Archived: The Simpson Centre

Updated 28 April 2017

The Simpson Centre provides GP services from two surgeries to 17,500 patients in and around the market town of Beaconsfield, Buckinghamshire and nearby village of Penn, Buckinghamshire. The practice serves an area with very low levels of deprivation. Ethnicity based on demographics collected in the 2011 census shows the population of the surrounding area is predominantly white British. It has fewer patients aged between 15 and 40 than the national average, and more aged 14 and under and 40 and over.

Just below 57% are in paid employment or full time education compared to the national average of 62%; among those in employment, a high number commute to work in London or other larger towns. Owing to house building projects in the area and the practice's commitment to accepting out of area patients when medically appropriate, patient numbers have increased by about 1,100 since the beginning of 2014.

The patient population has a life expectancy between four and five years longer than the national average and the practice provides support to three local care homes, including one with a specialist dementia unit. In total, 50% of its patients have a long standing health condition, compared to the national average of 54%.

The practice has eight GP partners, five female and three male, and three female salaried GPs. There are four practice nurses, equivalent to 3.7 whole time, and two healthcare assistants. A phlebotomist is available on site three days a week at The Simpson Centre, and one day a week at The Penn Surgery.

The practice has been a training practice for more than 30 years, but does not current have any GP Registrars owing to the retirement of its GP trainer. One partner commenced their GP trainer training in early 2017; after the training is completed the practice will again accept trainees. GP Registrars are qualified doctors who are undertaking additional training to gain experience and higher qualifications in general practice and family medicine.

The Simpson Centre is a large converted 1950s house, which has been extended since becoming a GP surgery in the 1970s. The Penn Surgery is a purpose built building, built nine years ago. The surgeries share a patient list, but patients are allocated to named GPs at one of the surgeries depending on where they live, and are encouraged to attend appointments at that location in most instances. The GPs are each based at one of the surgeries, with the nursing team and some non-clinical staff working across both sites.

The practice is open from 8.30am to 6.30pm Monday to Friday at both surgeries, with extended hour’s appointments four evenings a month, alternating between the surgeries, and from 8.30am until 11am on alternate Saturdays. A duty GP is available for emergency telephone calls and appointments from 8am on weekdays. The out of hour’s service is provided by Buckinghamshire Urgent Care and is accessed by calling NHS 111. Advice on how to access the out of hour’s service is contained in the practice leaflet, on the patient website and on a recorded message when the practice is closed.

Services are delivered from:

• The Simpson Centre, 70 Gregories Road, Beaconsfield, Buckinghamshire, HP9 1PS.

• The Penn Surgery, Elm Road, Penn, Buckinghamshire, HP10 8LQ.

Updated 28 April 2017

Letter from the Chief Inspector of General Practice

At our previous comprehensive inspection at The Simpson Centre in Beaconsfield, Buckinghamshire on 14 September 2016 we found a breach of regulations relating to the provision of safe services. The overall rating for the practice was good. Specifically, the practice was rated requires improvement for the provision of safe services and good for the provision of effective, caring, responsive and well-led services. The full comprehensive report on the September 2016 inspection can be found by selecting the ‘all reports’ link for The Simpson Centre on our website at www.cqc.org.uk.

This inspection was a desk-based review carried out on 19 April 2017 to confirm that the practice had carried out their plan to meet the legal requirements in relation to the breaches in regulations that we identified in our previous inspection in September 2016. This report covers our findings in relation to those requirements and also additional improvements made since our last inspection.

We found the practice had made improvements since our last inspection. Using information provided we found the practice was now meeting the regulations that had previously been breached. 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.

Our key findings were as follows:

• The practice including the branch surgery in Penn (also in Buckinghamshire) had established and was now operating safe and effective systems to assess, manage and mitigate the risks identified relating to fire safety, electrical installation and legionella.

• A system had been introduced to improve the security of prescription stationary. For example, all clinical rooms had been fitted with key coded locks and prescriptions were now locked away in a cupboard overnight to prevent unauthorised access to blank and completed prescription forms.

• Further steps had been taken steps to assist patients with hearing difficulties. The broken aid to assist patients with hearing difficulties had been removed and the practice had received quotes for two brand new hearing loops. Until installation, one of the managers within the practice had completed a basic sign language and communication for hearing impaired course. This had been cascaded to all practice staff during a training afternoon.

Professor Steve Field CBE FRCP FFPH FRCGP

Chief Inspector of General Practice

Updated 1 November 2016

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.

• Performance for diabetes related indicators was similar to the CCG and national average, with 77% of patients with diabetes achieving a target blood level of 64mmol or below compared to the CCG average and national average of 78%.

• One of the GP partners had trained in insulininitiation, and was able to provide this service to patients with diabetes on site, to avoid hospital visits.

• The practice had home blood pressure and electrocardiogram machines available to assist patients in monitoring their condition.

• The practice had undertaken screening and coding audit work to ensure that all patients with long-term conditions such as diabetes, atrial fibrillation and chronic obstructive pulmonary disease were identified at an early stage.

• An asthma review project was undertaken after an audit identified an excessive use of reliever inhalers by some patients with asthma. As a result, half of the patients using three or more reliever inhalers a year reduced their use.

• 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 1 November 2016

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

• 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 people 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 people were treated in an age-appropriate way and were recognised as individuals, and we saw evidence to confirm this.

• 76% of female patients aged 25 to 64 years had received a cervical screening test within the target period, compared to a CCG average of 75% and national average of 82%.

• Two GPs had undertaken additional gynaecology training which enabled them to carry out on site procedures which reduced the need for hospital referrals.

• 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.

Updated 1 November 2016

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

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

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

• The practice provided services to three care homes. Each resident had a named responsible GP, and in addition to weekly visits and on site flu jab clinics, the practice provided dedicated appointment slots at the surgery for residents who were able to travel.

• The practice had undertaken a number of projects with the care homes, including one to improve the nutrition of residents by replacing the use of sip feeds (prescribed oral nutritional supplements) with homemade equivalents. As a result, the care home provider had implemented the approach in all its homes across the UK, and the practice had adopted the approach for all its elderly patients with nutrition and hydration concerns.

• The practice had undertaken a falls avoidance project which involved identifying patients at most risk of falls and offering them physiotherapy assessments and recommendations including referral to the local falls clinic, suitable footwear and identifying hazards in the home.

• The practice had installed an automated telephone appointment booking system, and had worked with the patient participation group (PPG) to promote it to patients who may require additional support using the new technology

Updated 1 November 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 offered Saturday morning and weekday evening clinics for working patients who could not attend during normal opening hours.

• There was a high uptake of health checks offered to new patients and those aged over 40.

• 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.

• Contraception including the fitting of intrauterine devices, minor surgery, dermatology consultation, travel vaccinations, antenatal care and phlebotomy appointments were available on site.

Updated 1 November 2016

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

• 94% of patients with dementia had their care reviewed in a face to face meeting in the last 12 months, compared to the CCG average of 86% and the national average of 84%.

• 89% of patients diagnosed with schizophrenia, bipolar affective disorder and other psychoses had their care reviewed in a face to face meeting in the last 12 months, compared to the CCG average of 89% and the national average of 88%.

• The practice was undertaking work to become “dementia friendly”, through staff training, reviews of diagnostic tools, clinical practice and record coding, and development of a dementia plan, including a re-audit of the use of antipsychotic medicine in elderly patients. The number of patients identified with dementia had increased as a result of this work from 113 to 135 from April to September 2016.

• 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 1 November 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 homeless people, travellers and those with a learning disability.

  The practice had funded a pharmacist project to review the medicines prescribed to vulnerable patients, including the elderly, housebound and those living alone, as well as patients prescribed multiple medicines and those with chronic diseases.

• 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.