Gladstone Surgery

Updated 30 June 2016

Gladstone Surgery is located within a purpose built large health centre in Chesham, Buckinghamshire, is one of the practices within Chiltern Clinical Commissioning Group and provides general medical services to approximately 5,100 registered patients.

All services are provided from:

• Gladstone Surgery, Chess Medical Centre, 260-290 Berkhampstead Road, Chesham, Buckinghamshire HP5 3EZ.

The practice comprises of three GP Partners (two female and one male) and an all-female nursing team which consists of one nurse practitioner, one practice nurse and one nurse assistant practitioner.

Gladstone Surgery is located within a purpose built large health centre in Chesham, Buckinghamshire, is one of the practices within Chiltern Clinical Commissioning Group and provides general medical services to approximately 5,100 registered patients.

All services are provided from:

• Gladstone Surgery, Chess Medical Centre, 260-290 Berkhampstead Road, Chesham, Buckinghamshire HP5 3EZ.

The practice comprises of three GP Partners (two female and one male) and an all-female nursing team which consists of one nurse practitioner, one practice nurse and one nurse assistant practitioner.

A practice manager, practice supervisor and a team of reception and administrative staff undertake the day to day management and running of the practice.

According to data from the Office for National Statistics, Buckinghamshire has a high level of affluence and minimal economic deprivation. However, Chesham is in the most deprived fifth of the population for Buckinghamshire. People in this most deprived fifth generally have poorer health and lower life expectancy than the Buckinghamshire average.

The practice population has a higher proportion of patients aged under 14 compared to the national average. Ethnicity based on demographics collected in the 2011 census shows the population of Chesham is predominantly White British and 11% of the practice population is composed of patients with an Asian background.

The practice population also has approximately 10 patients residing in two local care homes.

The practice has core opening hours between 8am and 6.30pm Monday to Friday with appointments available from 8.10am to 6.30pm daily. Extended opening hours were on Monday and Wednesday evenings when the practice was open until 8pm.

The practice has opted out of providing the out-of-hours service. This service is provided by the out-of-hours service accessed via the NHS 111 service. Advice on how to access the out-of-hours service is clearly displayed on the practice website, on the medical centres front entrance and over the telephone when the surgery is closed.

When the inspection was announced we were informed there wasn’t a current registered manager. However, we saw evidence that one of the GP Partners had applied to the Commission to become the new registered manager.

A registered manager is a person who has registered with the Care Quality Commission to manage the service. Like registered providers, they are 'registered persons'. Registered persons have legal responsibility for meeting the requirements in the Health and Social Care Act 2008 and associated Regulations about how the service is run.

Updated 30 June 2016

Letter from the Chief Inspector of General Practice

We carried out an announced comprehensive inspection at Gladstone Surgery on 1 June 2016. Overall the practice is rated as good.

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

• Staff understood and fulfilled their responsibilities to raise concerns and report incidents and near misses. All opportunities for learning from internal and external incidents were maximised.

• Feedback from patients about their care was consistently positive.

• The practice had an active and supportive patient participation group. Improvement suggestions from this group had been implemented and changes made to the way it delivered services as a consequence of this feedback. For example, an amendment of the number of on-line appointments that could be pre-booked.

• The practice was located within a modern, spacious fully accessible medical centre and was well equipped to treat patients and meet their needs.

• The practice actively reviewed complaints and how they are managed and responded to, and made improvements as a result.

• The practice had a clear vision which had quality and safety as its top priority. The strategy to deliver this vision was regularly reviewed and discussed with staff.

• We found there was good staff morale in the practice, with high levels of team spirit and motivation. There was a strong learning culture evident in the practice. This came across clearly through discussions with staff members.

• The practice had clear, strong and visible clinical and managerial leadership and supporting governance arrangements.

We saw several areas of outstanding practice including:

• The practice had recognised that carer’s health often takes second best, or neglected and was offering designated clinics for carers. Of the 118 carers, all had been contacted and an appointment at the carers clinic offered. At the time of the inspection, 33 carers (28%) had attended a carers clinic which included a session with the local carers charity.

Professor Steve Field CBE FRCP FFPH FRCGP 

Chief Inspector of General Practice

Updated 30 June 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.

• Performance for diabetes related indicators showed the practice had achieved 100% of targets which was better when compared to the CCG average (93%) and the national average (89%). For example, 98%

• The practice was working towards care planning for patients with long-term conditions. The care plans would allow patients to be more involved in decisions about how their conditions were managed.

• There was a clear, simple yet highly effective recall system for patients with long-term conditions, known as the pyramid of chronic disease recall.

• Longer appointments and home visits were available when needed.

Updated 30 June 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 patients who had a high number of A&E attendances. Immunisation rates were comparable to local averages for all standard childhood immunisations.

• Patients told us that children and young patients 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 92%, which was higher when compared to the CCG average (84%) and the national average (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 and health visitors.

Updated 30 June 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 patients in its population.

• The practice worked with the multi-disciplinary teams in the care of older vulnerable patients.

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

• There was easy step free access to the building including a hand rail at the entrance instigated and proposed by the patient group.

• Gladstone Surgery provided GP services to approximately 10 patients at two local care homes. This included responsive visits and monthly ward rounds.

• 100% of patients aged 75 or over with a record of a fragility fracture on or after 1 April 2014 and a diagnosis of osteoporosis, were treated with an appropriate bone-sparing agent. This was better when compared to the CCG average (92%) and national average (93%).

Updated 30 June 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 opening hours suitable for working age patients were available on Monday and Wednesday evenings when the practice was open until 8pm.

• 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.

Updated 30 June 2016

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

• 100% of patients experiencing poor mental health have had a comprehensive care plan documented in the record, in the preceding 12 months, agreed between individuals, their family and/or carers as appropriate. This was better when compared to the CCG average (89%) and national average (88%).

• 92% of patients diagnosed with dementia had their care reviewed in a face to face meeting in the last 12 months. This was better when compared to the CCG average (86%) and national average (84%).

• 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. All practice staff had received dementia awareness training.

Updated 30 June 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. There were 14 patients on the learning disability register, the practice had carried out annual health checks for 93% (13 out of 14) of patients with a learning disability and there was evidence that these had been followed up.

• 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.

• There was a ‘carer’s champion’ providing support through the community to enable patients to live independently for longer. The practice worked closely with the local social care team and Carers Bucks (an independent charity to support unpaid, family carers in Buckinghamshire) to support carers including the promotion of completing a regular carers risk assessments. The practice had recognised that carer’s health often takes second best, is neglected and had offered designated clinics for carers. Of the 118 carers, 33 (28%) had attended a carers clinic and the remaining 85 had been contacted and offered an appointment.

• 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. All practice staff had attended domestic violence training.