We carried out an announced comprehensive inspection at The Boathouse Surgery on 30 October 2018 as part of our inspection programme. Our inspection team was led by a Care Quality Commission (CQC) Inspector and included a GP specialist advisor.

Our judgement of the quality of care at this service is based on a combination of what we found when we inspected, information from our ongoing monitoring of data about services and information from the provider, patients, the public and other organisations.

We have rated this practice as good overall.

This means that:

• Patients were protected from avoidable harm and abuse and that legal requirements were met.
• Patients had good outcomes because they received effective care and treatment that met their needs.
• Patients were supported, treated with dignity and respect and were involved as partners in their care.
• People’s needs were met by the way in which services were organised and delivered.
• The leadership, governance and culture of the practice promoted the delivery of high quality person-centred care.

We identified the following area of outstanding practice:

• End of life care (EOL) was tailored and reviewed to ensure outcomes were improved. The practice developed a video regarding positive EOL care and this was shared with other providers and services as a learning resource.

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

Professor Steve Field CBE FRCP FFPH FRCGP
Chief Inspector of General Practice

Letter from the Chief Inspector of General Practice

We carried out an announced focused inspection of The Boat House Surgery, Whitchurch Road, Pangbourne, Reading, Berkshire RG9 8DP on 28 July 2015. This inspection was undertaken to check the practice was meeting regulations. Our previous inspection in November 2014 had found breaches of regulations relating to the safe delivery of services. We found the practice required improvement for the provision of safe services, and was rated good for providing effective, caring, responsive and well-led services.

We found the practice has made improvements since our last inspection on 5 November 2014. At our inspection on the 28 July 2015 we found the practice was meeting the regulations that had previously been breached.

Specifically the practice was:

• Operating safe systems of recruitment. This included pre-employment checks, DBS checks and risk assessments.

• Systems were in place to manage infection control processes to specifically reduce the spread of the legionella.

• Procedures were in place to ensure a consistent application of medicine’s management processes and procedures. This included the management of emergency medicines and the security of medications and prescriptions.

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

Importantly the provider should

• Review the security of surgery rooms where prescriptions are stored.

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.

Professor Steve Field CBE FRCP FFPH FRCGP 

Chief Inspector of General Practice

Letter from the Chief Inspector of General Practice

We undertook a comprehensive inspection of The Boat House surgery on 5 November 2014. We have rated the overall practice as good. The practice was rated requires improvement in safe and  good in the effective, caring, responsive and well led domains.

Our key findings were as follows:

The practice is rated as requires improvement for providing safe services. Patients were at risk of harm because systems and processes had not been implemented in a way to keep them safe. For example, medicines management and dispensing systems did not reflect national guidelines. The practice did not have a policy for the management, testing and investigation of legionella (a germ found in the environment which can contaminate water systems in buildings). There was no risk assessment to determine if action was required to reduce the risk of legionella infection to staff and patients. We found some of the information required by the regulation was not recorded in the individual staff files. The practice had a system in place for reporting, recording and monitoring significant events. Multi-disciplinary practice meetings took place where attendance included clinicians from other disciplines

The feedback from patients was very positive. Patients were satisfied with the service provided by the practice. Patients described staff as caring and helpful. Patients commented they were always listened to and involved in their treatment and care.

We found the service was responsive to patient’s needs. Patients we spoke with were generally happy with the appointment system. The results from the national GP survey showed, 96% patients said it was easy to get through to this surgery by phone. Ninety eight percent of patients said their last appointment was convenient and 95% of patients were able to get an appointment to see or speak to someone the last time they tried.

Patients’ needs were assessed and care and was planned and delivered in line with current legislation. Staff had received training appropriate to their roles and further training needs had been identified and planned. The practice was well led, and had a clear vision and strategy. The practice had a clear leadership structure and staff we spoke felt supported and valued.

The practice is rated as good for being well-led. The practice had a clear vision to deliver high quality care and promote good outcomes for patients. The practice had a clear leadership structure which had named members of staff in lead roles. However, we found the practice had not taken all measures to identify, assess and manage some risks.

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

Importantly, the provider must:

• Ensure medicine management and dispensing systems are reviewed and reflect national guidelines.
• Ensure all information required relating to staff checks (such as references), identification documents, and evidence to confirm staff are physically and mentally fit to carry out their roles, are in place and available in staff records.
• Ensure risk assessments are documented to inform which members of staff required a Disclosure Barring Service (DBS) check and which members did not.

In addition the provider should:

• Introduce a legionella risk assessment and related management schedule.

Professor Steve Field (CBE FRCP FFPH FRCGP)

Chief Inspector of General Practice