Archived: The Mandeville Practice

Letter from the Chief Inspector of General Practice

We carried out an announced comprehensive inspection at The Mandeville Practice, Hannon Road, Aylesbury, Buckinghamshire, HP21 8TR on 02 July 2015. Overall the practice is rated as requires improvement.

Specifically, we found the practice to require improvement for providing effective and well led services. It was good for providing safe, responsive and caring service. The concerns which led to these ratings apply to all population groups using the practice.

Our key findings across all the areas we inspected were as follows:

• Staff understood and fulfilled their responsibilities to raise concerns, and to report incidents and near misses. Information about safety was recorded, monitored, appropriately reviewed and addressed.
• Risks to patients were assessed and well managed, with the exception of those relating to read coding issues and patients medicine reviews with long term conditions.
• Data showed patients outcomes were low for learning disabilities health checks and long term conditions medicine reviews. 
• Some audits have been carried out but the practice was struggling to carry out repeat audits which was making it difficult to identify improvement areas and monitor continuous progress effectively.
• The practice did not have registered manager in place.
• The practice has made a request to NHS England for a possible list closure of registering new patients. The practice informed us that they were facing recruitment crisis since April 2014 due to sickness, old partners retiring and were struggling to recruit new GPs.
• Patients said they were treated with compassion, dignity and respect and they were involved in their care and decisions about their treatment.
• Information about services and how to complain was available and easy to understand.
• Urgent appointments were usually available on the day they were requested. However patients said that they sometimes had to wait a long time for non-urgent appointments with a named GP.
• The practice had good facilities and was well equipped to treat patients and meet their needs.
• The practice proactively sought feedback from staff and patients, which it acted on.

The areas where the provider must make improvements are:

• Ensure there are formal governance arrangements in place including systems for assessing and monitoring all risks and the quality of the service provision.
• Resolve the read coding issue to ensure improvements to clinical practice can be identified and actions implemented.
• Implement and improve a system of clinical audit cycles to ensure effective monitoring and assessment of the quality of the service.
• Ensure regular medicine reviews are undertaken for patients with long term conditions.
• Ensure the comprehensive written business plan and strategy are reviewed regularly to adjust succession planning and recruiting new GPs, in order to address capacity and consistency concerns.

In addition the provider should:

• Improve the availability of non-urgent appointments with a named GP.
• Ensure personalised care plans for patients with learning disabilities are developed, which should be readily available when required and accessible by external relevant organisations
• Continue to closely monitor the staffing levels and take appropriate action to minimise the impact of patient care and treatment.

Professor Steve Field (CBE FRCP FFPH FRCGP) 

Chief Inspector of General Practice