Letter from the Chief Inspector of General Practice

At our previous comprehensive inspection at Twyford Practice in Twyford, Berkshire on 31 August 2016 we found a breach of regulations relating to the provision of safe services. The overall rating for the practice was good. Specifically, Twyford Practice was rated requires improvement for providing safe services and good for the provision of effective, caring, responsive and well-led services. The full comprehensive report on the August 2016 inspection can be found by selecting the ‘all reports’ link for Twyford Practice on our website at www.cqc.org.uk.

This inspection was a desk-based review carried out on 11 April 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 in August 2016. This report covers our findings in relation to those requirements and also additional improvements made since our last inspection.

We found the practice had made improvements since our last inspection. Using information provided by the practice we found the practice was now 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.

Our key findings were as follows:

• The practice had assessed, monitored and mitigated risks relating to the storage of test results, topical medicines and prescriptions within a previously unsecure area of the practice. This included a new process whereby all completed and signed prescriptions were taken directly to the dispensary.

• The practice had taken steps to increase the number of identified patients with caring responsibilities within the practice population. In April 2017, the practice patient population was 12,800. The practice had identified 241 patients, who were also a carer; this was an increase from 120 identified carers at the August 2016 inspection and amounted to approximately 1.8% of the practice list. A designated area within the practice waiting area and on the practice website signposted patients with caring responsibilities to the various avenues of support available from the practice, charities and voluntary organisations where appropriate.

• The practice had continued work in an attempt to improve patient satisfaction regarding access. We saw the practice was taking appropriate action with a view to monitor the patient experience. The practice had introduced additional telephone lines, a dedicated emergency number and a separate phone line for outgoing calls. Changes had been made to the receptionist’s rota to ensure that additional receptionist’s were available at the start of every day. Patients were also being encouraged to make bookings online rather than telephone for routine appointments. Furthermore, the practice had introduced a new system and supporting correspondence whereby follow up appointments requested by a GP could be booked directly by the reception team.
• The practice had reviewed accessibility expectations for patients with disabilities, those using wheelchairs and parents with children in pushchairs. As a result, adaptions had been made and the practice had further plans for the installation of automatic doors with wall mounted access buttons.
• Appropriate appraisal arrangements were now in place, appraisals had been completed and there was evidence of performance monitoring and identification of personal and professional development.

Professor Steve Field CBE FRCP FFPH FRCGP

Chief Inspector of General Practice

During our announced inspection we spoke with six patients, clinical staff, the practice manager, administration staff and receptionists.

The six patients we spoke with told us they were treated with care and respect and had their privacy upheld. One patient with mobility issues told us: "they have my tablets brought to my house for me.” Patients told us they thought the receptionist were “friendly and helpful.” The patients we spoke with told us that they were able to obtain an appointment with the doctor when they needed to.

Patients' needs were assessed and care and treatment was planned and delivered in line with their individual wishes.

We saw that medicines were stored safely and there were robust systems in place to monitor medicines stock control.

We looked at the recruitment records of three people. We saw appropriate checks were in place to ensure people employed had the necessary skills, experience, qualifications and were of good character.

Patients were given the support they needed to make a comment or complaint. Records were clear and showed that patient's concerns or complaints had been responded to appropriately and the information was used to improve the service.

Letter from the Chief Inspector of General Practice

At our previous comprehensive inspection at Twyford Practice in Twyford, Berkshire on 31 August 2016 we found a breach of regulations relating to the provision of safe services. The overall rating for the practice was good. Specifically, Twyford Practice was rated requires improvement for providing safe services and good for the provision of effective, caring, responsive and well-led services. The full comprehensive report on the August 2016 inspection can be found by selecting the ‘all reports’ link for Twyford Practice on our website at www.cqc.org.uk.

This inspection was a desk-based review carried out on 11 April 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 in August 2016. This report covers our findings in relation to those requirements and also additional improvements made since our last inspection.

We found the practice had made improvements since our last inspection. Using information provided by the practice we found the practice was now 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.

Our key findings were as follows:

• The practice had assessed, monitored and mitigated risks relating to the storage of test results, topical medicines and prescriptions within a previously unsecure area of the practice. This included a new process whereby all completed and signed prescriptions were taken directly to the dispensary.

• The practice had taken steps to increase the number of identified patients with caring responsibilities within the practice population. In April 2017, the practice patient population was 12,800. The practice had identified 241 patients, who were also a carer; this was an increase from 120 identified carers at the August 2016 inspection and amounted to approximately 1.8% of the practice list. A designated area within the practice waiting area and on the practice website signposted patients with caring responsibilities to the various avenues of support available from the practice, charities and voluntary organisations where appropriate.

• The practice had continued work in an attempt to improve patient satisfaction regarding access. We saw the practice was taking appropriate action with a view to monitor the patient experience. The practice had introduced additional telephone lines, a dedicated emergency number and a separate phone line for outgoing calls. Changes had been made to the receptionist’s rota to ensure that additional receptionist’s were available at the start of every day. Patients were also being encouraged to make bookings online rather than telephone for routine appointments. Furthermore, the practice had introduced a new system and supporting correspondence whereby follow up appointments requested by a GP could be booked directly by the reception team.
• The practice had reviewed accessibility expectations for patients with disabilities, those using wheelchairs and parents with children in pushchairs. As a result, adaptions had been made and the practice had further plans for the installation of automatic doors with wall mounted access buttons.
• Appropriate appraisal arrangements were now in place, appraisals had been completed and there was evidence of performance monitoring and identification of personal and professional development.

Professor Steve Field CBE FRCP FFPH FRCGP

Chief Inspector of General Practice