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Inspection Summary


Overall summary & rating

Good

Updated 15 December 2017

Letter from the Chief Inspector of General Practice

This practice is rated as Good overall.

At our previous inspection in June 2016 the practice had an overall rating as Good.

Following the November 2017 inspection, 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 Dr M L Swami and Partners in Reading, Berkshire on 21 November 2017. We carried out this inspection under Section 60 of the Health and Social Care Act 2008 as part of our regulatory functions. This inspection was planned to check whether Dr M L Swami and Partners was meeting the legal requirements and regulations associated with the Health and Social Care Act 2008.

At this inspection we found:

  • The practice had clear systems to manage risk so that safety incidents were less likely to happen and any notable events either positive or negative were learned from.
  • The practice had defined and embedded systems, processes and practices to minimise risks to patient safety.
  • However, we found these systems had not identified risks related to the ongoing monitoring of patients on medicines where care was shared with other health services. There were also risks identified related to actions following test results or other patient related information received into the practice.
  • Staff had received training appropriate to their roles and the population the practice served. Any further training needs had been identified and planned.
  • Our findings showed that systems were in place to ensure that all clinicians were up to date with both National Institute for Health and Care Excellence (NICE) guidelines and other locally agreed guidelines.
  • Clinical outcomes in national data submissions showed high performance for managing patients with long term conditions.
  • We received positive feedback from patients and external stakeholders which access GP services from the practice.
  • Patients found the appointment system easy to use.
  • The practice learned lessons from individual concerns and complaints and also from analysis of trends. For example, telephone access had been a historic concern within the practice. As a result, the practice reviewed the telephone system and increased staff who answered calls.
  • The practice had clear and visible clinical and managerial leadership and supporting governance arrangements.

The areas where the provider must make improvements are:

  • Ensure risks to patients are identified, assessed and mitigated to protect patients’ health and welfare.

The areas where the provider should make improvements are:

  • Review the potential requirements of patients with limited mobility and access to services to patients who may need additional support, with regard to the legal requirements of the Disability Discrimination Act (1995) and Equality Act (2010).
  • Undertake a full review of the requirements of the accessible information standard.

Professor Steve Field (CBE FRCP FFPH FRCGP) 

Chief Inspector of General Practice

Inspection areas

Safe

Good

Updated 14 September 2018

During our inspection in November 2017 we identified that the practice was not always monitoring patients on high risk medicines safely and that actions regarding test results may not have been acted on due to the system in place not being fully adequate.

We also recommended the practice should consider the risks posed regarding physical access to the building.

At this inspection we found;

Risks to patients

  • The practice assessed risks to patients including those related to prescribing and the monitoring of test results.
  • An assessment of accessibility for patients with limited mobility or hearing or visual impairments had been undertaken and actions completed as a result.

Information to deliver safe care and treatment

The practice had implemented a new system to monitor, act on and file outstanding pathology results. We saw this functioned as intended and provided patients with any follow up care they needed.

Appropriate and safe use of medicines

The practice had implemented a system to monitor all patients on high risk medicines. This ensured medicines could not continuously be prescribed without the necessary checks, such as blood tests, being undertaken. This ensured that patients on such medicines received the reviews they required.

Checks on specific services

Older people

Good

Updated 26 November 2015

The practice is rated as good for the care of older people.

Nationally reported data showed that outcomes for patients were good for conditions commonly found in older people. The practice offered proactive, personalised care to meet the needs of the older people in its population and had a range of enhanced services, for example, in dementia and end of life care. It was responsive to the needs of older people, and offered home visits and rapid access appointments for those with enhanced needs.

People with long term conditions

Good

Updated 26 November 2015

The practice is rated as good for the care of people with long-term conditions.

Nursing staff had lead roles in 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 these patients had a named GP and a structured annual review to check that their health and medication needs were being met. For those people with the most complex needs, the named GP worked with relevant health and care professionals to deliver a multidisciplinary package of care.

Families, children and young people

Good

Updated 26 November 2015

The practice is rated as good for the care of families, children and young people. T

here were systems in place to identify and follow up children living in disadvantaged circumstances and who were at risk, for example, children and young people who had a high number of A&E attendances. Immunisation rates were high for all standard childhood immunisations. Patients told us that children and young people were treated in an age-appropriate way and were recognised as individuals, and we saw evidence to confirm this. Appointments were available outside of school hours and the premises were suitable for children and babies. We saw good examples of joint working with midwives, health visitors and school nurses.

Working age people (including those recently retired and students)

Good

Updated 26 November 2015

The practice is rated as good for the care of working-age people (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.

People whose circumstances may make them vulnerable

Good

Updated 26 November 2015

The practice is rated as good for the care of people whose circumstances may make them vulnerable.

The practice held a register of patients living in vulnerable circumstances including those with a learning disability. It offered longer appointments and carried out annual health checks for people with a learning disability.

The practice regularly worked with multi-disciplinary teams in the case management of vulnerable people. It had told vulnerable patients 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.

People experiencing poor mental health (including people with dementia)

Good

Updated 26 November 2015

The practice is rated as good for the care of people experiencing poor mental health (including people with dementia).

The practice regularly worked with multi-disciplinary teams in the case management of people experiencing poor mental health, including those with dementia. It carried out advance care planning for patients with dementia.

Patients experiencing poor mental health had a care plan documented in their record in the preceding 12 months. Patients were told how to access various support groups and voluntary organisations.

It had a system in place to follow up patients who had attended accident and emergency where they may have been experiencing poor mental health. Staff had received training on how to care for people with mental health needs and dementia.