Lambourn Surgery

Updated 21 June 2017

Lambourn Surgery is located in Lambourn, Berkshire. The practice resides in purpose built premises and there is parking available. The practice has approximately 6,500 registered patients. The practice has patients from varying age groups with a slightly higher proportion of patients aged 40 to 79. The area in which the practice is located is placed in the third least deprived decile. In general, people living in more deprived areas tend to have a greater need for health services. According to the Office for National Statistics and information provided by the practice, the practice catchment area has a high proportion of people from a White British background.

There are four GP partners (one in their probation period) and one salaried GP, consisting of three male GPs and two female GPs. GPs provide approximately 35 sessions per week in total. The practice employs three female practice nurses and one health care assistant/ phlebotomist. The practice manager is supported by a team of administrative and reception staff.

The practice provides teaching to medical students and training for qualified doctors who are seeking to become GPs. The practice provides a dispensing practice to approximately half of its patients, who lived more than a mile from a community pharmacy. The practice employed four members of dispensary staff and one relief dispenser. The practice is open between 8am and 6.30pm Monday to Friday.

When the practice is closed patients can access the Out of Hours Service via NHS 111 service Services are provided via a General Medical Services (GMS) contract (GMS contracts are a contract between NHS England and general practices for delivering general medical services and is the commonest form of GP contract.

Services are provided from the following location:

Lambourn Surgery

Bockhampton Road

Lambourn

Berkshire

RG17 8PS

Updated 21 June 2017

Letter from the Chief Inspector of General Practice

We carried out an announced comprehensive inspection at Lambourn Surgery on 7 October 2016. The overall rating for the practice was good. However, the practice was found to require improvement in the provision of safe services. The full comprehensive report on the October 2016 inspection can be found by selecting the ‘all reports’ link for Lambourn Surgery on our website at www.cqc.org.uk.

This inspection was an announced focused inspection carried out on 17 May 2017 to confirm that the practice had carried out their plan to meet the legal requirements in relation to the breach in regulations that we identified in our previous inspection on 7 October 2016. This report covers our findings in relation to those requirements and also additional improvements made since our last inspection.

Provision of safe services is now rated good and overall the practice remains rated as good.

Our key findings were as follows:

• Medicines fridges were kept in a secure location within the practice.
• Vaccines stored within medicines refrigerators were kept in accordance with best practice guidance.
• Treatment room flooring was fitted in line with best practice for reducing the risk of cross infection.
• Appropriate systems were in place for the safe disposal of sharps bins.
• Staff training was up to date and relevant to the roles of staff.
• Competency checks had been completed and recorded for dispensary staff.
• An appropriate system was in place to report dispensing incidents, including near misses. Learning from dispensary incidents was shared and staff were aware of the learning.

We found aspects of the service where the provider should make improvement:

• A review of the risk assessment for keeping liquid nitrogen on site should be completed in sufficient detail to identify all storage risks.

Professor Steve Field (CBE FRCP FFPH FRCGP) 

Chief Inspector of General Practice

Updated 22 November 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.
• Performance for diabetes related indicators was lower than the CCG and national averages for some indicators and similar for others. They had employed a number of measures to improve the care received by patients with diabetes. The practice nurse told us that these measures had since resulted in a 25% reduction in patients with poorly controlled diabetes.
• Longer appointments and home visits were available for patients with long term conditions when needed.
• Patients with long term conditions had 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.

Updated 22 November 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.
• Childhood immunisation rates were in line with CCG and national averages.
• 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 81%, which was lower than the CCG average of 88% and similar to the national average of 82%.
• Appointments were available outside of school hours and the practice had taken steps to ensure that a greater number of same day appointments were available outside of school hours to meet patient need.
• Premises were suitable for children and babies. There were toys in the waiting area, baby changing facilities, and nappies available.
• We saw positive examples of joint working with midwives and health visitors.

Updated 22 November 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 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.
• The practice provided visits to patients living in residential homes.
• The practice website and waiting area contained information about health conditions and support services relevant to older patients.
• The practice had liaised with the CCG to ensure that patient transport services were available for patients in the practice catchment area.
• The practice encouraged patients to register as carers. They provided information for carers in the waiting area and on the website and had invited a representative from a local carers’ group to spend the morning at the surgery to provide information to patients.

Updated 22 November 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.
• Early morning and some evening and weekend appointments were available.
• The practice had reviewed appointment need and as a consequence offered additional same day appointments during the early afternoons to meet the needs of the local racing community.
• The GPs provided visits to patients at a local rehabilitation centre for people with complex physical needs.
• The practice provided meningitis immunisations for university students.

Updated 22 November 2016

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

• The percentage of patients diagnosed with dementia whose care has been reviewed in a face-to-face review in the preceding 12 months was 94% which was high compared to the CCG average of 85% and national average of 84%.
• The practice had completed a dementia audit tool and taken steps to make the environment more suitable for people with dementia.
• The practice had signed up the Dementia Friends scheme and staff had received training on how to support patients with dementia.
• The percentage of patients diagnosed with schizophrenia, bipolar affective disorder and other psychoses whose alcohol consumption has been recorded in the preceding 12 months was 96% compared to the CCG average of 90% and national average of 90%.
• 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 about how to access various support groups and voluntary organisations.

Updated 22 November 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.
• 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.