addition there are administration staff, receptionists and a registered manager. There were male and female GPs available. The practice has an Alternative Provider Medical Services (APMS) contract.

The premises were purpose built as a medical centre and cover two storeys. All consulting and treatment rooms are on the ground floor. There are approximately 9,000 patients registered with the practice. This had reduced from 9,500 when we last inspected.

The age profile of the registered population is similar to the national average with slightly more patients aged between 55 and 69 than average. There are is significant experience among the local population of income deprivation. The ethnic mix of the population is varied, with a significant proportion of people originating from Nepal.

All services are provided from: Circuit Lane Surgery, 53 Circuit Lane, Southcote, Reading, Berkshire, RG30 3AN.

The practice is open between 8am and 6.30pm Monday to Friday. Extended hours are offered on both Monday and Thursday until 8pm. They are also offered on alternate Saturday mornings from 8.30am to 11am.

When the practice is closed, out-of-hours (OOH) GP cover is provided by the Westcall OOH service.

Updated 19 April 2018

Letter from the Chief Inspector of General Practice

We carried out an announced comprehensive inspection at Circuit Lane Surgery on 24 January 2017. The overall rating for the practice was inadequate and the practice was placed in special measures for a period of six months and specific conditions were applied to the registration of the practice.

On 2 June 2017 we carried out a focused inspection at Circuit Lane Surgery to determine whether the practice was meeting the conditions applied following the January inspection. At that time we found some improvements and three of the six conditions applied were removed. However, the practice had not made sufficient improvements and remained in special measures. Both reports from the January 2017 and June 2017 inspections can be found by selecting the ‘all reports’ link for Circuit Lane Surgery on our website at www.cqc.org.uk.

This inspection was undertaken following the period of special measures and was an announced follow up comprehensive inspection on 12 October 2017. Overall the practice continues to be rated as inadequate.

Our key findings were as follows:

• There was a system in place for reporting and recording significant events.
• The practice had clearly defined and embedded systems, processes and practices in place to keep patients safe and safeguarded from abuse.
• We reviewed four personnel files and found appropriate recruitment checks had been undertaken prior to employment.
• The practice had adequate arrangements in place to respond to emergencies and major incidents.
• The GPs and nursing staff had access to relevant and current evidence based guidance and standards. However, the care of patients diagnosed with asthma did not always follow these guidelines.
• The practice used the information collected for the Quality and Outcomes Framework (QOF) and performance against national screening programmes to monitor outcomes for patients. (QOF is a system intended to improve the quality of general practice and reward good practice). The most recent data from the QOF year April 2016 to March 2017 showed performance had fallen from the previous year. The practice was an outlier for meeting indicators of care for patients diagnosed with asthma and diabetes. Data supplied by the provider for the period April 2017 to October 2017 showed that overall the practice has made an improvement on the previous year.
• The practice had a clear and safe procedure for medicine reviews.
• Staff had the skills, knowledge and experience to deliver effective care and treatment. However, the clinical pharmacist and senior advanced nurse practitioner did not receive or access clinical supervision.
• The information needed to plan and deliver care and treatment was available to relevant staff in a timely and accessible way through the practice’s patient record system and their intranet system.
• Staff sought patients’ consent to care and treatment in line with legislation and guidance. Although further understanding of the Mental Capacity Act 2005 was needed.
• We observed members of staff were courteous and helpful to patients and treated them with dignity and respect.
• Results from the national GP patient survey were consistently below local and national averages.
• The practice had a system in place for handling complaints and concerns. There were notes of meetings where complaints were discussed and learning shared.
• The provider’s vision to deliver high quality care and promote good outcomes for patients but this was not always supported by effective leadership and governance processes.
• There were arrangements for identifying, recording and managing risks within the practice. However, some risks were not addressed in a timely way. For example, the risk associated with patients waiting for long periods of time on the phone to seek advice or book appointments.
• Practice specific policies were implemented and were available to all staff.
• The practice had used most of their resources since the inspection in January addressing the areas of high risk and the clinical and administrative backlog.

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

Importantly, the provider must:

• Establish effective systems and processes to ensure good governance in accordance with the fundamental standards of care
• Ensure care and treatment is provided in a safe way to patients

In addition the provider should:

• Operate a system of providing clinical supervision that is received and accessed by all relevant staff.

This service was placed in special measures in January 2017. Insufficient improvements have been made such that there remains a rating of inadequate for provision of effective, caring, responsive and well-led services. Therefore we are taking 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 service will be kept under review and if needed could be escalated to urgent enforcement action. Where necessary, another inspection will be conducted within six months, and if there is not enough improvement we will move to close the service by adopting our proposal to vary the provider’s registration to remove this location or cancel the provider’s registration.

Professor Steve Field (CBE FRCP FFPH FRCGP) 

Chief Inspector of General Practice

Updated 19 April 2018

The provider was rated as inadequate overall and this affected all patients including this population group.

• Longer appointments and home visits were available when patients needed them.
• The number of structured annual reviews carried out for patients with long term conditions was below average when identified from national indicators.
• The practice performance for diabetes indicators was 64% which was significantly below the local clinical commissioning group (CCG) average of 92% and national average of 91%.
• There was evidence disease specific guidelines were not always being followed.
• Telephone access for people with long term conditions who had difficulty attending the practice was difficult.

Updated 19 April 2018

The provider was rated as inadequate overall and this affected all patients including this population group.

There were some examples of good practice:

• Immunisation rates for children were meeting the national targets. For those aged 24 months 94% and those aged five 90%. (The national target is 90%)
• Appointments were available outside of school hours and the premises were suitable for children and babies.

• The practice worked with midwives and health visitors to support this population group. For example, in the provision of ante-natal, post-natal and child health surveillance clinics.
• The practice had emergency processes for acutely ill children and young people and for acute pregnancy complications.

However,

• National indicators showed below average performance in supporting patients diagnosed with asthma. For example, the practice had undertaken 62% of the annual reviews, using national guidance, of patients with asthma compared to the CCG average of 70% and national average of 71%.
• Parents needing to seek urgent advice or an appointment had difficulty accessing the practice by telephone.

Updated 19 April 2018

The provider was rated as inadequate overall and this affected all patients including this population group.

There were some examples of good practice.

• There was a system to prioritise older patients for appointments.

• The practice offered home visits and urgent appointments for those with enhanced needs.
• We saw hospital admissions, letters from specialists and paramedic correspondence was now acted on promptly which reduced the risks for this population group.
• The practice identified older patients and coordinated the multi-disciplinary team (MDT) for the planning and delivery of palliative care for patients approaching the end of life.
• We saw unplanned hospital admissions and re-admissions for the over 75’s were regularly reviewed and improvements made.

However,

• Telephone access for older people who found it difficult to attend the practice was difficult.

Updated 19 April 2018

The provider was rated as inadequate overall and this affected all patients including this population group.

There were some areas of good practice:

• The practice offered evening appointments on a Monday and Thursday every week and alternate Saturday morning appointments were available.

• The practice was proactive in offering online services for repeat prescriptions as well as a range of health promotion and screening that reflects the needs for this age group.

However,

• Access to the practice by telephone was difficult for patients that worked.

Updated 19 April 2018

The provider was rated as inadequate overall and this affected all patients including this population group.

• The practice did not undertake screening of patients identified as at risk of developing dementia.

• National data showed the practice had not recorded use of an appropriate assessment tool for patients diagnosed with depression.
• The practice had only reviewed 38% of the care plans for patients with long term mental health problems in the last 12 months. This was significantly below the CCG average of 76% and national average of 79%
• All patients registered at the practice experienced difficulty in gaining telephone access when they sought advice or an appointment.

However,

• The practice had carried out 87% face to face reviews of the care of patients diagnosed with dementia which was better than the national average of 78% and CCG average of 79%.

Updated 19 April 2018

The provider was rated as inadequate overall and this affected all patients including this population group.

However, there were some examples of good practice.

• The practice offered longer appointments for patients with a learning disability. They were invited for an annual health check and there were records of these being undertaken.
• GPs worked within a multi-disciplinary team to ensure the best outcomes for vulnerable patients. The practice 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.
• All patients registered at the practice experienced difficulty in gaining telephone access when they sought advice or an appointment.