25 May 2017
The Health Centre (also known locally as Runnymede Medical Practice) is situated in Egham, Surrey within a purpose built premises with car parking for patients and staff. All patient services are offered on the ground floor at the main location and the branch practice. The main location (The Health Centre) comprises of six consulting rooms, two treatment rooms, a patient waiting area, a reception area, administrative and management office. The branch practice (Newton Court Medical Centre) comprises of five consulting rooms, one treatment room, a patient waiting area, a reception area, administrative and management office.
The practice has core opening hours from 8am to 6.30pm Monday to Friday. The practice offers a range of scheduled appointments to patients every weekday from 8.30am to 5.50pm including open access appointments with a duty GP throughout the day. The practice offers extended hours appointments at the branch practice (Newton Court Medical Centre) every Monday evening from 6.30pm to 8.30pm. In addition, the patients at the practice are able to access extended hours appointments through a East Berkshire extended hours service Monday to Friday from 6.30pm to 9pm, Saturday from 9.30am to 4pm and Sunday from 9.30am to 4pm at Kings Edward Hospital and Saint Marks Hospital.
The practice has a patient population of approximately 12,200 registered patients. The practice population of patients aged between 40 to 54, 65 to 69 years and aged above 80 years old is higher than the national average and there are lower number of patients aged between 0 to 4 and 15 to 34 years old compared to national average.
Ethnicity based on demographics collected in the 2011 census shows the patient population is predominantly White British and 13% of the population is composed of patients with an Asian, Black or mixed background. There are parts of Egham and Old Windsor with the lowest levels of income deprivation in the area.
There are five GP partners, a salaried GP, three trainee GPs at the practice. Three GPs are female and six male. The practice employs two practice nurses. The practice manager is supported by an IT and personnel manager, a practice coordinator, a team of administrative and reception staff. Services are provided via a General Medical Services (GMS) contract (GMS contracts are negotiated nationally between GP representatives and the NHS).
This is a training practice, doctor who is training to be qualified as a GP has access to a senior GP throughout the day for support. We received positive feedback from the trainee we spoke with.
Services are provided from the following main location and the branch practice, and patients can attend any of the two practice premises. We visited both premises during this inspection.
The Health Centre (the main practice)
Newton Court Medical Centre (the branch practice)
The practice has opted out of providing out of hours services to their patients. There are arrangements in place for services to be provided when the practice is closed and these are displayed at the practice, in the practice information leaflet and on the patient website. Out of hours services are provided during protected learning time by East Berkshire Primary Care service or after 6:30pm, weekends and bank holidays by calling NHS 111.
25 May 2017
Letter from the Chief Inspector of General Practice
We carried out an announced comprehensive inspection at The Health Centre (Runnymede Medical Practice) on 11 April 2017. We carried out this inspection to check that the practice was meeting the regulations and to consider whether sufficient improvements had been made.
Our previous announced comprehensive inspection in August 2016 found breaches of regulations relating to the safe, effective, caring and well-led delivery of services. Specifically, the practice was rated inadequate for safe and well-led domains, requires improvement in effective and caring domains and good in responsive. The overall rating of the practice in August 2016 was inadequate and the practice was placed into special measures for six months. Following the inspection, we received an action plan which set out what actions were to be taken to achieve compliance.
At the inspection in April 2017, we found the practice had made significant improvements. Specifically, we found the practice good for the provision of safe, effective, caring, responsive and well-led services. Overall, the practice is rated as good.
Our key findings across all the areas we inspected were as follows:
- The practice had strong and visible clinical and managerial leadership and governance arrangements and they demonstrated significant improvements since the previous inspection.
- The practice had a clear vision which had quality and safety as its top priority.
- The practice had implemented effective monitoring system and all the areas of concerns from the previous inspection had been resolved.
- There was an open and transparent approach to safety and an effective system in place for reporting and recording significant events. Staff understood and fulfilled their responsibilities to raise concerns and report incidents and near misses.
- Risks to patients were assessed and well-managed.
- The practice used innovative and proactive methods to improve patient outcomes, working with other local providers to share best practice. There was a clear leadership structure. The practice had provided effective leadership and support to the nursing team.
- We found that completed clinical audit cycles were driving positive outcomes for patients.
- Data showed the practice had demonstrated improvements in patient’s outcomes.
- The practice worked closely with other organisations and with the local community in planning how services were provided to ensure that they meet patients’ needs.
- The practice implemented suggestions for improvements and made changes to the way it delivered services as a consequence of feedback from patients and from the patient participation group (PPG). For example, the practice had organised health education and awareness workshops in consultation with PPG delivered by practitioners, to support patients self managing their long term conditions.
- Staff feedback had been considered and the practice had increased staffing levels.
- Staff assessed patients’ needs and delivered care in line with current evidence based guidance.
- The practice actively reviewed complaints and how they are managed and responded to, and made improvements as a result.
- The provider was aware of and complied with the requirements of the duty of candour.
We saw areas of outstanding practice including:
- There was a proactive approach to understanding the needs of different groups of patients and to deliver care in a way that meets these needs. Specifically the practice was able to demonstrate how they promoted quality improvements and how their approach improved patient outcomes for health and well-being. This included patients who were in vulnerable circumstances or who had complex needs. For example,
- The practice had responded to the needs of a higher than average older patients list size by developing a ‘pro-active care scheme’ during the winter time, which included combination of health and social care support. This scheme had been evaluated and recognised by Health Education England. This scheme had identified more than 2000 patients with frail characteristics and the practice was planning a targeted approach to deliver the services to meet their needs.
- The practice had secured the funding and launched a project ‘you care, we care’ to identify carers to enable them to access the support available via the practice and external agencies. The practice had taken a number of positive steps and the register of patients who were carers had increased from 76 (0.63%) patients to 299 patients (2.5% of the practice patient population list size).
I am taking this service out of special measures. This recognises the significant improvements made to the quality of care provided by this service.
Professor Steve Field (CBE FRCP FFPH FRCGP)
Chief Inspector of General Practice
25 May 2017
The practice is rated as good for the care of patients with long-term conditions.
- There were clinical leads for chronic disease management and patients at risk of hospital admission were identified as a priority.
- Longer appointments and home visits were available when needed.
- All patients with long term conditions had a named GP and the practice carried out a structured annual review to check that 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.
- The practice offered an ECG and an anti-coagulation services to 151 patients onsite.
- The practice had organised health talks delivered by practitioners, to support patients self managing their long term conditions.
25 May 2017
The practice is rated as good for the care of families, children and young patients.
- 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.
- The practice had identified three young carers in the last few months as part of their new initiative ‘you care, we care’.
- The practice’s uptake for the cervical screening programme was 83%, which was above the national average of 81%.
- Immunisation rates were comparable or higher than the national average for all standard childhood immunisations.
- Patients told us that children and young patients were treated in an age-appropriate way and were recognised as individuals.
- Appointments were available outside of school hours and the premises were suitable for children and babies.
- We saw positive examples of joint working with midwives, health visitors and school nurses.
25 May 2017
The practice is rated as good for the care of older patients.
- The practice offered proactive, personalised care to meet the needs of the older patients in its population.
- It was responsive to the needs of older patients, and offered home visits and urgent appointments for those with enhanced needs.
- The practice had higher than average older patients and they responded by developing a ‘pro-active care scheme’ during the winter time. This scheme had helped to meet complex health needs, patients were referred to social services if required and identified more than 2000 patients with frail characteristics, which would help to plan targeted services.
- There was a register to effectively support patients requiring end of life care.
- There were good working relationships with external services such as district nurses, social worker and project coordinator for external carers support organisation.
- The premises were accessible to those with limited mobility.
25 May 2017
The practice is rated as good for the care of working-age patients (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.
- The bowel cancer screening uptake had increased from 55% to 73% since the previous inspection.
- The practice had achieved an attendance rate of 62% for NHS health checks for patients aged 40–74 in last five years. This was significantly higher than the local authority average of 42% and national average of 48% in 2016/17.
- We noted the practice offered telephone consultations.
- The practice offered extended hours appointments at the branch practice (Newton Court Medical Centre) every Monday evening from 6.30pm to 8.30pm. In addition, the practice offered extended hours appointments Monday to Friday from 6.30pm to 9pm, Saturday from 9.30am to 4pm and Sunday from 9.30am to 4pm at Kings Edward Hospital and Saint Marks Hospital (funded by Prime Minister’s Access Fund).
25 May 2017
The practice is rated as good for the care of patients experiencing poor mental health (including people with dementia).
- Data from 2015-16 showed, performance for dementia face to face reviews was higher than the CCG and national average. The practice had achieved 97% of the total number of points available, compared to 86% locally and 84% nationally.
- The practice had secured funding to have dementia friendly status and was in the process of implementing changes which would help to identify more patients with early risk of dementia.
- Patients experiencing poor mental health were involved in developing their care plan and health checks.
- 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 how to access various support groups and voluntary organisations.
- Systems were in place to follow up patients who had attended accident and emergency, when experiencing mental health difficulties.
- Staff had a good understanding of how to support patients with mental health needs and dementia.
25 May 2017
The practice is rated as good for the care of patients whose circumstances may make them vulnerable.
- The practice held a register of patients living in vulnerable circumstances including homeless patients, travellers and those with a learning disability.
- The practice offered services to three learning disability care homes, two nursing homes, a residential home and a probation bail hostel.
- Data from 2016-17 showed health checks and care plans were completed for 92% patients on the learning disability register.
- 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 in normal working hours and out of hours.