Western Elms Surgery

Updated 6 March 2018

Western Elms is a well-established GP surgery which has operated in this locality for over 100 years. The practice has a registered population of approximately 18,000. The premises are located on three floors with all treatment and consultation rooms on the ground floor. There is wheelchair access to the waiting area and to most consultation rooms. There are eight GP partners and a total of 12 GPs working at the practice, as well as locums. There is a mix of male and female GPs working at the practice.

The nursing team consists of two nurse practioners, two practice nurses, two health care assistants (HCA) and one phlebotomist. The practice team also includes three pharmacists and are piloting the employment of a paramedic four hours per day to manage the home visits and carry out the treatment of minor illness. Administrative and reception staff also work at the practice and Western Elms Surgery is also a training practice.

The practice has a Primary Medical Services (PMS) contract. PMS contracts are subject to local negotiations between commissioners and the practice.

There is a higher than average number of working age patients and fewer older patients than average registered. The practice is located in an area of Reading with a high density of rented accommodation which results in a highly transient population and a greater than average turnover of patients. Approximately 1,500 patients left and 2,000 registered with the practice in the last 12 months equating to nearly 11% turnover. The practice commented that local factors, has led to a year on year increase in their registered population (3% growth in the previous 12 months) and planning permission has been granted to extend the building to cope with the increased demand.

Western Elms Surgery is located in a pocket with a higher level of deprivation than the clinical commissioning group (CCG) average and comparable with the national average. People living in more deprived areas tend to have a greater need for health services.

The main entrance to the practice is accessed via ramps and all consulting and treatment rooms are located on the ground floor and accessible to patients with a disability or those with prams and pushchairs. Cover for holidays and other periods of absence is provided by regular locum GPs.

The practice is open between 8am to 6.30pm Monday to Friday. Pre-booked appointments are available from 8.30am to 5.50pm Monday to Friday and patients with an urgent need to see a GP can be seen up until 6.30pm. Extended surgery hours, staffed by doctors and nurses, are offered between 7.00am and 8.30am two days per week, between 6.30pm and 7.50pm two days per week and on Saturday mornings.

The practice has opted out of providing out of hours services to their patients. Out of hours services are provided by Westcall. The out of hours service is accessed by calling NHS111. There are arrangements in place for services to be provided when the surgery is closed and these are displayed at the practice, in the practice information leaflet and on the website.

We carried out an announced comprehensive inspection at Western Elms Surgery on 10 January 2018 as part of our inspection programme.

All services are provided from: Western Elms Surgery, 317 Oxford Road, Reading, Berkshire, RG30 1AT.

The practice has been inspected before in November 2014 when it was found to be good for the delivery of safe, effective, caring, responsive and well led services, giving rise to an overall rating of good.

Updated 6 March 2018

Letter from the Chief Inspector of General Practice

This practice is rated as Good overall.

At our previous inspection in November 2014 the practice had an overall rating as good.

Following the November 2014 inspection, the key questions were rated as:

• Are services safe? – Good

• Are services effective? – Good

• Are services caring? – Good

• Are services responsive? – Good

• Are services well-led? – Good

As part of our inspection process, we also look at the quality of care for specific population groups. The population groups were rated as:

• Older People – Good

• People with long-term conditions – Good

• Families, children and young people – Good

• Working age people (including those recently retired and students – Good

• People whose circumstances may make them vulnerable – Good

• People experiencing poor mental health (including people with dementia) – Good

We carried out an announced comprehensive inspection at Western Elms Surgery in Reading, Berkshire on 10th January 2018. We carried out this inspection under Section 60 of the Health and Social Care Act 2008 as part of our regulatory functions. This inspection was planned to check whether Western Elms Surgery was meeting the legal requirements and regulations associated with the Health and Social Care Act 2008.

At this inspection we found:

• The practice had clear systems to manage risk so that safety incidents were less likely to happen.
• When incidents did happen, the practice learned from them and improved their processes.
• The practice fully engaged with programmes developed in the local area to support patient’s health and wellbeing in a number of different ways. For example, a coffee morning hosted at a local church for patients over 75 years to share health information and receive feedback.
• The practice routinely reviewed the effectiveness and appropriateness of the care it provided. It ensured that care and treatment was delivered according to evidence-based guidelines.
• Staff involved and treated patients with compassion, kindness, dignity and respect. The practice was above average for its satisfaction scores on consultations with GPs and nurses in a number of areas.
• Patients found the appointment system easy to use and reported that they were able to access urgent care when they needed it.
• Services were tailored to meet the needs of individual people and delivered in a way that ensured flexibility and choice. For example, the practice operated a drop-in family planning clinic and worked collaboratively with other external organisations and charities.
• There was a strong focus on continuous learning and improvement at all levels of the organisation.
• We received positive feedback from external stakeholders and patients who access GP services from the practice.

We saw one area of outstanding practice including:

• Accessible Information Standard (a requirement to make sure that patients and their carers can access and understand the information they are given): The practice had nominated a project leader and established a working group, involving representatives of the Patient Participation Group (PPG) and local healthcare charities, to survey patients and recommend improvements. For example greetings and frequently asked questions at reception had been produced in six different languages and representatives from Mencap and Healthwatch frequently attended the surgery to act as advocates for appropriate patients. Signage in the waiting room offered information in alternative formats and a protocol had been developed to help patients with hearing difficulties. All staff had received dementia awareness training and Makaton (a language programme using signs and symbols to help people communicate) training had been scheduled for a future practice training day.

The areas where the provider should make improvements are:

• Continue to review arrangements for the identification of carers to assure the practice that they are being identified effectively and provide any support they may require.
• Review processeses to ensure that Patient Group Directions (PGDs) are signed by appropriate members of staff.
• Review processes for increasing the take up of children’s immunisations.
• Continue to prioritise patients on the Learning Disabilities register and review arrangements to ensure all patients receive an annual health check. 

Professor Steve Field CBE FRCP FFPH FRCGP 

Chief Inspector of General Practice

Updated 22 January 2015

Patients with health conditions were well managed by the practice. Where there were concerns from national data regarding diabetic check-ups the practice had introduced a new means of delivering diabetic care and this new system was being monitored. Patients were provided with access to regular health reviews in line with national standards. Off-site health checks were organised if patients could not attend the practice. There were walk-in cardiovascular clinics to improve patient attendance and flexibility. There were clinical leads for different long term conditions. Patients could be discussed at virtual reviews with external specialists from local hospitals without referring patients to local hospitals. Flu vaccinations for patients at risk of serious health concerns associated with flu (due to long term health conditions), were above national average.

Updated 22 January 2015

Staff had systems to quickly identify children at risk of abuse. There were regular meetings with the local child safeguarding team and other relevant services. There were walk-in family planning and sexual health clinics available which had been increased by the practice due to their success. The premises were accessible for prams and buggies. Thirty minute antenatal appointments and postnatal clinics were available. The practice worked with health visitors to share information and provide a continuity of care for new babies and families.

Updated 22 January 2015

Staff had systems to quickly identify vulnerable adults. Patients over 75 had a named GP to promote continuity of care. The premises were accessible to those with limited mobility. GPs provided care to patients in two local care homes and there were processes to ensure these patients had continuity in their care. Flu vaccinations were promoted for over 65s and the uptake was slightly below national average. The practice had participated in a dementia friends event organised by the patient participation group. There were strong working relationships with external services such as district nurses.

Updated 22 January 2015

Extended hours appointments were available on Monday and Tuesday evenings until 8pm and on Saturday mornings from 8.30am to 12pm. The evening extended hours were walk in surgeries for patients who could not attend during normal working hours. Some patients who worked were concerned about the waiting time for appointments when attending the practice. This was reflected in practice survey. Staff told us they were opportunistic in undertaking health checks, such as smears, when patients who did not attend regularly were at the practice.

Updated 22 January 2015

External support services were advertised on the practice website and in the waiting area for patients experiencing poor mental health. The practice provided Improving Access to Psychological Therapies (IAPT) access to patients experiencing poor mental health. Staff had regular meetings with the community mental health team (CMHT) and local psychiatrists to discuss and plan patient care. Annual health checks were offered and the practice achieved the national average in the uptake among patients experiencing poor mental health.

Updated 22 January 2015

Staff had systems to quickly identify patients who may be vulnerable so they could take appropriate action when planning or delivering care. Disabled patients were considered in the design and layout of the building; including accessibility to reception, waiting areas and treatment rooms, plus there was a hearing aid induction loop. The practice had implemented an IT tool which assisted the practice in identifying patients at risk of unplanned admissions and 45 vulnerable patients per GP had been identified as requiring a care plan. The practice worked with local drug and alcohol support services to care for this vulnerable group of patients. Patients at a local probation hostel received care from the GP practice. A translation service was available for patients who did not speak English.