Downing Street Group Practice

Updated 26 January 2017

Downing Street Group Practice is located in a grade two listed building that has been a GP practice for over 200 years and has been extended with areas converted into a medical practice from a GP private dwelling. The practice is located in the centre of Farnham at 4 Downing Street, Farnham, Surrey, GU9 7PA.

The practice has an NHS Personal Medical Services contract to provide health services to approximately 12,780 patients in and around the Farnham area. The practice covers an urban and rural population and has a higher than national average for males and females aged 40 to 80 years.

The clinical team consists of three GP partners, two male and one female, five salaried GPs, three female and two male and a GP registrar. The practice has a nurse practitioner, four practice nurses, a healthcare assistant and a phlebotomist. The clinical team are supported by a practice manager, deputy practice manager, reception manager and a total 16 receptionists, administration, secretarial support staff.

Downing Street Group Practice has been training and teaching practice for many years and train GP registrars, junior doctors and medical students.

The practice is open Monday to Friday from 8:00am to 6:30pm. Phone lines are open from 8.00am to 6.30pm Monday to Friday (excluding public holidays).

GP appointments are available Monday to Friday with the GPs and the practice offering extended hours on Monday and Wednesday evenings between 6.30pm and 8.00pm and one Saturday morning per month for booked appointments.

Routine appointments for GPs and Nurses could be booked up to four weeks in advance. If the patient felt that the problem was urgent, they were offered a same-day appointment. On busy days, the patient will be offered a telephone call with a GP or advanced nurse practitioner to establish the urgency of any medical need.

The practice 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.

Updated 26 January 2017

Letter from the Chief Inspector of General Practice

We carried out an announced comprehensive inspection at Downing Street Group Practice, Farnham on 22 November 2016. Overall the practice is 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.
• 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.
• Patients said they found it easy to make an appointment with a named GP and there was continuity of care, with urgent appointments available the same day.
• 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.

Professor Steve Field (CBE FRCP FFPH FRCGP) 

Chief Inspector of General Practice

Updated 26 January 2017

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.
• The percentage of patients with diabetes, on the register, in whom the last blood pressure reading (measured in the preceding 12 months) was acceptable was 74% compared to the national average of 79%.
• 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.
• The practice has a lead nurse who can perform ischaemic heart disease and heart failure new patient assessments. There was a recall system for annual reviews with GPs which were integrated with community nurse specialist and community services reviews.

Updated 26 January 2017

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.
• The percentage of women aged 25-64 whose notes record that a cervical screening test had been performed in the preceding 5 years was 81% compared 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.
• Families were registered together with same GP for continuity and familiarity.

Updated 26 January 2017

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.
• The practice had a hearing loop in the reception, a named GP for patients over 75 and a specific phone number for these patients to have direct access to the practice.
• Patients who were housebound were given information on services designed for them.
• WALC (Walk and Live Confidently) is a locally developed falls prevention campaign which the practice has fully adopted and continued to use.
• The practice has developed an evidence based “Over 75 year old health check” and delivered approximately 800 health checks to 80% of older patients, including housebound patients.

Updated 26 January 2017

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.
• 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.
• The practice offered online services for booking appointments and to order medicines.
• There was a wide collection of self-help patient information in the waiting room and on the practice website.
• Meetings of the practice Patient Participation Group are held in the evenings to encourage attendance from a wider selection of the patient population. The practice has developed an active email forum to enable involvement by patient who cannot easily attend meetings.
• There is an onsite drop-in stop smoking clinic on Monday evenings.

Updated 26 January 2017

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

• 80% of patients with schizophrenia, bipolar affective disorder and other psychoses had a comprehensive, agreed care plan documented in the record, in the preceding 12 months which was below the national average of 89% in the 2014-2015 figures. This had risen to 91% in the 2015-2016 figures. The national average had remained at 89%.
• 79% of patients diagnosed with dementia had their care reviewed in a face-to-face review in the preceding 12 months. This was below the national average of 85%. This had risen to 82% in the 2015-2016 figures with an exception rate of 4%. (Exception reporting is the removal of patients from QOF calculations where, for example, the patients are unable to attend a review meeting or certain medicines cannot be prescribed because of side effects).
• 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.
• The practice was the first Dementia Friendly Practice in the clinical commissioning group area, as accredited by the Wessex Academic Health Science Network.

Updated 26 January 2017

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.
• 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 led a project to create a Farnham wide Information Directory for the vulnerable. It was accessed via the practice’s website and used by the practice team. The directory included telephone numbers and helpful signposting information for an array of local services.