Long Barn Lane Surgery

Updated 21 March 2017

Long Barn Lane Surgery provides primary care services to approximately 5,700 patients from a converted dwelling in South Reading. The premises are accessible for patients and visitors who have difficulty managing steps. All patient services are offered on the ground and first floors. The practice comprises three consulting rooms, one treatment room, a patient waiting area, reception area, administrative and management offices and a meeting room. The practice also offers services from a satellite surgery at Southcote Clinic. The satellite practice has one consulting room, one treatment room, a patient waiting area and reception area.

The practice population of patients aged between 0 to 19 years and 25 to 34 years are higher than the national average and there are a lower number of patients aged above 55 years old compared to the national average. The practice serves a large ethnic population (22%), with diverse cultural beliefs and needs. The practice is located in a part of Reading with the highest levels of income deprivation in the area.

The practice has two male GP partners, one female salaried GP and a regular locum GP (male). The GP whole time equivalent (WTE) represents 2.75 full time GPs. One of the GP partners started in December 2016 and has submitted an application to the Care Quality Commission to become a registered partner.

The practice employs two practice nurses (both female) who make up 1.75 WTE. The new practice manager is supported by a lead receptionist and a team of administrative and reception staff. Services are provided via a Primary Medical Services (PMS) contract. (PMS contracts are negotiated locally between GP representatives and the local office of NHS England).

The practice is open between 8am and 6.30pm Monday to Friday at Long Barn Lane Surgery. Appointments are from 8.30am and 11.50pm every morning and 2pm to 6.20pm daily. Extended hours appointments are offered on Monday, Tuesday and Thursday evenings until 7.30pm and every alternate Saturday. In addition to pre-bookable appointments that could be booked up to six weeks in advance, urgent appointments were also available for patients that needed them.

The practice at Southcote surgery (the satellite) is open at the following times:

• Monday afternoons from 3pm to 5.30pm, with a GP available from 4pm until 5pm.
• Wednesday afternoons from 4pm to 5.30pm, with a GP available from 4.30pm until 5.30pm
• Friday mornings from 8.30am to 11am, with a GP available from 9.30am to 10.30am.

There are no pre-bookable appointments at Southcote surgery. Patients can walk in and see a GP during the opening times.

Services are provided from the following two sites:

Long Barn Lane Surgery, 22 Long Barn Lane, Reading, Berkshire, RG2 7SZ

and

Southcote Clinic, Coronation Square, Southcote, Reading, RG30 3QP

Patients can attend either of the two practice locations. We visited both the main surgery and the satellite clinic during this inspection.

Updated 21 March 2017

Letter from the Chief Inspector of General Practice

We carried out an inspection in May 2016 to follow up on concerns raised at a previous inspection in January 2015. We found some aspects of the service had improved but others continued to be in breach of regulation. Specifically, we found the provider requires improvement for safe and effective services, good for caring and responsive services and inadequate for well led. We rated the practice as requires improvement overall. Following the inspection in May 2016, the practice sent us an action plan explaining what actions they were going to take to meet regulations.

We carried out an announced comprehensive follow up inspection at Long Barn Lane Surgery on 17 January 2017. We carried out this inspection to check the practice was meeting the regulations and to consider whether sufficient improvements had been made. Overall the practice is rated as good.

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

• There was an open and transparent approach to safety and an effective system in place for reporting and recording significant events.
• Risks to patients were assessed and well managed, with the exception of fridge temperature recording.
• 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.
• Child immunisation rates were below national average for most of the standard immunisations.
• Some patient health screening data showed the practice was below the national average, although they were in line with local averages.
• 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.
• Patients 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 and complied with the requirements of the duty of candour.

The areas where the provider should make improvements are:

• Ensure governance arrangements include monitoring of daily fridge temperature  recording.

• Ensure patients referred under the two week wait referral process are followed up.

• Ensure all staff, who are eligible, have received a yearly appraisal.

• Continue to encourage patients to attend for smoking cessation, health screening and childhood immunisations.

• Continue to review patient feedback and address concerns relating to care and treatment and telephone access.

Professor Steve Field (CBE FRCP FFPH FRCGP) 

Chief Inspector of General Practice

Updated 21 March 2017

The practice is rated as good for the care of people with long-term conditions.

• The practice had improved their care planning for patients with long term conditions who were at risk of hospital admission. The practice had been acknowledged by the clinical commissioning group (CCG) for having the highest patient uptake (29%) for alternative services to hospital admission than other practices across the four CCGs in West Berkshire.

• Nursing staff had lead roles in chronic disease management and patients at risk of hospital admission were identified as a priority.

• Data for diabetes indicators showed 75% of patients with diabetes had achieved a target blood sugar level of 64 mmol or less in the preceding 12 months. This was comparable to the CCG average of 72% and national average of 78%.

• 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 21 March 2017

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

• 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.

• The practice prioritised on the day appointments for children aged under three years. Appointments were available outside of school hours and the premises were suitable for children and babies.

• We saw positive examples of joint working with midwives and health visitors.

• 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. Immunisation rates were below the national standard for many standard childhood immunisations.

• 76% of women aged 25 to 64 years had a record of a cervical smear test in their notes in the preceding five years compared to the CCG average of 78% and national average of 81%.

Updated 21 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.

• Data from the quality outcomes framework (QOF) from 2015/16 showed the practice had achieved 100% for many clinical indicators affecting this patient group, including patients with atrial fibrillation (a heart rhythm disorder) and hypertension (high blood pressure).

Updated 21 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 offered extended hours clinics, a text messaging appointment reminder and cancellation service and telephone appointments for working patients who were unable to attend the practice during their core opening hours.

• 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 21 March 2017

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

• Data from 2015/16 showed 85% of patients diagnosed with dementia had their care reviewed in a face to face meeting in the last 12 months compared to the CCG average of 89% and national average of 84%.The practice had already met their target for this indicator for the period 2016/17 and had achieved 97%.

• 87% of patients with a diagnosed mental health condition had received an agreed care plan in the preceding 12 months compared to the CCG average of 91% and 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.

• 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.

Updated 21 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.

• During our inspection in May 2016, the practice had not completed any care plans for patients with a learning disability. The practice had commenced initiating care plans for patients with a learning disability. At the inspection in January 2017 the practice had undertaken nine care plans out of 24 patients (38%). They had confirmed appointments for the remaining 15 patients and were confident they would achieve 100% by the end of the March 2017.

• The practice offered longer appointments for patients who were vulnerable, including carers and patients with a learning disability.

• There was a patient flag for vulnerable patients on the practice’s computer system, but it was not obvious to all users.

• 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.

• The practice hosted a substance abuse clinic for local patients with drug and alcohol misuse.

• 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. The practice had been commended by the local safeguarding team for a 100% response rate to safeguarding queries.