Archived: Priory Avenue Surgery

Updated 11 February 2016

Priory Avenue Surgery provides primary medical services to the Caversham area of Reading from a two-storey converted dwelling, which has undergone several extensions over the last 10 years. The practice serves a population of over 7,500 patients in an area of low deprivation. The practice has a larger proportion of patients of working age compared with both local and national averages. There are no onsite parking facilities and the local roads have available parking for restricted times. There is one parking space adjacent to the practice for patients with limited mobility.

The consultation and treatment rooms are on both the ground and first floors with three waiting areas. The first floor can only be reached by a staircase, with no lift facility currently in place.

The practice has a large number of staff including two salaried GPs (one male, one female), three regular locum GPs (all male), two practice nurses (both female), a health care assistant (female), a specialist nurse (female), a practice manager and deputy practice manager, ten reception/administration staff, two secretaries and a clinical data manager.

The practice is open between 8am and 6.30pm Monday to Friday. Appointments are from 8.30am to 12.30pm every morning and 2pm to 5.50pm daily. Extended hours surgeries are offered on Tuesday and Wednesday evenings until 7.30pm and on alternate Saturdays. 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.

When the practice is closed, out-of-hours (OOH) GP cover is provided by the Westcall 111 service. Notices on the entrance door, in the patient leaflet and on the practice website clearly inform patients of how to contact the OOH service.

Priory Avenue Surgery has seen a number of management changes between 2012 and 2015. Following a Care Quality Commission (CQC) inspection in November 2014 the practice was placed into special measures with a breach of four regulations of the Health and Social Care Act 2008. Following a further management change, NHS England and the Clinical Commissioning Group successfully secured Berkshire Health Foundation Trust on an interim alternative provider medical services contract for 12 months. They took over on 1 June 2015 and remains as the registered provider.

A CQC inspection in July 2015 found the practice had improved and were able to take the practice out of special measures (report published September 2015), although improvements were still required to be made regarding recruitment checks, staffing levels, the complaints system, patient safety risk assessments and ensuring an ongoing programme of clinical audits. At the time of this inspection the new provider had been working with the practice for six months.

All services are provided from:

2 Priory Avenue

Caversham

Reading

Berkshire

RG4 7SF

Updated 11 February 2016

Letter from the Chief Inspector of General Practice

We carried out an announced comprehensive inspection at Priory Avenue Surgery on 8 December 2015. We carried out a previous announced inspection in July 2015 and found the provider was not meeting the regulations for recruitment checks, complaints system, continuous clinical audit programme, staffing levels and assessing risks. As a result, the practice was rated as requires improvement. At the inspection in December 2015 we followed up on all these concerns and found improvements had been made and the practice is rated as good overall.

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 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.
• Patients said they found it easy to make an appointment with a named GP and that 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.

However,

• Information about services was available but not everybody would be able to understand or access it. For example, there were no information leaflets available in different languages despite there being patients on the practice list for whom English was not their first language.

The areas where the provider should make improvements are:

Provide practice information in a range of languages and formats.

Professor Steve Field (CBE FRCP FFPH FRCGP) 

Chief Inspector of General Practice

Updated 11 February 2016

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.

• There was a dedicated diabetes nurse specialist who was driving improvements in diabetes care. Data shows the practice had achieved 100% of the available quality outcomes framework points for this patient group.

• Longer appointments and home visits were available when needed.

• All these patients had a named GP and a structured annual review to check that their health and medicines needs were being met. For those people with the most complex needs, the named GP worked with relevant health and care professionals to deliver a multidisciplinary package of care.

Updated 11 February 2016

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

• 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 similar or slightly higher for all standard childhood immunisations.

• 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.

• 89% of women aged between 25-64 had cervical screening in the last five years which was above the national average of 82%.

• Appointments were available outside of school hours and the premises were suitable for children and babies.

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

Updated 11 February 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 people in its population.

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

• 82% of people aged over 65 had received their annual flu immunisation compared to a national average of 73%.

Updated 11 February 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.

Updated 11 February 2016

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

• 94% of people diagnosed with long term mental health conditions had their care plan reviewed in the last 12 months.

• The practice regularly worked with multi-disciplinary teams in the case management of patients experiencing poor mental health, including those with dementia.

• It 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.

• It 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 people with mental health needs and dementia.

Updated 11 February 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 homeless people, travellers and those with a learning disability.

• It offered longer appointments for patients with a learning disability.

• The practice regularly worked with multi-disciplinary teams in the case management of vulnerable patients.

• It had told 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.