Background to this inspection
Updated
19 April 2017
Dr Allan & Partners is situated in Chalfont St Peter, Gerrards Cross in Buckinghamshire. The practice is located in a purpose built premises. There is a car parking area with disabled bays and easy access for prams and wheelchairs with automatic doors.
The reception has a self-check in facility and a low desk for those in wheelchairs. There is an accessible toilet and the toilet area is signposted with a dementia friendly sign. Also present are a hearing loop, practice brochure in large print plus television screens presenting topics relating to health and lifestyle choices. There is a self-check blood pressure monitor available. A privacy screen is available in case of an emergency in a public area. The practice has a patient population of approximately 8,800 registered patients. The practice population of registered patients aged 0 to 4 is lower than the national average, patients aged 5 to 14 are above the national average. Patients aged 65 plus years, 85 years and over are above the national average of registered patients.
We were told that the profile of the population registered with the practice work in managerial professions, this is 20% above the national average. Patients registered with the practice claiming benefits were 10% below the national average, and 90% of the practice population were born in the UK.
There are five GP partners, three female and two male. The practice employs three practice nurses. A practice manager, together with a team of reception, secretarial and administrative staff undertake the day to day management and running of the practice. Services are provided via a General Medical Services (GMS) contract. (GMS contracts are negotiated nationally between GP representatives and the NHS). One GP is an experienced trainer and another GP is undertaking the new trainer’s course. The practice plans to develop as a training practice in 2017.
Services are provided from the following location:
- Dr Allan & Partners, Calcot Medical Centre, Hampden Road, Chalfont St Peter, Gerrards Cross, Buckinghamshire SL9 9SA
The practice has core opening times between 7.30am to 6.00pm Monday to Friday. Extended opening hours are available each week day at 7.30am and at 7am on Wednesdays and Fridays.
The out of hours services are provided by Bucks Urgent Care. 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 practice website. Out of hours services are provided by Bucks Urgent Care and NHS 111. During protected learning time when the practice is closed, cover is provided by Bucks Urgent Care.
Updated
19 April 2017
Letter from the Chief Inspector of General Practice
At our previous comprehensive inspection at Dr Allan & Partners in Gerrards Cross, Buckinghamshire on 20 July 2016 we found a breach of regulations relating to the provision of effective services. The overall rating for the practice was good. Specifically, Dr Allan & Partners was rated good for providing safe, caring, responsive and well-led services. The practice was rated requires improvement for the provision of effective services. The full comprehensive report on the July 2016 inspection can be found by selecting the ‘all reports’ link for Dr Allan & Partners on our website at www.cqc.org.uk.
This inspection was carried out on 21 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 in July 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 and 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. Furthermore, the practice had resolved the concerns related to the management of people with long term conditions, this population group rating is also now rated good. Overall the practice is now rated as good.
Specifically the practice had:
- Reviewed how patients were identified and supported to attend for yearly reviews and check-ups in relation to their medical conditions, medicines and to support improved patient outcomes.
- Shared actions and learning outcomes from significant events and complaints with all practice staff.
- Reviewed and formalised an ongoing programme of clinical audit. This included designated clinical audit meetings and the appointment of one the GPs as clinical audit lead.
Professor Steve Field CBE FRCP FFPH FRCGP
Chief Inspector of General Practice
People with long term conditions
Updated
19 April 2017
The practice had resolved the concerns related to the effective domain identified at our inspection on 20 July 2016 which applied to this population group.
- The practice had reviewed how patients were identified and supported to attend for yearly reviews and check-ups in relation to their medical conditions. This review included a six point action plan with a view to improve patient outcomes for patients with asthma, chronic obstructive pulmonary disease (COPD) and osteoporosis (a condition that weakens bones, making them fragile and more likely to break).
- One of the action points was an audit of the management and reviews of patients with COPD. On completion of this audit, a change had been planned to ensure patients are invited to the practice for a review before the winter months when historically the symptoms of COPD worsen.
This population group rating has been updated to reflect the improvements.
Families, children and young people
Updated
27 September 2016
The practice is rated as requires improvement for the care of people with long-term conditions.
- High QOF exception reporting and patients without recorded condition or medication reviews may have had an impact on patient outcomes for this group.
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The practice monitored the exception rates of patients not having annual reviews for long term conditions. However, there were higher levels of patients without annual health checks and reviews recorded on the practice system. This meant these patients may have been at risk of poor longer term outcomes.
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Nursing staff had lead roles in chronic disease management and patients at risk of hospital admission were identified as a priority.
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Longer appointments and home visits were available when needed
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All these patients had a named GP and a structured annual review to check their health and medicines needs were being met. Many patients chose to access health checks from providers in the private sector or abroad. 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
27 September 2016
The practice is rated as good for the care of older people.
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The practice offered proactive, personalised care to meet the needs of the older people in its population.
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The practice was responsive to the needs of older people, and offered home visits and urgent appointments for those with enhanced needs
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The practice used a Coordinate Care Record for End of Life Care for personalised care plans. This included sharing information with other agencies and involved the care of carers
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The practice attended the Village Older Peoples Action Group – (VOPAG) to discuss health promotion and prevention services provided by the practice. The Patients Participation Group lead told us that topics included the benefits flu and shingles vaccines.
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The premises were accessible to those with limited mobility, with an automatic door, and low level reception desk. All consulting rooms were on the ground floor.
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We saw evidence of good working relationships with other health and social care services. These included District Nurses, Palliative Care teams, and Multi Agency Group meetings. The multi professional and multi-agency groups coordinated care and support for the elderly, vulnerable and socially isolated.
Working age people (including those recently retired and students)
Updated
27 September 2016
The practice is rated as good for the care of working-age people (including those recently retired and students).
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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.
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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.
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The practice offered appointments from 7.30am to 6.00pm daily which enabled patients who worked the opportunity to be seen before normal opening hours. There was a tiered system of bookable appointments and the practice offered on the day appointments for everyone who required one. The practice had audited their appointments system and had summer and winter templates to reflect the changing needs of their patients.
People experiencing poor mental health (including people with dementia)
Updated
27 September 2016
The practice is rated as good for the care of people experiencing poor mental health (including people with dementia).
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Performance for dementia face to face review was comparable with the Clinical Commissioning Group and national averages. The practice had achieved 88% of the total number of points available, compared to 86% to the CCG average and national average of 84%.
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The practice regularly worked with multi-disciplinary teams in the case management of patients experiencing poor mental health, including those with dementia.
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The practice carried out advance care planning for patients with dementia.
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The practice had told patients experiencing poor mental health about how to access various support groups and voluntary organisations.
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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.
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Staff had a good understanding of how to support patients with mental health needs and dementia.
People whose circumstances may make them vulnerable
Updated
27 September 2016
The practice is rated as good for the care of people whose circumstances may make them vulnerable.
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The practice held a register of patients living in vulnerable circumstances including homeless people, travellers and those with a learning disability.
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The practice offered annual health checks for patients with learning disabilities. Health checks and care plans were completed for 90% of patients with a learning disability.
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The practice offered longer appointments for patients with a learning disability.
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The practice regularly worked with other health care professionals in the case management of vulnerable patients.
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The practice informed vulnerable patients about how to access various support groups and voluntary organisations.
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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.