Letter from the Chief Inspector of General Practice

Emmer Green surgery is based in a purpose built practice that has been extended over the years as the number of patients increased. Over 9,000 patients are registered with the practice. We carried out an announced comprehensive inspection of the practice on 19 November 2014. This was the first inspection of the practice since registration with the CQC.

The feedback received from patients was positive. Patients spoke positively about the care they received and described the staff as caring. The practice results for the national GP patient survey 2013 mostly compared well with the clinical commissioning group (CCG) and national averages. The practice was aware the satisfaction rating for obtaining appointments was not as high as other practices in the area. Changes had been made to the appointment system and an additional clinic had been established in the last month.

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

Emmer Green Surgery was rated good overall.

Our key findings were as follows:

• the practice operates mostly safe systems. However, improvements must be made in the way medicines are managed.
• 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. We saw evidence of close working relationships with consultants in both psychiatry and diabetology that benefitted patient care.
• patients told us and we observed that they were treated with care and compassion.
• the practice offers a range of appointment options and alternative means of booking appointments, including online booking.
• the practice is well led. Staff show a strong commitment to delivering patient centred care in a timely manner and are involved in planning services for the future.

We saw areas of outstanding practice including:

• patients with long term mental health problems who moved to other locations within Reading were able to remain registered at Emmer Green Surgery to support continuity in their care and treatment.
• an ear nose and throat (ENT) clinic was held at the practice by one of the GPs qualified in this specialty. Working with local commissioners enabled the practice to provide physiotherapy, talking therapies and speech and language clinics on site. This benefitted patients who found it easier to attend the practice rather than local hospital or clinics elsewhere.

There were areas of practice where the provider needs to make improvements.

Importantly, the provider must:

• introduce a system to confirm that actions required from national medicine alerts have been taken.
• ensure fridges holding vaccines and medicines required to be stored at a controlled temperature are locked when not in use.
• cease the practice of the health care assistant administering flu immunisations without prior written authorisation from an approved prescriber.

In addition the provider should:

• ensure practice nurses are familiar with the fridge failure protocol contained in the service continuity plan.
• improve the training of reception staff who occasionally carry out chaperone duties to ensure they are fully trained in this role
• provide updating training on infection control for the infection control lead and provide training in infection control to all staff appropriate to their role.

Professor Steve Field (CBE FRCP FFPH FRCGP) 

Chief Inspector of General Practice

Letter from the Chief Inspector of General Practice

We carried out a comprehensive inspection on 19 November 2014 and published a report setting out our judgements. We found improvements were required regarding provision of safe services. In July 2015 we carried out a focussed desktop review (an inspection where we did not need to visit the practice) to ensure that since our last inspection, in November 2014, systems had been put in place to manage medicines safely. We also received evidence from the provider showing the practice had expanded and improved training for staff on how to reduce the risks of cross infection and in chaperone duties. We found the improvements had been made and the practice was providing safe services.

Our findings from this review were:

• Evidence sent to us showed medicines were kept securely and vaccines administered in accordance with legislation.
• The practice had also taken action on matters relating to cleanliness and infection control, safeguarding and recruitment which improved the way they managed these aspects of their service

We have changed the rating for this practice in respect of the safe domain to reflect these improvements. The practice is now rated good for the provision of safe, effective, caring, responsive and well led services.

Professor Steve Field CBE FRCP FFPH FRCGP 

Chief Inspector of General Practice