Archived: Meadowcroft Surgery

Updated 11 February 2016

Dr Shirley Tinnion and Partners practice is a purpose built premises with car parking for patients and staff. There was easy access for patients/carers with a ramp and automatic main door. All patient services are provided on the ground floor. The practice comprises of 12 consulting rooms, two treatment rooms, one patient waiting area and administrative and management office and meeting spaces.

There are five GP partners at the practice, four salaried GPs and one trainee doctor. Two GPs are male and eight female. The practice employs four practice nurses, two health care assistants and a phlebotomist (a specialist clinical worker who take blood samples from patients). The practice had recruited a new pharmacist in November 2015 taking a lead role in medicine reviews and health checks. The practice manager had been appointed in September 2015. The practice manager is supported by operations manager, reception admin team leader and a team of administrative and reception staff. Services are provided via a General Medical Services (GMS) contract (GMS contracts are negotiated nationally between GP representatives and the NHS). Dr Shirley Tinnion and Partners was a training practice.

The practice has a patient population of approximately 14,200 including 11% with Asian ethnic background. The practice population of patients aged between 25 and 34 and 0 and 14 years are slightly higher than average and there are a lower number of patients over 60 years old.

The local community has areas of deprivation and the staff were aware of the needs of this section of the population. The appointment system allowed advanced appointments to be booked from two days to six weeks in advance. Urgent appointment slots were also available.

Services are provided from:

Dr Shirley Tinnion & partners (also locally known as Meadowcroft surgery)

Jackson Road

Aylesbury

Buckinghamshire

HP19 9EX

We visited Dr Shirley Tinnion & Partners practice during this inspection.

The practice has opted out of providing out of hours services to their patients. There are arrangements in place for services to be provided when the surgery is closed and these are displayed at the practice, in the practice information leaflet and on the patient website. Out of hours services are provided during protected learning time by Bucks Urgent Care or after 6:30pm, weekends and bank holidays by calling NHS 111.

Updated 11 February 2016

Letter from the Chief Inspector of General Practice

Our previous inspection in July 2015 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. The population groups were rated as good for the patients registered at the practice.

This inspection was undertaken to check the practice was meeting regulations. For this reason we have only rated the location for the key questions to which these relate. This report should be read in conjunction with the full inspection report of 30 July 2015.

We found the practice had made improvements since our last inspection. At our inspection on the 20 January 2016 we found the practice was meeting the regulations that had previously been breached.

Specifically we found:

• Most of the staff had undertaken safeguarding children and adult training and the remaining staff were due to attend refresher training course in February 2016.
• Improvements had been made to maintain the accurate records of patient information. For example Read Codes had been properly recorded of all patients on child protection register and audit had been carried out to ensure continuous monitoring.
• The practice had revised protocol for handling blank prescription forms in accordance with national guidance.
• The practice was actively identifying, assessing and managing risks to prevent, detect and control the spread of infections.

However, the areas where the provider should make improvements are:

• Review the processes for continuous and effective monitoring of safeguarding training for all staff.
• Implement the process for the tracking of hand written prescription forms.

We have amended the rating for this practice to reflect these changes. The practice is now rated good for the provision of safe services.

Professor Steve Field (CBE FRCP FFPH FRCGP) 

Chief Inspector of General Practice

Updated 24 September 2015

The practice is rated as good for the care of people with long-term conditions. There were clinical leads for chronic disease management and patients at risk of hospital admission were identified as a priority. Longer appointments and home visits were available when needed. However, not all these patients had a named GP and data showed improvement was required in patients outcomes for long term conditions. However, the practice was working to improve these area and we had witnessed effective diabetic care planning which resulted improvements in diabetic patients outcomes. There was a secondary care diabetic nurse working one day a week in the practice. The practice nurse was sending blood test results to the diabetic patient before the patient attended their annual review. The practice had recruited a full time pharmacist to take on lead role in rolling out similar care planning projects for other long term conditions.

Updated 24 September 2015

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. Staff were aware of the legal requirements of gaining consent for treatment for those under 16. A separate facility was provided on the practice website for requesting online repeat prescriptions for under 16. Chlamydia testing kits were available in accessible location for under 25s. Appointments were available outside of school hours and the premises were suitable for children and babies. Antenatal appointments and postnatal clinics were available. We saw good examples of joint working with midwives, health visitors and school nurses. The Asian link worker was employed to assist diverse multi-ethnic community.

Updated 24 September 2015

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 people in its population. For example, the practice had recruited a nurse to work with patients aged over 75 to reduce emergency and hospital admissions. We reviewed evidence that showed the practice had reduced emergency admissions. The practice was responsive to the needs of older people and offered rapid access, longer appointments and home visits for those with enhanced needs. Patients aged over 75 had a named GP to promote continuity of care. Flu vaccination rates for over 65 were above the national average. The premises were accessible to those with limited mobility with automatic main doors and disabled toilets. There was a register to manage end of life care and unplanned admissions. There were good working relationships with external services such as district nurses.

Updated 24 September 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. Extended hours appointments were available on minimum three or maximum five mornings and one evening during weekdays until 7:30pm. The practice was proactive in offering online services. Health promotion advice was offered and smoking cessation advisor was recruited for one day a week. However, there was a low uptake for NHS health checks which was not reflecting the needs for this age group. For example, only 2% patients attended NHS health checks aged 40 to 75 years old. Extra flu clinics were offered on some Saturdays during flu season.

Updated 24 September 2015

The practice is rated as good for the care of people experiencing poor mental health (including people with dementia). Seventy eight per cent of people experiencing poor mental health had received care plan in last 12 months. The practice regularly worked with multi-disciplinary teams in the case management of people experiencing poor mental health, including those with dementia.

The practice had told patients experiencing poor mental health about 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 (A&E) 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. However, mental capacity act training had not been completed.

Updated 24 September 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 homeless people, travellers and those with a learning disability. It had not carried out the enhanced service to provide annual health checks for people with a learning disabilities. Data showed only 16 patients out of 32 patients on the learning disability register had received an annual health check and only 15 patients had completed care plans. However, the practice had developed a user friendly questionnaire for learning disabilities patients and GP was visiting care homes as and when required. The practice offered longer appointments 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 about how to access various support groups and voluntary organisations. Most staff knew how to recognise signs of abuse in vulnerable adults and children. Most 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. A translation service was available for patients who did not speak English.