Letter from the Chief Inspector of General Practice

This practice is rated as Good overall. (Previous inspection November 2014 – Good)

The key questions are rated as:

Are services safe? – Requires improvement

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 are 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 Balmore Park Surgery on 22 November 2017. This inspection was carried out as part of our new phase of inspections, which commenced on 1 November 2017. The practice had previously been inspected in October 2014 and was rated as good overall and outstanding for responsive.

At this inspection we found:

• The practice had some systems to manage safety. However, these were not always consistently applied and we found concerns with aspects of medicines management, staff recruitment files and identifying and managing risk.
• 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.
• Patients found the appointment system easy to use and reported that they were able to access care when they needed it.
• There was a strong focus on continuous learning and improvement at all levels of the organisation.

The areas where the provider must make improvements are:

• Ensure care and treatment is provided in a safe way to patients.

The areas where the provider should make improvements are:

• Ensure staff health needs are identified, reviewed and recorded so reasonable adjustments can be made, where necessary.
• Review tracking and logging processes for blank prescriptions.
• Review training for non-clinical staff in relation to sepsis and training for all staff on the accessible information standard.
• Improve uptake of health checks for patients with a learning disability.
• Review and update practice policies.

Professor Steve Field (CBE FRCP FFPH FRCGP) 

Chief Inspector of General Practice

Letter from the Chief Inspector of General Practice

Balmore Park Surgery is located in a purpose built medical centre in the Caversham area of Reading. There is a commercial pharmacy located in the practice premises. Approximately 16,000 patients are registered at the practice. We carried out an announced comprehensive inspection of the practice on 4 November 2014. This was the first inspection of the practice since registration with the CQC.

Patients we spoke with were positive about the care they received and described the staff as caring. The practice results for the national GP patient survey 2013 were positive and compared well with the clinical commissioning group (CCG) and national average. Ninety seven per cent of patients said they would recommend the practice to others.

We spoke with eight patients during the inspection. We met with two members of the patient participation group and spoke with seven GPs and a range of practice staff.

Balmore Park Surgery was rated good overall.

Our key findings were as follows:

• medicines are managed safely in a clean and well kept environment.
• GPs treat patients in accordance with national and local guidelines. Staff are trained and knowledgeable. The practice works with other services to ensure patients with complex needs are cared for appropriately. District nurses and health visitors told us there are good working arrangements with the GPs.
• patients told us and we observed that they were treated with care and compassion. Staff were careful to maintain confidentiality of patient information.
• the practice offers a range of appointment options and alternative means of booking appointments, including online booking. Patients receive continuity of care from a named GP and arrangements are in place to meet patients’ needs when GPs are not on duty.
• the practice is well led. Staff show a strong commitment to delivering patient centred care in a timely manner.
• extended hours clinics are available on four evenings a week and every other Saturday. From 8 November clinics would be held every Saturday
• the practice added a pulse check to the blood pressure check for patients with high blood pressure. This led to early diagnosis of an abnormal heart rhythm for some patients who were then treated promptly for this condition.

We saw an area of outstanding practice this was:

• the practice worked with local health commissioners to provide a wide range of additional services. Including ultrasound, dermatology clinics, podiatry, physiotherapy and talking therapies. All providing local access for the practice patients and reducing the need for travel or attendance at hospital.

However, there were also areas of practice where the provider needs to make improvements.

The provider should:

• increase the take up of health checks for patients with a learning disability

Professor Steve Field (CBE FRCP FFPH FRCGP) 

Chief Inspector of General Practice

At our previous comprehensive inspection at Balmore Park Surgery in Caversham, Berkshire in November 2017 we found a breach of regulations relating to the management of risks, specifically risks associated with the management of medicines, recruitment and health and safety.

Although the overall rating for the practice was good, the practice was rated requires improvement for the provision of safe services. The practice was rated good for the provision of effective, caring, responsive and well-led services. In addition, all population groups were also rated good.

The full comprehensive report on the November 2017 inspection can be found by selecting the ‘all reports’ link for Balmore Park Surgery on our website at www.cqc.org.uk. This inspection was an announced focused inspection carried out on 29 August 2018 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 in November 2017. This report covers our findings in relation to those requirements and improvements made since our last inspection. We found the practice had made improvements since our last inspection.

At our inspection on the 29 August 2018 we found the practice was meeting the regulations that had previously been breached. We have amended the rating for this practice to reflect these changes. The practice is now rated good for the provision of safe, effective, caring, responsive and well led services. The overall rating remains good.

Our key findings were as follows:

• Systems had been implemented and embedded which ensured care and treatment was provided in a safe way to patients.
• The practice had established and was now operating safe and effective systems to assess, manage and mitigate the risks associated with the management of medicines, recruitment and health and safety.
• There was greater awareness and documented assessments which identified and reviewed individual staff health needs and we saw reasonable adjustments were made, where necessary.
• There was an improved process which tracked and monitored the usage of prescription stationary including blank prescriptions.

• Practice staff had attended additional training specific to their roles, this included training on sepsis. Sepsis is a rare but serious complication of an infection.

• The practice had improved the arrangements to support patients with learning disabilities. Specifically, the number of patients who had an annual health check had increased from 54% in November 2017, to 80% in August 2018.

• The practice had revised and reviewed the policies and procedures in place to govern activity and support the safe running of the practice.

Professor Steve Field CBE FRCP FFPH FRCGP

Chief Inspector of General Practice