Archived: Radnor House Surgery and Ascot Medical Centre

Updated 19 January 2017

Radnor House Surgery and Ascot Medical Centre offer primary medical services to approximately 5,150 patients in the Ascot area. The two practices merged in April 2015 and initially continued to see patients at both sites. Following the CQC inspection in March 2016 the practice have moved all clinical staff and equipment to Ascot Medical Centre, which is based at Heatherwood Hospital. Radnor House is now used as an administration base and no regulated activities are being carried out at this site. The practice have submitted an application to CQC to register Ascot Medical Centre as their main site.

The practices are located in an area of low deprivation, meaning few patients are affected by social or economic deprivation locally. The patient list has a higher proportion of adults, both male and female, in the 45 to 69 age group, meaning a higher proportion of working age patients are registered at this practice.

The practice has two GP partners (both male), four salaried GPs (all female), three practice nurses (all female) and one Health Care Assistant (female). The clinical staff are supported by a practice manager, 10 receptionists, administration staff and a receptionist team leader. The practice is a training practice for GP trainees but does not currently have a GP trainee working with them.

Ascot Medical Centre is situated within the grounds of Heatherwood Hospital. It is a purpose built ground level building with easy access for disabled patients. The entrance has automatic doors which lead to a corridor from which all consultation and treatment rooms are accessible. The reception area is clearly signed with the waiting area across the hallway. There are toilet facilities available including disabled access with wide doorways.

The opening hours at Ascot Medical Centre are:

• Mondays to Friday between 8am and 6.30pm.
• Early Tuesday from 7.30am
• Late Monday until 7.30pm

Patients can also access appointments with a GP at King Edward Hospital via a service provided through the Prime Ministers Challenge Fund, which aims to help improve access to general practice and stimulate innovative ways of providing primary care services across the country.

Radnor House Surgery and Ascot Medical Centre operates with a General Medical Services contract. They offer enhanced services for childhood immunisations, improving patient online access, influenza and pneumococcal immunisations, annual health checks for patients with a learning disability and avoiding unplanned admissions.

Radnor House Surgery and Ascot Medical Centre are registered for providing diagnostic and screening procedures, maternity and midwifery services, treatment of disease, disorder or injury, surgical procedures and family planning.

The practice has opted out of providing out of hours services to their patients. The out of hours service is provided by East Berkshire Primary Care Out of Hours Service and is accessed by calling NHS 111. Advice on how to access the out of hours service is contained on a recorded message when the practice is closed.

All services are provided from:

Ascot Medical Centre, Gate 3, Heatherwood Hospital, Ascot, SL5 8AA.

Updated 19 January 2017

Letter from the Chief Inspector of General Practice

We carried out an announced comprehensive inspection at Radnor House Surgery and Ascot Medical Centre on 10 November 2016. This comprehensive inspection was carried out to check that the practice was meeting the regulations and to consider whether sufficient improvements had been made since the previous inspection in March 2016.

Our previous inspection in March 2016 found breaches of regulations relating to the safe, effective, caring, and responsive delivery of services. There were also concerns and regulatory breaches relating to the management and leadership of the practice, specifically in the well led domain. The overall rating of the practice in March 2016 was inadequate and the practice was placed into special measures for six months.

During the inspection in November 2016, we found evidence that improvements had been made. Our improved rating of good for the provision of well led services reflects the positive development of leadership and management systems to deliver significant progress in improving services across the board for all patient groups. Our rating of requires improvement for the provision of safe and effective services reflects that some positive changes have been made, however improvements are still required.

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

• Risks to patients were assessed and well managed. However, they had not ensured that blank prescription stationery was tracked within the practice. The practice implemented a change in process and sent an action plan following the inspection.
• There was an open and transparent approach to safety and an effective system in place for reporting and recording significant events.
• The practice had responded to their vulnerable population group and had worked effectively to ensure that their needs were fully met. All staff within the practice showed that they recognised the signs when further support may be needed.
• 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.
• Patients said they did not find it easy to make an appointment; the practice had recognised and put measures in place to respond to this.
• 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 practice had recently integrated their Saturday flu clinics with a one-stop shop service to encourage patients to have regular health reviews.

The areas where the provider must make improvements are:

• Ensure blank prescription stationery distribution is monitored within the practice in accordance with current guidelines.

The areas where the provider should make improvements are:

• Ensure there is a system in place to action and mitigate the risks to patients if a vaccine cold chain breach occurs.
• Ensure patient outcomes are reviewed to ensure that patients with long term conditions receive appropriate care and treatment.

This service was placed in special measures in March 2016. Improvements have been made such that ratings of good for the delivery of responsive, caring and well led services and a rating of requires improvement for safe services have now been achieved. This has led to an improved rating of good. I am taking this service out of special measures. This recognises the significant improvements made to the quality of care provided by this service.

Professor Steve Field (CBE FRCP FFPH FRCGP) 

Chief Inspector of General Practice

Updated 19 January 2017

The practice is rated as requires improvement for the care of people with long-term conditions. The provider was rated as requires improvement for safe and effective services. The concerns which led to these ratings apply to everyone using the practice, including this population group.

• Nursing staff had lead roles in chronic disease management and patients at risk of hospital admission were identified as a priority.
• Performance for chronic kidney disease related indicators was 100% which was comparable to the clinical commissioning group average of 99% and national average of 99%.
• Longer appointments and home visits were available when needed, although accessing these appointments was an issue according to patient feedback.
• 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.
• Long term condition review clinics were held by the practice nurses.
• The practice participated in the clinical commissioning group complex case management scheme which provided proactive care for those at highest risk of emergency admission.
• Performance for Chronic Obstructive Pulmonary Disease (COPD, a collection of lung diseases including chronic bronchitis and emphysema) indicators showed the practice had achieved 95% of targets which was similar when compared to the CCG average (99%) and higher when compared to the national average (96%).

Updated 19 January 2017

The practice is rated as requires improvement for the care of families, children and young people. The provider was rated as requires improvement for safe and effective services. The concerns which led to these ratings apply to everyone using the practice, including this population group.

• 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 relatively high 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.
• The practice’s uptake for the cervical screening programme was 94%, which was above the CCG average of 84% and the national average of 82%.
• Childhood immunisation rates for the vaccinations given were mixed. For example, childhood immunisation rates for the vaccinations given to under two year olds ranged from 91% to 100% compared to the CCG range of 91% to 96% and five year olds from 73% to 95% compared to the CCG range of 85% to 96%.
• 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 school nurses.

Updated 19 January 2017

The practice is rated as requires improvement for the care of older people The provider was rated as requires improvement for safe and effective services. The concerns which led to these ratings apply to everyone using the practice, including this population group..

• 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 and urgent appointments for those with enhanced needs.
• The practice identified older patients and coordinated the multi-disciplinary team (MDT) for the planning and delivery of palliative care for patients approaching the end of life.
• We saw unplanned hospital admissions and re-admissions for the over 75s were regularly reviewed.
• Nationally reported data showed that outcomes for patients for conditions commonly found in older people were comparable to local and national averages. For example, the percentage of patients with dementia having their care reviewed was 100% which was above the CCG average of 83% and national average of 84%.
• Immunisation campaigns for the elderly such as flu, shingles and pneumonia were advertised through posters, messages on prescriptions, website updates and letters, with follow up phone calls to those who did not attend.

Updated 19 January 2017

The practice is rated as requires improvement for the care of working-age people (including those recently retired and students). The provider was rated as requires improvement for safe and effective services. The concerns which led to these ratings apply to everyone using the practice, including this population group.

• 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 surgery offered extended late appointments every week on Monday until 7.30pm.
• The practice was proactive in offering online services for repeat prescriptions and booking appointments as well as a full range of health promotion and screening that reflects the needs for this age group.

Updated 19 January 2017

The practice is rated as requires improvement for the care of people experiencing poor mental health (including people with dementia). The provider was rated as requires improvement for safe and effective services. The concerns which led to these ratings apply to everyone using the practice, including this population group.

• 100% of patients diagnosed with dementia that had their care reviewed in a face to face meeting in the last 12 months, which is above the local average of 86% and the national average of 84%. Exception reporting was 0%

• 81% of patients diagnosed with a severe mental health issue who had a comprehensive, agreed care plan documented in the last 12 months, which was lower than the local average of 89% and the national average of 88%. The practice had recognised this and designed an action plan to improve uptake. Exception reporting was 0%.

• 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 19 January 2017

The practice is rated as requires improvement for the care of people whose circumstances may make them vulnerable. The provider was rated as requires improvement for safe and effective services. The concerns which led to these ratings apply to everyone using the practice, including this population group.

• The practice held a register of patients living in vulnerable circumstances including homeless people, travellers and those with a learning disability.
• The practice offered longer appointments for patients with a learning disability.
• An audit had been completed to highlight areas of development with uptake of learning disability health checks.
• The practice had designed an easy read format (easy read refers to the presentation of text in an accessible, easy to understand format) invitation letter to improve the uptake of learning disability health checks. The number of health checks undertaken was 44%, which is comparable to the national average of 44%.
• Practice staff were trained to recognise signs of abuse within their vulnerable patients.
• GPs worked within a multi-disciplinary team to ensure the best outcomes for vulnerable patients.
• 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.