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Dr K M Emerson & Partners Outstanding


Inspection carried out on 24/06/2019

During an inspection looking at part of the service

Our previous inspection of Dr K M Emerson and partners was carried out in January 2015. At that time the practice was rated Outstanding.

We carried out an announced inspection of Dr K M Emerson and Partners on 24 June 2019.

We decided to undertake an inspection of this service following our annual review of the information available to us. The decision to inspect was required because our previous inspection had been carried out over four years ago.

This inspection looked at the following key questions: Was the practice providing effective and well-led services. We found the practice had consolidated their provision of care and treatment for patients and the rating of Outstanding had been maintained.

We have rated this practice as outstanding overall.

We did not check whether this practice was providing safe services because our monitoring of the practice indicated no significant change since the last inspection. The rating of Good from the last inspection has been carried forward.

We did not check whether this practice was providing caring services because consistently positive patient feedback and monitoring indicated no change since the last inspection. The rating of Good from the last inspection has been carried forward.

We did not check whether this practice was providing responsive services because patient feedback and monitoring indicated no change since the last inspection. The rating of Outstanding from the last inspection has been carried forward. Data held by the practice showed the practice to be in the top 60 practices in England from the results of the 2018 national GP patient survey.

We rated the practice as good for providing effective services because:

  • Patients received effective care and treatment that met their needs.
  • Provision of effective care and treatment was kept under review and quality improvement activity was evident.
  • There was active health promotion and initiatives undertaken to reduce the risk of patients developing health problems.

We rated the practice as Outstanding for provision of well-led services because:

  • The culture of the practice and the way it was led and managed drove the delivery and improvement of high-quality, person-centred care.
  • All staff at the practice were active in ensuring sustainable high quality care was provided to all patients.
  • There was an emphasis on continuing improvement by working with other organisations and patients to address service development.
  • There was a clear vision and strategy focused on providing high quality care.
  • When service developments were undertaken patients and other stakeholders were informed and their views were sought.
  • The practice took an active role in the local community and provided a range of opportunities for local residents to understand health issues and promote healthy lifestyles.
  • Learning and development was promoted and provided for all staff.

These outstanding areas, from the current and previous inspection, benefitted all population groups and so we rated all population groups as outstanding.

We saw several areas of outstanding practice including:

  • The practice provided a wide range of healthy lifestyle activities such as; a green gym, walking for health and on your bike. Since the last inspection walking football and pilates had also been introduced to encourage older people to maintain good balance, posture and partake in team sport to maintain their health and mobility.
  • An increase of approximately 1,000 patients, due to the closure of a neighbouring practice, had been well managed. Resources had been put in place before these patients started to register with the practice and the premises had been restructured to provide additional consulting rooms. The practice had maintained their rating of outstanding during a period of rapid growth in patient numbers and added additional services to those previously offered.

Details of our findings and the evidence supporting the change in rating are set out in the evidence tables.

Dr Rosie Benneyworth BM BS BMedSci MRCGP

Chief Inspector of Primary Medical Services and Integrated Care

Inspection carried out on 14/01/2015

During a routine inspection

Letter from the Chief Inspector of General Practice

We carried out an announced, comprehensive inspection on 14 January 2015.

We visited the practice location of Dr GAM Burnett and Partners at Sonning Common Health Centre, Wood Lane, Sonning Common, Reading, RG4 9SW. Overall the practice is rated as outstanding.

Our key findings across all the areas we inspected were as follows:

  • Staff understood and fulfilled their responsibilities to raise concerns, and to report incidents and near misses. Information about safety was recorded, monitored, appropriately reviewed and addressed.
  • Risks to patients were assessed and well managed, with the exception of those relating to the security and monitoring of fridge temperatures.
  • Patients’ needs were assessed and care was planned and delivered following best practice guidance. Staff had received training appropriate to their roles and any further training needs were being assessed.
  • Patients said they were treated with compassion, dignity and respect and they were involved in their care and decisions about their treatment.
  • Information about services and how to complain was available and easy to understand.
  • Patients said they found it easy to make an appointment with a named GP and that there was continuity of care, with urgent appointments available the same day.
  • The practice had good facilities and was well equipped to treat patients and meet their needs.
  • There was a clear leadership structure and staff felt supported by management. The practice proactively sought feedback from staff and patients, which it acted on.

We saw several areas of outstanding practice including:

  • The health promotion initiatives led by the practice to encourage patients to adopt healthy lifestyles, including ‘Health Walks’, ‘Green Gym’ (gardening and conservation project) and cycling club.
  • The practice’s strong focus on creating a culture of education and learning was demonstrated through the four GP trainees in post, one trainee practice nurse and mentor scheme for salaried GPs.
  • A nurse practitioner with advanced skills in administering joint injections provided this service to patients.
  • A weekly transport service, via a local voluntary group was funded by the practice. This was available for patients resident in a nearby village, without their own transport for routine appointments, which the practice scheduled on Friday mornings.
  • The practice had an effective and efficient leadership structure which included the use of an “away day” to develop future practice planning. All staff shared the practice objectives to deliver high quality person centred care. There was a very strong quality and educational ethos in the practice.

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

The provider should

  • Ensure the medicines management procedures are consistently followed by staff.

Professor Steve Field (CBE FRCP FFPH FRCGP) 

Chief Inspector of General Practice

Inspection carried out on 8 July 2014

During a routine inspection

Dr GAM Burnett and Partners, also known as Sonning Common Health Centre, is located in purpose built premises in a semi-rural area. It provides primary medical services to just over 8500 registered patients. The practice dispenses prescriptions to approximately one third of its patients.

We visited the practice location at Sonning Common Health Centre, Wood Lane, Sonning Common, Reading, RG4 9SW.

We spoke with 11 patients and 14 staff during the inspection.This was the first inspection since registration.The announced inspection at Sonning Common Health Centre took place on 8 July 2014.

We found the provider was in breach of the regulation, Management of medicines.

The practice operated from premises that were clean and well maintained. Systems were in place to report and learn from incidents to improve patient safety. The policies and procedure used by the service for the management of medicines had been reviewed, but were not always followed. Prescription pads completed by hand were not stored securely which increased the risk of prescriptions being misappropriated. Repeat prescriptions were signed by a GP after collection by the patient. Assurances could not be provided that refrigerated and non-refrigerated medicines were stored within their recommended temperature ranges.

Staff told us if they suspected abuse in children or adults they would raise concerns with the GP. We found staff had received training in safeguarding children but not in safeguarding adults. Emergency procedures were in place to respond to medical emergencies.

Systems were in place to ensure evidence based practice including national and local guidelines were used and monitored through audits. The practice supported patients to adopt healthy lifestyles by facilitating exercise programmes such ‘Health Walks’, cycling club and a gardening project.

The practice nurses were developed in their roles. For example, the lead nurse for diabetes was an advanced nurse practitioner in diabetes education and provided support to patients with diabetes. All staff received regular appraisals.

The practice was caring and compassionate in its approach. We spoke with 11 patients. They were very positive about all aspects of the care they received. This was supported by the national GP survey results for this practice. We also observed staff were respectful in their interactions with patients in a way that preserved their dignity and confidentiality.

The practice understood the different needs of the population it served and had developed services to meet their needs. For example, late evening and fortnightly Saturday morning surgeries were offered. A complaints system was in place to investigate and take action where concerns were identified.

Staff described a supportive team environment to provide a patient centred service. Governance arrangements were in place that ensured patients needs were a priority. Staff told us they were comfortable to raise issues and concerns when they arose and were confident they would be dealt with constructively. However, a whistleblowing policy was not in place.

All the GPs mentioned the practice’s  focus on education. All staff had been appraised in the last year. Staff said they had mandatory training updates. For example, in infection control, child safeguarding and basic life support. However, a robust system for recording and monitoring  all staff training needs was not in place. The practice were aware of this but had not yet addressed this issue.

The practice considered the needs of older people in all aspects of the delivery of the service. The GPs involved patients and family in discussions before completion of the do not attempt cardiopulmonary resuscitation form. GPs and nurses were aware of what action to take if they judged a patient lacked the mental capacity to give their consent and they acted appropriately.

The practice supported patients with long term conditions to manage their health, care and treatment. The practice nurses were trained and experienced in providing diabetes and asthma care to ensure patients with these long term conditions were regularly reviewed and supported to manage their conditions.

Specific services for mothers, babies, children and young people included weekly antenatal clinics, baby immunisation clinics and baby development clinics. Family planning clinics were offered in the evening to improve access for young people.

The practice had introduced fortnightly Saturday morning surgeries and a weekly late evening surgery for routine appointments, to accommodate the needs of working age people.

The patient participation group was running a campaign to promote a local carers group which highlighted the support carers needed in relation to their own health and well-being.

The practice was working towards the joint Oxfordshire dementia plan to increase awareness and improve identification of patients at risk of dementia.