Pembroke Surgery

Updated 20 April 2016

Pembroke surgery is located in a residential area close to Reading town centre. The practice occupies a converted house and has been at the current location since 1989. The practice also offers a service from a branch surgery nearby. This location was not inspected as part of our visit. Pembroke Surgery is the trading name of the limited company.

The Pembroke Surgery site has a car park with disabled parking spaces available. There is ramped access but there are no automated front doors. The Eldon Square location has no parking facilities at the practice. Parking in the surrounding roads is restricted but bus routes pass nearby enabling easy public transport access to the practice.

There are approximately 5,180 patients registered with the practice. The profile of the registered patient group shows a higher than average number aged between 0-4 years and 20-40 years old. The number of patients over 50 is much lower than average. The practice has identified 20% of the patient list turnover each year. The population of the practice has changed significantly over the years with a higher number of patients from minority ethnic backgrounds. Income deprivation is recognised within pockets of the registered population. Patients are able to access appointments with the GPs and nurses at either of the practice locations.

There is one partner and a salaried GP at the practice. One male and one female. This makes up the equivalent of 1.4 WTE of GPs. There is a part time nurse prescriber and two part-time practice nurses and a part time health care assistant. A member of the practice administration staff also undertakes phlebotomy duties. The practice also has a part-time prescribing pharmacist who has received training enabling him to manage minor illnesses and some long term conditions. The practice manager is supported by an assistant practice manager, a financial accountant and a team of reception and administration staff.

Services are delivered via a Personal Medical Services (PMS) contract. A PMS contract is 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.

The practice is open from 8am to 6.30pm Monday-Thursday and 8am to 6pm on a Friday. Appointments are available between these times at either the Pembroke Surgery or Eldon Square site. Extended hours clinics are offered every Thursday evening until 7.30pm, Friday mornings between 7am and 8am and on Saturdays between 8am and 11am.

Services are provided from:

Pembroke Surgery, 31 Alexandra Road, Reading, Berkshire RG1 5PG and

Eldon Square, Reading, RG1 4DP.

The practice has opted out of providing out of hours services to their patients. Out of hours services are provided by Westcall. This out of hours service is accessed by calling 111. A message on the practice telephone system advises patients to call this number when the practice is closed. The arrangements in place for services to be provided when the surgery is closed are displayed at the practice, in the patient information leaflet and on the practice website.

This is the first inspection of the Pembroke Surgery.

Updated 20 April 2016

Letter from the Chief Inspector of General Practice

We carried out an announced comprehensive inspection at Pembroke Surgery on the 9 March 2016. Overall the practice is rated as good. The practice was rated as good for the provision of safe, effective, caring, responsive and well led services.

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. However, some patients reported having to wait sometime to see their preferred GP.
• 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.

We saw one area of outstanding practice:

A GP in the practice had received training in ultrasound scanning and provided this service to patients of the practice. The service supported patients who were pregnant with routine and non-routine scans and assisted with the diagnosis of abdominal conditions such as gallstones. The GP worked closely with specialists and consultants at the local hospital and was able to seek advice, as required. This offered an improved service and experience for patients of the practice with a reduction in referrals and admissions, more rapid diagnosis and increased scans for pregnant women offering reassurance with early pregnancy concerns.

The areas where the provider should make improvement are:

• Ensure the system for monitoring training is more robust and implement a more consistent approach to the recording of training documentation and dates.

• Consider a review of the PPG virtual group and how this could be further developed to ensure enhanced engagement and involvement with the practice.

• Review the cervical screening and breast cancer screening to increase uptake to nearer the national average.

• Clearly display comments and compliments forms in reception.

Professor Steve Field (CBE FRCP FFPH FRCGP) 

Chief Inspector of General Practice

Updated 20 April 2016

The practice is rated as good for the care of patients 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.

• The percentage of patients on the diabetes register, with a record of a foot examination and risk classification within the preceding 12 months (01/04/2014 to 31/03/2015) was 92% and was better than the national average of 88%.

• 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.

• The lead diabetic nurse worked closely with the local community specialist diabetic nurse and consultant specialist to ensure patients were managed in line with best practice.

Updated 20 April 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 patients who had a high number of A&E attendances. Immunisation rates were comparable to clinical commissioning group averages for all standard childhood immunisations.
• The percentage of patients with asthma, on the register, who have had an asthma review in the 12 months from April 2014 to March 2015 that included an assessment of asthma control using the three RCP questions, was 71%, which is slightly lower than the national average of 75%.
• 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’s uptake for the cervical screening programme was 77%, which was slightly below the national average of 82%.
• 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.
• Safeguarding was promoted as everyone’s business and all staff had a good understanding of how to identify possible signs of abuse and how to report any concerns.

Updated 20 April 2016

The practice is rated as good for the care of older patients.

• 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.

• A systematic approach to long term condition management and review was in place.

• Multidisciplinary working with community based nurses’ ensured patients who were housebound received high quality care and treatment.

• Choose and book support was offered to patients who were unable to use the IT booking system.

• All over 75’s were added to an unplanned admissions register with personalised care plans based on individual need.

• A GP regularly visited two local residential homes for patients who had dementia, to provide care and treatment to the residents and support to relatives.

Updated 20 April 2016

The practice is rated as good for the care of working-age patients (including those recently retired and students).

• The needs of the working age population, those recently retired and young families 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 as a full range of health promotion and screening that reflects the needs for this age group.

• Extended hours appointments were available on a Thursday evening, Friday and Saturday morning.

• Online registration, booking of appointments and ordering repeat prescriptions was available.

• 24/7 telephone appointment booking and cancellation was available.

• In house ultrasound and joint injections reduced the need for hospital attendance.

Updated 20 April 2016

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

• The percentage of patients diagnosed with dementia whose care has been reviewed in a face-to-face review in the 12 months from April 2014 to March 2015 was 88% which was higher than the national average 84%.
• The percentage of patients with physical and/or mental health conditions whose notes record smoking status in the 12 months April 2014 to March 2015 was 96% when compared with the national average of 94%.
• 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.
• Patients with dementia were referred to the memory clinic and recommendations highlighted on care plans which were shared with the out of hours provider and other urgent and emergency care organisations.
• Patients had access to talking therapies and self-help techniques.
• 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 20 April 2016

The practice is rated as good for the care of patients whose circumstances may make them vulnerable.

• The practice held a register of patients living in vulnerable circumstances including homeless patients, travellers and those with a learning disability.

• The practice offered longer appointments for patients with a learning disability.

• The practice regularly worked with multi-disciplinary teams 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.

• Safeguarding was promoted as everyone’s business and all staff had a good understanding of how to identify possible signs of abuse and how to report any concerns.

• Ongoing training was provided to staff to ensure early identification of Female Genital Mutilation (FGM).