Iver Medical Centre

Updated 21 July 2016

Iver Medical Centre is located in the village of Iver. The practice premises were purpose built within the last 20 years. Patients are registered from the local area. The practice population, of approximately 9,500, has a higher proportion of patients aged 40-65 compared to the national average. Iver Heath Health Centre is a purpose built centre located in the village of Iver Heath and has its own car parking available for patients. The premises are shared with a private clinic. Just over 1000 of the registered patients prefer to be seen at Iver Heath but patients can be seen at either of the practice premises.

There is minimal local area deprivation according to national data. The prevalence of patients with a long term health problem is 48% compared to the national average of 54%. Local traveller communities and those living in canal boats are registered at the practice.

The main practice at Iver Medical Centre is open between 8.30am and 6.30pm ever Monday to Friday. The telephone lines open at 8am for patients to book appointments. Appointments are from 8.30am to 12pm every morning and 1.30pm to 5.30pm each weekday. Extended hours surgeries are offered on a Tuesday morning from 7.30am to 8.30am and on a Monday evening from 6.30pm until 7.30pm. The opening hours are more limited at the Iver Heath Health Centre branch surgery. This site is open every weekday but operates between 8.30am and 12.30pm from Tuesday to Thursday and is closed in the afternoons. On a Monday the branch surgery is open between 8.30am and 12.30pm in the morning and in the afternoon from 1.30pm to 5.30pm. On Friday the branch surgery is open from 8.30am to 12.30am and 3pm to 5pm in the afternoon.

The practice patient list has increased by approximately 1000 patients in the last three years due to the closure of a local practice. Care and treatment is delivered by five GP partners and a salaried GP. There are four female GPs and two male GPs and they make up just over four whole time GPs. The practice nursing team comprises three practice nurses and a health care assistant, all are female. The day to day management and administration is undertaken by the practice manager, a deputy manager and a team of reception and administration staff.

The practice is a member Chiltern CCG.

Services are provided from:

Iver Medical Centre, High Street, Iver, Buckinghamshire, SL0 9NU

and

Iver Heath Health Centre, 91 Trewarden Avenue, Iver Heath, Buckinghamshire, SL0 0SB

Both practice sites were visited as part of the inspection.

This is a training practice. The practice has a General Medical Services (GMS) contract. GMS contracts are nationally agreed between the General Medical Council and NHS England.

The practice has opted out of providing out-of-hours services to its own patients. There are arrangements in place for patients to access care from an out-of-hours provider and NHS 111.

The practice has submitted an application for one of the partners to become the registered manager. This application was being processed at the time of our inspection.

Updated 21 July 2016

Letter from the Chief Inspector of General Practice

We first inspected Iver Medical Centre in April 2015. At that time we rated the practice as requires improvement. Specifically we found the practice had breached the regulation related to good governance of services by not operating consistent systems of risk assessment or responding to patient feedback.

This inspection was carried out on 26 May 2016 and was a comprehensive inspection because we had not returned to the practice within six months. We found the practice had addressed the issues that gave rise to the breach of regulation that occurred in 2015 and had made significant progress. Overall the practice is now rated as good.

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

• There was an open and transparent approach to safety and an effective system in place for reporting and recording significant events. The practice had made improvements to ensure learning from significant events was shared with the practice team in a consistent manner.
• Risks to patients were assessed and well managed.
• Staff assessed patients’ needs and delivered care in line with current evidence based guidance. Staff had been trained to provide them with the skills, knowledge and experience to deliver effective care and treatment.
• 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. Improvements were made to the quality of care as a result of complaints and concerns.
• The practice had good facilities and was well equipped to treat patients and meet their needs.
• There was a clear leadership structure and staff felt supported by management. The practice proactively sought feedback from staff and patients, which it acted on.
• The provider was aware of and complied with the requirements of the duty of candour.
• Patients reported an improvement in their ability to obtain appointments within a reasonable timescale and the practice had amended their appointment system to ensure urgent appointments were available the same day.
• The practice had formed a patient participation group (PPG) (a PPG is a group of patients registered with a practice who work with the practice to improve services and the quality of care). Members of the PPG told us that the practice was open in working with them and encouraging feedback. Both the practice and PPG told us they were on a continuing path of improvement.

We saw an area of outstanding practice:

• The practice had initiated a visiting NHS physiotherapy clinic specifically for patients aged over 75 years. The clinic helped these patients to maintain mobility and independence and reduced the number of visits to hospital clinics. Twenty six patients had been referred to this service in four months and they had received between one and five treatments after initial assessment.

The areas where the provider should make improvement are:

• Review systems to monitor and review telephone calls to the practice to ensure patients have appropriate access to booking appointments.

• Continue to review appointment availability based on patient feedback.

• Ensure chaperoning during intimate examinations is only undertaken by staff who understand the nature of the examination.

• Review the knowledge and understanding of staff carrying out chaperone duties based on the nature of the examination being supported.

• Review how hospital discharges are managed and reported to ensure patient safety.

• Ensure the improvements in security of blank prescriptions are sustained.

Professor Steve Field (CBE FRCP FFPH FRCGP) 

Chief Inspector of General Practice

Updated 21 July 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.

• 70% of patients diagnosed with diabetes were achieving target cholesterol levels which was similar to the CCG and national average of 71%.

• 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 21 July 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. They also told us it was easy to get urgent appointments for younger children.

• 79% of eligible female patients had cervical screening tests compared to the CCG average of 84% and national average of 82%. However, the number of women the practice excepted from this screening was 6% compared to the CCG average of 8%. The lower exception reporting contributed to the lower overall achievement.

• 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 and health visitors.

Updated 21 July 2016

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.

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

• GPs undertook a weekly visit to a local care home for the elderly to coordinate the care of the residents.

• NHS physiotherapy services were available at the practice for patients aged over 75. This helped avoid lengthy trips to hospital for these patients to attend the physiotherapy clinic.

Updated 21 July 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.

• Extended hours clinics were held both before and after working hours at Iver Medical Centre and all GPs took part in these extended hours on a rota. This meant there was access to the patients preferred GP.

• 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.

• Smoking cessation services and a visiting dietician were available at the practice.

Updated 21 July 2016

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

• < >

  98% of the indicators for care of patients with severe and enduring mental health problems had been achieved compared to the CCG average of 97% and national average of 93%.

• 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.

• A consultant psychiatrist held clinics at the practice once a month.

Updated 21 July 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 offered longer appointments for patients with a learning disability and completed annual health checks for over 80% of these patients.

• 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.

• The practice attended local forums to encourage those with caring responsibilities to register to enable them to receive support and advice.