Claremont Surgery

Updated 2 March 2017

Claremont Surgery, also known as Claremont & Holyport Practice, is a two-site GP service. Services are provided from the following main location and branch practice, and patients can attend any of the two practice premises. We visited the main location during this inspection:

Claremont Surgery (the main practice)

Medical Centre

2 Cookham Road

Maidenhead

SL6 8AN

Holyport Practice (the branch practice)

Stroud Farm Road

Holyport

Maidenhead

SL6 2LP

The Claremont site has level access from the car park to all treatment rooms and the Holyport site has level access from the car park to the ground floor only. The practice has a clinical team of six GP partners, one nurse practitioner partner, six salaried GPs, two registrars, six practice nurses and two healthcare assistants. Eleven doctors and all of the nursing team are female. The non-clinical team consists of a business manager, an operations manager, a practice coordinator and a team of receptionists and administrators. District nurses, health visitors and a midwife are based in the practice.

The practice is a training practice, with approval from the local School of General Practice until 2018. Up to three trainee doctors, from F2 to ST4 grades, can be accommodated and supervised at any one time.

A portable hearing loop system is available and there are quiet waiting facilities for patients who find the main waiting area can cause anxiety. Private space is available for breast-feeding. Patients can check-in using a self-service kiosk, which provides instructions in several languages.

The practice services a patient list of 18,124 and is in an area of very low deprivation. Of the patient list, 51% are living with a long-term condition and 62% are in paid employment or full time education.

Appointments are from 8am to 6.30pm Mondays to Fridays. Appointments from 7.30am are offered three days a week and evening appointments from 6.30pm are offered two days a week. Out of hours patients are directed to use the NHS 111 service and have access to GP and nurse appointments at a local hospital hub as part of a seven day access programme.

We had not previously carried out an inspection at this practice.

Updated 2 March 2017

Letter from the Chief Inspector of General Practice

We carried out an announced comprehensive inspection at Claremont Surgery, also known as Claremont & Holyport Practice, on 28 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 for reporting and recording significant events.
• Risks to patients were assessed and well managed through audits, benchmarking and learning from feedback.
• 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 reported through comment cards 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 proactively recorded informal complaints to identify trends that could help improve the service.
• Appointments were available to meet the needs of the local population. This included early morning, evening and telephone appointments and weekend appointments through participation in a local seven-day access scheme.
• There was a clear leadership structure that supported staff to develop professionally and valued contribution, suggestions and innovation. 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.

We saw one area of outstanding practice:

• Extensive in-house services were available for patients who experienced substance misuse. This included weekly GP-led opiate substitute prescribing clinics and nurse-led bloodborne virus clinics. Clinical staff had undertaken specialist training to provide services.

Professor Steve Field (CBE FRCP FFPH FRCGP) 

Chief Inspector of General Practice

Updated 2 March 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. Multidisciplinary team members had completed training on care planning for patients with long term conditions and an additional nurse practitioner had been recruited to help implement this.
• The practice had established service agreements with in-house community nursing teams, which improved patient access. For example, patients who needed anticoagulation treatment were monitored and dosed at the same visit.
• Longer appointments and home visits were available when needed.
• All patients with a long term condition had a named GP and a structured annual review to check their health and medicines needs were being met. For 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 participated in the national diabetes prevention programme and was inviting patients to participate at the time of our inspection.

Updated 2 March 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 patients who had a high number of A&E attendances. Immunisation rates were relatively high for all standard childhood immunisations.
• Antenatal and post-natal care was available in the practice and a midwife was available four sessions per week. Nurses offered opportunistic pertissus and flu vaccinations.
• Monthly multidisciplinary vulnerable children meetings took place to review children with safeguarding needs.
• Children and young patients were treated in an age-appropriate way and were recognised as individuals, and we saw evidence to confirm this.
• Appointments were available outside of school hours and the premises were suitable for children and babies.
• Staff had direct access to district nurses and a midwife in-house, as well as regular access to health visitors for help in caring for patients with a child protection order.
• Young patients had direct access to contraception, including free condoms, through a healthcare assistant young person’s coordinator without always having to make an appointment. Men only appointments were offered for advice, care and treatment related to sexual health.
• The practice proactively referred patients to a community exercise and health programme offered by the local authority as part of a broader approach to delivering age-appropriate health promotion.

Updated 2 March 2017

The practice is rated as good for the care of older people.

• The practice offered proactive, personalised care to meet the needs of older patients in its population. This included taking the time to establish the most appropriate form of communication with each patient and ensuring they had access to community support services, particularly to improve exercise and reduce the risk of social isolation.
• The practice was responsive to the needs of older patients. For example, it offered home visits and urgent appointments and ran a lug ulcer clinic and Doppler assessments.
• A pharmacist-led review of medications led to older patients being invited to extended appointments to review their prescriptions and ensure they were appropriate for their needs.
• A carer’s registration pack had been developed as part of a new relationship with another organisation to provide services to carers. A dedicated information board was available in the practice to signpost carers to services and a member of staff had trained as a carers champion.

Updated 2 March 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 expanded the services it offered to ensure these were accessible, flexible and offered continuity of care. This included appointments from 7.30am three days per week and evening appointments from 6.30pm two days per week.
• The practice participated in a local seven-day access scheme to offer GP and nurse appointments at weekends at a local hospital.
• The practice was proactive in offering online services as well as a full range of health promotion and screening. A text message service was used to send out appointment reminders.

Updated 2 March 2017

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

• 84% of patients diagnosed with dementia had their care reviewed in a face to face meeting in the last 12 months, which was the same as the national average and similar to the Clinical Commissioning Group (83%).
• The practice was responsive to the mental health needs of the local population. For example, clinical staff undertook specialist training to help them support patients who were at risk of self harm.
• In-house depot injections were provided for patients and those living with dementia were cared for using the national shared-care protocol, which included six-monthly reviews.
• All patients with mental health needs were offered an annual review.
• 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 supported patients experiencing poor mental health to access 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 dementia and a specialist outreach worker would be based in the practice from January 2017.

Updated 2 March 2017

The practice is rated as outstanding for the care of people whose circumstances may make them vulnerable.

• The practice held a register of patients living in vulnerable circumstances including homeless patients 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 had identified 2% of patients considered to be most vulnerable and provided care plans with input from patients and their relatives, where appropriate. All patients in this group were offered home visits.
• A monthly multidisciplinary palliative care meeting was held with community nurses and Macmillan nurses to review patients.
• The practice advocated on behalf of vulnerable patients, for example to facilitate access to food share vouchers.
• Seven GPs were trained to Royal College of General Practitioner standards in providing care for patients who experienced substance misuse. A weekly opiate prescribing clinic and nurse-led bloodborne virus clinic was offered as part of a broader programme to provide proactive care and support.