Herschel Medical Centre

Updated 13 January 2017

Herschel Medical Centre is situated in Slough. The practice is located in a purpose built premises. The practice is accessible for patients and visitors who have difficulty managing steps. All patient services are offered on the ground floor. The practice comprises of 26 consulting rooms, two treatment rooms, a patient waiting area, reception area, administrative and management offices and a meeting room.

The premises had undergone extension work and the provider has built additional four consulting rooms and a waiting area. The practice informed us that new areas would be operational from February 2017.

The practice has core opening hours from 8am to 6.30pm Monday to Friday. The practice has a range of different types of appointments for patients every weekday from 8am to 5:30pm including open access appointments with a duty GP. Extended hours appointments are available every morning from 7.30am to 8am. In addition, the practice has offered extended hours appointments every Saturday and Sunday from 9am to 1pm at Bharani Medical Centre (funded by Prime Minister’s Access Fund) as a collective of local practices.

The practice had a patient population of approximately 13,100 registered patients including 43% South Asian and a significant Polish patient population. The number of patients aged between 15 to 24 years and aged above 50 years old are lower than the national average and there are a higher number of patients aged between 0 to 9 years old and aged between 25 to 44 years old compared to national average.

There are two GP partners, three salaried GPs, three locum GPs and a trainee GP at the practice. Six GPs are male and three female. The practice employs one locum nurse practitioner, two practice nurses, two clinical pharmacists and three health care assistants. The practice manager is supported by three patient services coordinators, a team of administrative and reception staff.

Services are provided via a General Medical Services (GMS) contract (GMS contracts are negotiated nationally between GP representatives and the NHS). This is a training practice, doctor training to be qualified as a GP has access to a senior GP throughout the day for support. We received positive feedback from the trainee we spoke with.

Services are provided from following location:

45 Osborne Street

Slough

SL1 1TT

The practice has opted out of providing out of hours services to their patients. There are arrangements in place for services to be provided when the practice is closed and these are displayed at the practice, in the practice information leaflet and on the patient website. Out of hours services are provided during protected learning time by East Berkshire out of hours service or after 6:30pm, weekends and bank holidays by calling NHS 111.

Updated 13 January 2017

Letter from the Chief Inspector of General Practice

We carried out an announced comprehensive inspection at Herschel Medical Centre on 23 November 2016. We carried out this inspection to check that the practice was meeting the regulations and to consider whether sufficient improvements had been made.

Our previous inspection in May 2016 found breaches of regulations relating to the safe, effective and responsive delivery of services. There were also concerns and regulatory breaches relating to the governance and leadership of the practice, specifically in the well led domain. The overall rating of the practice in May 2016 was requires improvement. Specifically, the practice was rated require improvement for provision of safe, effective, responsive and well-led services in May 2016. It was good for providing caring service. Following the inspection, we received an action plan which set out what actions the practice would take to achieve compliance.

At the inspection in November 2016, we found the practice had made improvements since our last inspection in May 2016. Overall the practice is rated as good. Specifically, we found the practice good for providing 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.
• Data showed the practice had demonstrated improvements in patient’s outcomes. Audits had been carried out and we saw evidence that audits were driving improvement in patient outcomes.
• 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.
• The patients we spoke with on the day of inspection informed us they had noticed improvements in the availability of appointments.
• 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:

• Continue to review and improve the waiting time it takes to get through to the practice by telephone.
• Review and monitor the system in place to continue encouraging the uptake for the bowel screening programme.

Professor Steve Field (CBE FRCP FFPH FRCGP) 

Chief Inspector of General Practice

Updated 13 January 2017

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

• There were clinical leads for chronic disease management and patients at risk of hospital admission were identified as a priority.
• Longer appointments and home visits were available when needed.
• All patients with long term conditions had a named GP and the practice carried out a structured annual review to check that their health and medicines needs were being met.
• Data showed the practice had demonstrated improvements in patient’s outcomes. For example, the practice had undertaken 88% (on average) structured annual medicine reviews for patients with long term conditions (e.g. Diabetes, asthma, chronic obstructive pulmonary disease, chronic heart disease and dementia), which was 57% when we inspected the practice in May 2016.
• The practice had recruited two new clinical pharmacists to carry out medicines reviews for complex cases patients with long term conditions.
• 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 13 January 2017

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 comparable 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.
• The practice’s uptake for the cervical screening programme was 83%, which was above the national average of 82%.

• The practice offered Saturday morning clinics for women who found it difficult to attend for their cervical screening test during week days.
• 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 13 January 2017

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.
• It was responsive to the needs of older patients, and offered home visits and urgent appointments for those with enhanced needs.
• There was a register to effectively support patients requiring end of life care.
• There were good working relationships with external services such as district nurses.
• The premises were accessible to those with limited mobility. The practice provided a low level desk at the front reception.

Updated 13 January 2017

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 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 appointments Monday to Friday from 7.30am to 8am at the premises. In addition, the practice offered extended hours appointments every Saturday and Sunday from (9am to 1pm) at Bharani Medical Centre (funded by Prime Minister’s Access Fund).
• 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.
• We noted the practice offered telephone consultations.

Updated 13 January 2017

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

• Data from 2015-16 showed, performance for dementia face to face reviews was comparable to the CCG and national average. The practice had achieved 84% of the total number of points available, compared to 85% locally and 84% nationally.
• Patients experiencing poor mental health were involved in developing their care plan and health checks.
• The practice regularly worked with multi-disciplinary teams in the case management of patients experiencing poor mental health, including those with dementia.
• The practice had told patients experiencing poor mental health how to access various support groups and voluntary organisations.
• Systems were in place to follow up patients who had attended accident and emergency, when experiencing mental health difficulties.
• Staff had a good understanding of how to support patients with mental health needs and dementia.

Updated 13 January 2017

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 people, travellers and those with a learning disability.
• It offered annual health checks for patients with learning disabilities. Data from 2016-17 showed health checks were completed for 51 patients out of 67 patients on the learning disability register. Care plans were completed for 52 patients out of 67 patients on the learning disability register.
• The practice offered longer appointments for patients with a learning disability.
• 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.