Millbarn Medical Centre

Updated 16 March 2017

Millbarn Medical Centre is a purpose built medical facility. It opened in 1976 and refurbishment and extension of the premises was undertaken in 2004. Approximately 7,600 patients are registered with the practice. The practice is accessible from the local station and bus routes run nearby.

There are four GP partners at the practice and they are equivalent to 3.8 whole time GPs. Two are male and two female. The practice nursing team comprises two practice nurses and two health care assistants (HCAs). They are equivalent to 1.99 whole time staff. The practice manager is supported in the day to day management of the practice by a head receptionist and a team of 12 part time administration and reception staff. The practice is accredited to train qualified doctors who are seeking to become GPs.

The practice is open between 8am and 6.30pm Monday to Friday. Appointments are offered from 8.30am to 12.50pm every morning and 1.40pm to 5.40pm daily. Extended hours appointments are offered on a Monday evening between 6.30pm and 7.30pm. The practice has opted out of providing the out-of-hours service. This service is provided by Care UK and they are accessed via the NHS 111 service. Advice on how to access the out-of-hours service is clearly displayed on the practice website, at the entrance to the practice and over the telephone when the surgery is closed.

According to data from the Office for National Statistics, Buckinghamshire has a high level of affluence and minimal economic deprivation. Data also shows the local population to be over 95% white British.

The age distribution of the registered patients is mostly similar to the national averages. Although there is a slightly higher than average number of patients aged between 0 and 14 and 40 to 54 years of age. However, the number of patients over 85 years of age is significantly higher than the national average.

Ear, nose and throat (ENT) clinics are held at the practice. They are run by one of the GP partners with specialist skills in this area of medicine. The clinics are for patients from the local area and reduce the need for patients to attend the general hospital for this service.

All services are provided from:

Millbarn Medical Centre

34 London End

Beaconsfield

Buckinghamshire

HP 9 2JH

Updated 16 March 2017

Letter from the Chief Inspector of General Practice

We carried out an announced comprehensive inspection at Millbarn Medical Centre on 26 July 2016. The overall rating for the practice was good but the practice had breached regulations relating to operating consistent monitoring and management of safety systems and staff training. This led to a rating of requires improvement for provision of safe services. The full comprehensive report on the July 2016 inspection can be found by selecting the ‘all reports’ link for Millbarn Medical Centre on our website at www.cqc.org.uk.

This inspection was a desk-based review carried out on 1 March 2017 to confirm that the practice had carried out their plan to meet the legal requirements in relation to the breach in regulations that we identified in our previous inspection on 26 July 2016. This report covers our findings in relation to those requirements and also additional improvements made since our last inspection.

Overall the practice remains rated as good and is now rated good for provision of safe services.

Our key findings were as follows:

• The practice had completed relevant checks on the gas services within the practice premises.

• Appropriate risk assessments for legionella (Legionella is a term for a particular bacterium which can contaminate water systems in buildings) had been undertaken and control measures adopted.

• Relevant training in safeguarding had been completed by all members of the nursing team.

• Arrangements had been put in place for patients diagnosed with a learning disability to receive an annual physical health check.

• The policy for maintaining medicines requiring refrigeration had been updated to detail actions required if fridge temperatures were recorded outside of the recommended range.

Professor Steve Field (CBE FRCP FFPH FRCGP) 

Chief Inspector of General Practice

Updated 14 September 2016

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

• The practice offered GP led delivery of services to patients with long term conditions.

• Patients at risk of hospital admission were identified as a priority.

• 97% of patients diagnosed with diabetes had a foot examination and associated risk assessment which was better than the CCG average of 90% and national average of 88%.

• Longer appointments and home visits were available when needed.

• All these patients had a named GP and a structured annual review to check 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.

Updated 14 September 2016

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. Immunisation rates were relatively high 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, and we saw evidence to confirm this.

• The practice’s uptake for the cervical screening programme was 84%, which was comparable to the CCG average of 84% and above the national average of 82%.

• 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 and health visitors.

Updated 14 September 2016

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

• The practice offered proactive, personalised care to meet the needs of the older patients in its population.

• The practice was responsive to the needs of older patients, and offered home visits and urgent appointments for those with enhanced needs.

• Hearing tests were available at the practice and these were carried out by practice staff.

• Nationally reported data showed that outcomes for patients for conditions commonly found in older people were above average. For example, 100% of patients aged over 75 with a fragility fracture were prescribed bone sparing medicine which was better than the CCG average of 92% and national average of 93%.

Updated 14 September 2016

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.

• Extended hours clinics were held on a Monday evening until 7.30pm by all practice GPs.

• Telephone consultations were available.

Updated 14 September 2016

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

• 91% of patients diagnosed with a severe and enduring mental health problem had an agreed care plan recorded. This was better than the CCG average of 89% and national average of 88%.

• The practice regularly worked with multi-disciplinary teams in the case management of patients experiencing poor mental health, including those with dementia.

• The practice carried out advance care planning for patients with dementia.

• The practice had told patients experiencing poor mental health about how to access various support groups and voluntary organisations.

• The practice 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 a good understanding of how to support patients with mental health needs and dementia.

Updated 14 September 2016

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 travellers and those with a learning disability. The practice had not adopted the programme to offer annual health checks for patients with a learning disability.

• 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.

• The practice registered patients from a local travelling community. These patients were offered reminders to attend their appointments. Those that had difficulty reading and writing received additional verbal information to support the care and treatment advice being offered.

However,

• Patients diagnosed with a learning disability had not received an annual health check in the last year.