Wargrave Practice

Updated 24 April 2017

Wargrave Practice is registered with the Care Quality Commission to provide primary care services. The practice provides to approximately 6,970 patients from Wargrave Practice, Victoria Road, Wargrave, RG10 8BP. They also have two outreach clinics at The Neville Hall, Milley Road, Waltham St Lawrence, RG10 0JP and Knowl Hill Village Hall, The Terrace, Knowl Hill, Reading, RG10 9XB.

Services to patients are provided under a General Medical Services (GMS) contract with NHS England. (A GMS contract is a contract between NHS England and general practices for delivering general medical services and is the commonest form of GP contract). The practice is a dispensing practice to 1,945 patients.

The building is a one storey annexe to a sheltered accommodation complex, which is owned by the housing association. The practice has four GP partners, two salaried GP, three practice nurses, a health care assistant, two dispensers, a pharmacist and a receptionist and administration team. The practice serves patients across three counties, five clinical commissioning groups and five local authorities.

Information from Public Health England 2015 shows the practice population age distribution is not comparable to national averages; the practice has a lower working age population and a higher elderly population. Of the working population 2% were unemployed which is below the national average of 5%.

The general Index of Multiple Deprivation (IMD) population profile for the geographic area of the practice is in least deprived decile. (An area itself is not deprived: it is the circumstances and lifestyles of the people living there that affect its deprivation score. Not everyone living in a deprived area is deprived and that not all deprived people live in deprived areas).

Average male and female life expectancy for the practice is 81 and 84 years respectively, which is higher than the national averages of 79 and 83 years.

The practice is open between 7.30am and 7pm Monday to Thursday, closing at 6.30pm on Fridays Additional appointment times are available and on the 2nd and 4th Saturdays of each month from 8.30am - 11.30am (pre-booked appointments only).

In addition to pre-bookable appointments that could be booked up to four weeks in advance, urgent appointments were also available for people that needed them.

Out of Hours cover is provided by Berkshire Healthcare NHS Foundation Trust, via the Walk in Centre at Broad Street Mall in Reading, or Westcall via telephone 111.

The practice provides its services from the following address:

Wargrave Surgery, Victoria Road, Wargrave, RG10 8BP.

Updated 24 April 2017

Letter from the Chief Inspector of General Practice

We inspected Wargrave Practice on 9 June 2016. At that time the practice was rated requires improvement. The provision of safe services was specifically rated inadequate. We asked the practice to tell us what action they would take to address the breach of regulation found at inspection. The full comprehensive report on the June 2016 inspection can be found by selecting the ‘all reports’ link for Wargrave Practice on our website at www.cqc.org.uk.

This inspection, on 9 February 2017, was undertaken to check the actions taken had addressed the breach of regulation and to apply an updated rating for the practice.

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

• There was an open and transparent approach to safety and a system in place for reporting and recording significant events.
• The practice had clearly defined and embedded systems to minimise risks to patient safety.
• Staff were aware of current evidence based guidance. Staff had been trained to provide them with the skills and knowledge to deliver effective care and treatment.
• Results from the national GP patient survey showed patients were treated with compassion, dignity and respect and were involved in their care and decisions about their treatment.
• Information about services and how to complain was available. Improvements were made to the quality of care as a result of complaints and concerns.
• Patients we spoke with 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 the requirements of the duty of candour. Examples we reviewed showed the practice complied with these requirements.
• Following our findings during the June 2016 inspection that patients were at risk of harm because some systems and processes were not implemented in a way to keep them safe, specifically in relation to medicine reviews which were not always undertaken by a GP, the practice had implemented a policy that medicine reviews were only completed by a GP.

The areas where the provider should make improvement are:

• Review the storage and access to emergency medicines to ensure timely access to staff.
• Implement timely training for all new staff to enable them to carry out their role effectively.
• Implement improved process to ensure clear dosage instructions appear on the labels of all dispensed medicines.

Professor Steve Field (CBE FRCP FFPH FRCGP) 

Chief Inspector of General Practice

Updated 24 April 2017

The provider had resolved the concerns for safety and well-led identified at our inspection on 9 June 2016 which applied to everyone using this practice, including this population group. The population group ratings have been updated to reflect this.

Specifically we found:

• Nursing staff had lead roles in chronic disease management and patients at risk of hospital admission were identified as a priority.
• The practice’s results for management of patients with diabetes were above the national average, in particular for the management of blood pressure, where the practice achieved 92% for patients with a reading within recommended targets, compared to a national average of 80%.
• Performance for Chronic Obstructive Pulmonary Disease (known as COPD, a collection of lung diseases including chronic bronchitis and emphysema) indicators showed the practice had achieved 100% of targets which was similar when compared to the CCG average (99%) and higher when compared to the national average (96%).
• 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.
• The practice followed up on patients with long-term conditions discharged from hospital and ensured that their care plans were updated to reflect any additional needs.
• There were emergency processes for patients with long-term conditions who experienced a sudden deterioration in health.
• All these patients had a named GP and there was a system to recall patients for 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 24 April 2017

The provider had resolved the concerns for safety and well-led identified at our inspection on 9 June 2016 which applied to everyone using this practice, including this population group. The population group ratings have been updated to reflect this.

Specifically we found:

• From the sample of documented examples we reviewed we found there were systems 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 accident and emergency (A&E) attendances.
• Immunisation rates were below expected achievements in three out of four areas for standard childhood immunisations. However, unvalidated data shows that the practice have achieved the targets in all four areas for the year 2016/2017.
• The practice provided support for premature babies and their families following discharge from hospital, including regular reviews and home visits if required.
• The practice worked with midwives, health visitors and school nurses 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.
• Patients told us that children and young people were treated in an age-appropriate way and were recognised as individuals.
• 81% of female patients aged 25 to 64 had attended for cervical screening within the target period, compared to a national average of 81%.
• Appointments were available outside of school hours and the premises were suitable for children and babies.

Updated 24 April 2017

The provider had resolved the concerns for safety and well-led identified at our inspection on 9 June 2016 which applied to everyone using this practice, including this population group. The population group ratings have been updated to reflect this.

Specifically we found:

• 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, outreach clinics and urgent appointments for those with enhanced needs.
• A delivery service for prescriptions was available for patients unable to travel to the surgery.
• The practice were being considered as a ‘Thames Valley dementia beacon practice.’

Nationally reported data showed that outcomes for patients for conditions commonly found in older people were above national figures. For example, 92% of patients with atrial fibrillation were appropriately treated with anti-coagulation therapy. This was higher when compared to the CCG average (86%) and the national average (87%).

Updated 24 April 2017

The provider had resolved the concerns for safety and well-led identified at our inspection on 9 June 2016 which applied to everyone using this practice, including this population group. The population group ratings have been updated to reflect this.

Specifically we found:

• The needs of these populations had been identified and the practice had adjusted the services it offered to ensure these were accessible, flexible and offered continuity of care, for example, extended opening hours and Saturday appointments.
• 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.
• Phlebotomy services were available at the practice which meant patients did not have to attend hospitals for testing.
• Health promotion advice was offered but there was accessible health promotion material available through the practice.

Updated 24 April 2017

The provider had resolved the concerns for safety and well-led identified at our inspection on 9 June 2016 which applied to everyone using this practice, including this population group. The population group ratings have been updated to reflect this.

Specifically we found:

• 77% of patients diagnosed with dementia had their care reviewed in a face to face meeting in the last 12 months, which is lower than the national average of 84%. However, the practice provided us with invalidated data to show that improvments had been made and this years unvalidated achievement was 94%.
• 91% of patients with schizophrenia, bipolar affective disorder and other psychoses had a comprehensive, agreed care plan documented in the preceding 12 months, compared to the national average of 89%.
• The practice regularly worked with multi-disciplinary teams in the case management of patients experiencing poor mental health, including those with dementia and carried out advance care planning for patients with dementia.
• The practice specifically considered the physical health needs of patients with poor mental health and dementia. They had invited clinical experts to assess the building as part of the dementia friendly scheme.
• The practice had a system for monitoring repeat prescribing for patients receiving medicines for mental health needs.
• Patients at risk of dementia were identified and offered an assessment.
• The practice had information available for patients experiencing poor mental health about how they could access various support groups and voluntary organisations.
• The practice had a system to follow up patients who had attended accident and emergency where they may have been experiencing poor mental health.
• Staff interviewed had a good understanding of how to support patients with mental health needs and dementia.

Updated 24 April 2017

The provider had resolved the concerns for safety and well-led identified at our inspection on 9 June 2016 which applied to everyone using this practice, including this population group. The population group ratings have been updated to reflect this.

Specifically we found:

• The practice held a register of patients living in vulnerable circumstances including homeless people, travellers and those with a learning disability.
• End of life care was delivered in a coordinated way which took into account the needs of those whose circumstances may make them vulnerable.
• The practice offered longer appointments (double appointments, 20 minutes in length) for patients with a learning disability.
• We saw there were 15 patients on the learning disabilities register and 8 of the patients (53%) had a recorded health check. The remaining patients had been contacted and invited to attend a health check if appropriate.
• 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.