Alexander House Surgery

Updated 17 January 2017

Alexander House Surgery is located near the centre of Farnborough, a large town in Hampshire. The practice is based in a purpose built building which has been extended and is on two floors. Treatment rooms are predominantly on the ground floor with two available on the first floor. There is no lift access to the first floor. Arrangements are made to see patients with limited mobility on the ground floor.

The practice provides services to approximately 9200 patients under a NHS Personal Medical Services Contract and is part of the North Hampshire and Farnham Clinical Commissioning Group (CCG). The practice has a slightly higher than average number of patients who are aged 85 years and older and those aged 40 to 49 years of age. Alexander House Surgery is situated in an affluent area of Farnborough and there are low levels of deprivation.

The practice has five GP partners and employs one salaried GP. Two GPs are male and four are female. The practice employs one nurse practitioner who is also a non-medical prescriber and a further two practice nurses, one of whom is also a non-medical prescriber. There are also two health care assistants. The clinical team are supported by a management team and a team of support staff who perform secretarial, administrative and reception duties.

The practice is open between 8am and 6:30pm Monday to Friday. Appointments are from 8am to 12pm every morning and 2pm to 6:30pm daily. Individual GP and nurses appointment times vary but these are published both on the website and at reception. Extended surgery hours are offered on Thursdays until 8pm and on the mornings of the first and third Saturday of each month. In addition, pre-bookable appointments can be booked up to two weeks in advance. Each GP triages their own patient list and offers an urgent appointment if a patient required this. Home visits are also available. Alexander House Surgery has opted out of providing out-of-hours services to their own patients and refers them to the out of hours service via the NHS 111 service.

We carried out our inspection at the practice’s only location which is situated at:

2 Salisbury Road, Farnborough, Hampshire, GU14 7AW

We previously inspected Alexander House Surgery on 10 February 2016. Following this inspection, the practice was given a rating of good. The practice was rated as requires improvement for providing safe care. This was because the practice had not completed all of the actions necessary to improve fire safety following a fire risk assessment. We also found that the use of blank prescriptions was not monitored.

A copy of the report detailing our findings can be found at www.cqc.org.uk

Updated 17 January 2017

Letter from the Chief Inspector of General Practice

We carried out a focused inspection of Alexander House Surgery on 13 December 2016 to assess whether the practice had made the improvements required in providing safe care and services.

We had previously carried out an announced comprehensive inspection at Alexander House Surgery on 10 February 2016 when we rated the practice as good overall. The practice was rated as requires improvement for providing safe care. This was because the use of blank prescription stationery was not monitored. Also, the practice had not completed all recommended actions to improve fire safety.

We asked the provider to send a report of the improvements they would make to comply with the regulations they were not meeting at that time. The practice is now able to demonstrate that they are meeting the regulations. The practice is now rated as good for providing safe care and the overall rating remains as good.

This report should be read in conjunction with the full inspection report dated 13 May 2016.

Our key finding across the area we inspected was as follows:

• The systems to monitor blank prescription stationary use were safe.
• The practice had taken all action required to improve fire safety.

Professor Steve Field (CBE FRCP FFPH FRCGP) 

Chief Inspector of General Practice

Updated 13 May 2016

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

• 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 better than the national average. For example the percentage of patients identified with diabetes having a foot examination in the past 12 months was 91% in comparison to the 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 13 May 2016

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

• 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 accident and emergency 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.

• The practice’s uptake for the cervical screening programme was 84%, which was comparable to 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, health visitors and school nurses.

Updated 13 May 2016

The practice is rated as good for the care of older people. The practice is rated as requires improvement for the safe domain.

• 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.

• The practice offered longer appointments to older patients to proactively address medical and social needs.

• The practice routinely visited care homes in the area to provide care and treatment and administer vaccines.

• The practice had developed a housebound register identifying those patients who needed home visits.

• All GPs held personal lists to provide continuity of care.

Updated 13 May 2016

The practice is rated as good for the care of working-age people (including those recently retired and students). The practice is rated as requires improvement for the safe domain.

• 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.

• Well woman clinics were offered on Saturday mornings.

• Telephone triage was available for urgent on the day appointments.

Updated 13 May 2016

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

• A total of 95% of patients diagnosed with dementia had had their care reviewed in a face to face meeting in the past 12 months which is above the national average of 84%

• Indicators for patients with a mental health condition showed that the practice was performing above the national averages. For example, the percentage of patients with schizophrenia, bipolar affective disorder and other psychoses who had a comprehensive agreed care plan documented was 94% compared with the national average of 88%.

• Patients with a mental health condition which was stable were able to receive their depot medicine injections at the practice.

• 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 13 May 2016

The practice is rated as good for the care of people whose circumstances may make them vulnerable. The practice is rated as requires improvement for the safe domain.

• The practice held a register of patients living in vulnerable circumstances including homeless patients, travellers and those with a learning disability.

• The practice offered longer appointments for patients with a learning disability.

• The practice regularly worked with multi-disciplinary teams 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.