Drs T A Underwood & M A Thompson

Updated 22 June 2016

Drs T.A. Underwood and V.A. Pizura operate from two premises in Reading. The practice has approximately 13300 registered patients between the two sites. The practice has a high proportion of patients aged 0 to 19 years and 45 to 59 years.

There are two GP partners, three salaried GPs and five long term locum / associate GPs. The practice employs two female practice nurses, and one health care assistant. The practice manager is supported by a team of administrative and reception staff. A number of staff work across both premises.

Services are provided via a Personal Medical Services (PMS) contract (PMS contracts are negotiated locally between GP representatives and the local office of NHS England).

Services are provided from the following locations:

Tilehurst Village Surgery

92 Westwood Road

Tilehurst,

Reading,

Berkshire,

RG31 5PP

Chancellor House Surgery

6 Shinfield Road

Reading,

Berkshire,

RG2 7BW

We visited both sites during our inspection.

When the practices are closed patients can access the Out of Hours Service via NHS 111 service.

Initial registration assessment determined that the practice was non-compliant with a minor impact for all regulated activities in relation to Regulation 21, Requirements relating to workers, of the Health and Social Care Act 2008 (Regulated Activities) Regulations 2010.

Updated 22 June 2016

Letter from the Chief Inspector of General Practice

We carried out an announced comprehensive inspection at Drs T.A. Underwood and V.A. Pizura on 25 May 2016. 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.
• 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.
• Most 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 GP appointments, although there could be a delay before seeing a named GP. Urgent appointments were available on the same day.
• The practice had good facilities and was 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.

We saw two areas of outstanding practice:

• The practice provided a ‘reversing diabetes’ programme. Patients with type 2 diabetes were supported to manage their condition through weight loss and diet and reduce reliance on medicine. 103 patients had participated in the programme and 37 of these had three years of follow-up study. 59% of the patients who had three years follow up had experienced improvement in diabetes. 12 patients managed diabetes through diet alone and no medicine and 10 patients were prediabetic or non diabetic.
• The practice website provided comprehensive information for patients with a wide variety of health and emotional needs. GPs used the website as an educational resource and referred patients to this during consultations to direct patients to relevant services. The website included information about technology that patients could use to promote a healthy lifestyle.

The areas where the provider should make improvement are:

• Ensure that there are single versions of both the adult and child safeguarding policies available to staff.

Professor Steve Field (CBE FRCP FFPH FRCGP) 

Chief Inspector of General Practice

Updated 22 June 2016

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

• GPs and 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 slightly lower than the national average for some indicators.
• The practice offered a ‘reversing diabetes’ programme whereby patients with type 2 diabetes were supported to manage their condition through weight loss and diet, and reduce the need for medicine.
• Longer appointments and home visits were available when needed.
• 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 22 June 2016

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

• 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 patients who had a high number of A&E attendances.
• Immunisation rates were relatively high for all standard childhood immunisations.
• Patients told us that children and young patients were treated in an age-appropriate way and were recognised as individuals, and we saw evidence to confirm this.
• The practice average for cervical screening was in line with CCG and national averages.
• 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, health visitors and nurses.
• There was a dedicated page on the practice website providing information for young people about confidentiality, sexual health, smoking, drugs and alcohol, and emotional support. There was also information for new mothers about breast feeding.

Updated 22 June 2016

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.
• The practice provided visits and monitoring for patients at local nursing homes and liaised with relevant health and social care professionals and nursing home staff.
• There was a dedicated page on the practice website providing information for older patients about health screening and immunisations.
• The practice referred older patients to services to help reduce isolation where appropriate.
• GPs reviewed all patients aged over 75 within three days of discharge from hospital.
• The practice had compiled a register of patients with frailty to ensure that the needs of these patients were monitored and met.

Updated 22 June 2016

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.
• The practice offered face to face and telephone appointments.
• Early morning, evening, and weekend appointments were available.
• There was a text reminder and cancellation service for appointments.
• As a result of increasing numbers of students registering, the practice had carried out a survey to seek the views of this population group. Results demonstrated positive feedback. Where areas for development were highlighted the practice acted on these, such as increased appointment availability.
• The practice had provided extra clinics to help students receive appropriate immunisations when starting university.

Updated 22 June 2016

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

• The percentage of patients diagnosed with dementia who had their care reviewed in a face-to-face meeting between 1 April 2014 to 31 March 2015 was 75%, which was lower than the CCG and national averages of 84%.
• Performance for other mental health related indicators was in line with CCG and national averages.
• The practice website contained information about dementia and a link to an online dementia screening test.
• 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 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 22 June 2016

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 patients with learning disabilities, homeless people, travellers, patients who are unable to leave the house.
• The practice offered longer appointments for vulnerable patients where needed.
• The practice regularly worked with other health care professionals in the case management of vulnerable patients.
• The practice had liaised with the safeguarding team to enable patients who were unable to leave the house to have home fire safety checks.
• 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.