Edlesborough Surgery

Updated 30 September 2022

Edlesborough Surgery is a two-site GP practice with a patient list size of approximately 8,500 and located in two villages, Edlesborough and Pitstone on the Buckinghamshire and Bedfordshire border.

The practice is part of a wider network of GP practices, this is known locally as the North Bucks Primary Care Network (PCN) and comprises of four GP practices collaboratively working together for a combined population of approximately 35,000 patients.

The practice is also part of the Buckinghamshire, Oxfordshire and Berkshire West Integrated Care Board (ICB). (An ICB is a statutory NHS organisation that decides how to spend the NHS budget and plans how to improve people’s health, deliver high-quality care and get better value for money locally). 

Services are provided from two locations:

• Edlesborough Surgery, 11 Cow Lane, Edlesborough, Dunstable LU6 2HT
• Pitstone Surgery (known as the branch practice), The Village Health Centre, Yardley Avenue, Pitstone LU7 9BE

Both surgeries include a dispensary. Dispensing services are provided to registered patients who live more than a mile away from a community pharmacy.

The practice website is: www.edlesboroughsurgery.co.uk

The provider is registered with CQC to deliver the following Regulated Activities (these are delivered from both sites):

• Diagnostic and screening procedures
• Family planning services
• Maternity and midwifery services
• Surgical procedures
• Treatment of disease, disorder or injury

Information published by the UK Health Security Agency (UKHSA) shows the age distribution of the registered patients differs when compared to the national averages, for example there are significantly less patients aged between 20 and 49 and more patients aged over 50. Further information published by UKHSA shows that deprivation within the practice population group is in the highest decile (10 out of 10). The higher the decile, the less deprived the practice population is relative to others. According to the latest available data, Edlesborough, Pitstone and the surrounding villages has little ethnic diversity.

The practice has a cohort of transient patients including patients from the Travelling Community and in the last five months, patients who have arrived and registered with the practice under the Ukraine Family or the Ukraine Sponsorship (Homes for Ukraine) Scheme.

There are two GP Partners and three salaried GPs at the practice. The practice is a training practice for GP Registrars and at the time of the inspection, six GP Registrars were attached to the practice. (GP Registrars are qualified doctors who undertake additional training to gain experience and higher qualifications in general practice and family medicine). The nursing team is led by a clinical manager who is also a nurse prescriber and consists of three nurse practitioners, a phlebotomist and a trainee nursing associate (also a qualified dispenser).

One of the GPs is the designated dispensary lead and the combined dispensary team consists of a dispensary manager and five team members.

A practice manager (also a nurse), a clinical manager (a nurse prescriber) and a small team of reception and administrative staff undertake the day to day management and running of the practice.

The practice has core opening hours between 8am and 6pm, Monday to Friday. Patients can also access pre-bookable appointments between 7am and 8am every Monday morning and until 8pm every Tuesday evenings. Both the dispensary in Edlesborough and Pitstone have core opening hours between 8am and 12noon then 2pm until 6pm every weekday. Patients could also access dispensed medicines via the automated prescription dispensing machine, located at the Edlesborough practice 24 hours a day, seven days a week.

The practice offers a range of appointment types including book on the day, telephone consultations and advance appointments the practice is closed out of hours services are provided by FedBucks GP out of hours service which patients can access via the NHS111 service.

Updated 30 September 2022

We carried out an announced inspection at Edlesborough Surgery on 2 September 2022. Overall, the practice is rated as Good.

• Safe - Good
• Effective - Good
• Caring - Good (rating awarded at the 2017 inspection)
• Responsive - Good (rating awarded at the 2017 inspection)
• Well-led - Good

Following our previous inspection in January 2017, the practice was rated Good overall and for all key questions.

The full reports for previous inspections can be found by selecting the ‘all reports’ link for Edlesborough Surgery on our website at www.cqc.org.uk

Why we carried out this inspection

This inspection was a focused inspection, the practice was selected at random, from a selection of services rated Good and Outstanding to test the reliability of our new monitoring approach which involved a site visit.

We looked at the Safe, Effective and Well-led key questions.

How we carried out the inspection

Throughout the pandemic CQC has continued to regulate and respond to risk. However, taking into account the circumstances arising as a result of the pandemic, and in order to reduce risk, we have conducted our inspections differently.

This inspection was carried out in a way which enabled us to spend a minimum amount of time on site. This was with consent from the provider and in line with all data protection and information governance requirements.

This included:

• Conducting staff interviews including interviews using video conferencing facilities
• Completing clinical searches on the practice’s patient records system and discussing findings with the provider
• Reviewing patient records to identify issues and clarify actions taken by the provider
• Requesting evidence from the provider
• A site visit to Edlesborough Surgery
• Observations of the dispensary at Edlesborough Surgery
• Discussions with patients, practice staff and the patient participation group.

Our findings

We based our judgement of the quality of care at this service on a combination of:

• What we found when we inspected
• Information from our ongoing monitoring of data about services
• Information from the provider, patients, the public and other organisations.

We have rated this practice as Good overall.

We found that:

• The practice provided care in a way that kept patients safe and protected them from avoidable harm and there was active and appropriate engagement in local safeguarding processes.
• Patients received effective care and treatment that met their needs. We reviewed patient consultation records and found examples of appropriate clinical interventions, monitoring, prescribing and coding.
• Personal development and learning was actively promoted and a wide range of learning opportunities were provided for staff of all grades and disciplines.
• The practice adjusted how it delivered services to meet the needs of patients during the COVID-19 pandemic. Patients could access care and treatment in a timely way.
• The way the practice was led and managed promoted the delivery of high-quality, person-centre care.
• There was an established network of internal meetings to share information, assist with planning, and review any emerging concerns or new workstreams.
• The practice had a proactive approach to seeking out and embedding new and more sustainable models of primary care, this included work to become a ‘Green Practice’ and become a more environmentally friendly.

We saw two areas of outstanding practice:

• One of the GPs had worked alongside the reception team and created a ‘traffic light’ signposting tool to enable reception staff to identify deteriorating or acutely unwell patients. The tool also supported reception to signpost other clinical presentations to the most appropriate service. This tool aligned to the training the reception team had received to recognise medical emergencies which included a module on how to spot suspected sepsis. Within a week of the launch of the tool and completed training, one of the reception team had correctly recognised the presentation of sepsis and summoned emergency help. Sepsis is a life-threatening reaction to an infection.
• In April 2022, the practice installed an automated prescription dispensing machine, located at the Edlesborough practice. Staff were asked to name the machine and agreed to name the machine ‘Spenser’. Dispensary staff prepared the prescriptions, bagged and labelled the prescribed items as normal, then loaded ‘Spenser’ (the machine). At the point an individual bag was loaded, the patient was contacted via secure message to tell them their medicines were ready for collection. The message contained a unique six-digit code and information on how long the patients had to pick up their prescription. Using the touchscreen built into the machine, the patient then entered their PIN code, made payment (where required) and then received their bagged prescription. Both staff feedback and patient feedback was overwhelmingly positive, dispensary staff advised ‘…it felt like an extra pair of hands…’ whilst patient feedback highlighted the efficiency of the machine. We saw data which indicated between one recent Friday evening and Monday morning, 60 different patients had collected their medicines, this would not have been possible without the machine. Given the success and positive feedback from the dispensary staff and patients, the practice was looking to install a similar machine at the branch practice in Pitstone.

Whilst we found no breaches of regulations, the provider should:

• Revise the format of the medication reviews, thus ensuring the reviews are structured and include additional detail.
• Review and seek to improve the process for staff to follow to help raise any concerns, this includes promotion of the Freedom to Speak Up Guardian.

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

Dr Sean O’Kelly

Chief Inspector of Hospitals and Interim Chief Inspector of Primary Medical Services