Farnham Road Surgery

Updated 17 March 2017

Farnham Road Surgery is a purpose built medical centre that has been home to the practice since 1991. It is located close to public transport routes and has disabled parking spaces available. Weekes Drive Surgery is also purpose built and is far smaller in size than Farnham Road Surgery.

There are approximately 25,000 patients registered at the practice. Data shows that there are a higher than average number of patients registered aged under 49. There are significantly fewer than average patients registered aged 50 and over. National census data reports income deprivation at point five in a 10 point scale. (The scale reports highest levels of deprivation as one and lowest levels of deprivation at 10). The practice recognises that income deprivation is an issue for a large number of their registered population. Income deprivation often leads to a higher incidence of long term medical conditions and poor health in general. The practice population has a higher than average number of patients diagnosed with long term conditions being 53% compared to the clinical commissioning group (CCG) average of 49%. However, this is similar to the national average of 54%

There are 20 GPs at the practice of whom 13 are partners. They make up the equivalent of 14.2 full time GPs and 11 are male and nine are female. There is an all-female practice nurse team of 11 of which eight are qualified practice nurses and three are health care assistants (HCAs). In addition the practice employs two clinical pharmacists (1.6 whole time) a paramedic practitioner and an associate physician both of whom are part time. The practice general manager is supported in the day to day management of the practice by a team of 12 administration staff and 17 reception staff. The practice is approved to train qualified doctors who are seeking to become GPs. There are currently three trainees at the practice.

The practice, and branch surgery, are open between 8am and 6.30pm Monday to Friday. Appointments are from 8.30am to 12pm every morning and 2pm to 6pm daily. Extended hours appointments are offered every weekday at Farnham Road between 7.30am and 8.30am and 6.30pm to 8pm. The main practice also offers appointments on both Saturday and Sunday morning from 9am to 1pm.

The practice provides services via a Personal Medical Services (PMS) contract (PMS contracts are a locally agreed alternative to the standard GMS contract used when services are agreed locally with a practice which may include additional services beyond the standard contract) from:

Farnham Road Surgery, 301 Farnham Road, Slough, Berkshire, SL2 1HD and

Weekes Drive Surgery, 100 Weekes Drive, Cippenham, Slough, SL1 2YP

We visited both sites during the inspection.

The practice has opted out of providing out of hours services to their patients. Out of hours services are provided by the local out of hours provider, East Berkshire Primary Care Out Of Hours Services Limited. The out of hours service is accessed by calling NHS 111. The arrangements in place for services to be provided when the surgery is closed are displayed at the practice, on the practice website and in the practice information leaflet.

Updated 17 March 2017

Letter from the Chief Inspector of General Practice

We carried out an announced comprehensive inspection at Farnham Road Surgery on 5 January 2017. Overall the practice is rated as good. Specifically it is rated good for the provision of safe, effective, caring and well led services and outstanding for delivery of responsive services.

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

• 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. Learning and trends from complaints were shared with stakeholders. For example, with the patient participation group (PPG).
• Patients said they found it easy to make an appointment, there was continuity of care. Urgent appointments were available the same day and appointments were offered on both Saturday and Sunday mornings.
• 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.
• A wide range of services were provided at the practice to facilitate easier access for patients and reduce time consuming and costly trips to hospitals and other clinics.

We saw areas of outstanding practice including:

• Learning from significant events was central to improvement in practice performance. Detailed presentations of significant events were given to staff at team meetings to ensure consistent learning. Significant events were shared with the patient participation group and other external stakeholders to facilitate wider learning and improvement.

• Patients individual needs and preferences were central to planning of services. The practice provided specialist clinics, led by the GPs, to increase attendance and reduce referrals. These included: dermatology and orthopaedics. Data showed this increased attendance and reduced referrals to hospitals and other clinics.

• The practice took an active role in provision of services to the wider community and those in vulnerable circumstances. They provided a specialist drug and alcohol prescribing service to both registered patients and those from other practices in the area. This recognised that this group of patients frequently found contact with new services difficult.

The areas where the provider should make improvement are:

• Ensure exception reporting for patients diagnosed with diabetes is reviewed.
• Ensure a system is put in place to provide patients diagnosed with a learning disability to access annual health reviews.

Professor Steve Field (CBE FRCP FFPH FRCGP) 

Chief Inspector of General Practice

Updated 17 March 2017

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.

• Performance for diabetes related indicators was 97% which was higher than the clinical commissioning group average (CCG) of 90% and national average of 90%.

• Performance for chronic obstructive pulmonary disease related indicators was 100% which was higher than the clinical commissioning group average (CCG) of 98% and national average of 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.

Updated 17 March 2017

The practice is rated as good for the care of families, children and young people.

• Performance for asthma related indicators was 100% which was higher than the clinical commissioning group average (CCG) of 99% and national average of 97%.

• Childhood immunisation rates for the vaccinations given were comparable to national averages for those immunisations for five year olds but below national average for those aged 24 months.

• Rates of attendance for cervical cancer screening were the same as the CCG average of 80%.

• Same day appointments were available for children and there were appointments available outside of school hours.

Updated 17 March 2017

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 patients in its population.

• The practice was responsive to the needs of older patients, and offered home visits and urgent appointments for those with enhanced needs.

• Outcomes for long term conditions associated with older patients were above average. For example, the practice achieved 100% of the indicators relating to care of patients diagnosed with osteoporosis (a thinning of the bones). This was better than the CCG average of 92% and national average of 87%.

Updated 17 March 2017

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.
• Appointments were available early morning and until 8pm every weekday. In addition the practice offered appointments on both Saturday and Sunday morning to assist those patients who found it difficult to attend an appointment during the working day.
• Women’s health clinics were held in the evening and at weekends.

Updated 17 March 2017

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

• The practice provided a specialist service for patients who were diagnosed with drug and alcohol misuse problems.

• 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 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.

• Performance for mental health related indicators was 100% which was above the CCG average of 98% and the national average of the national average of 93%.

Updated 17 March 2017

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. However, the arrangements for providing annual health checks for patients with a learning disability were not operated effectively. Only 26% of these patients had received an annual health check in the last year. However, the practice had appointed a lead GP for learning disability patients. The practice were aware due to cultural difficulties that patients with learning difficulties did not often engage with health services. The lead GP had the knowledge to engage with this patient group and were starting to engage with local community leaders.
• The practice offered longer appointments for patients with a learning disability.
• 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.