Salisbury House Surgery

Updated 7 April 2016

Salisbury House Surgery provides a range of primary medical services from its location at Lake Street in the market town of Leighton Buzzard. The practice is located in purpose built premises adjoining a pharmacy. The practice is arranged over three floors, with consulting rooms on the ground level and first floor. There is provision of a lift for patients to all levels of the building. The practice serves a population of approximately 10,938 patients, with slightly higher than average populations of males and females aged between 50 to 54 years and slightly lower than average populations of males and females aged 15 to 29 years. The practice population is largely white British. National data indicates the area served is less deprived in comparison to England as a whole.

The clinical team consists of three male GP partners, a female GP partner, a female salaried GP, a lead nurse, a nurse practitioner, a trainee nurse practitioner, three practice nurses and two healthcare assistants. The team is supported by a practice manager and a team of administrative support staff. The practice also employs a female physician’s assistant; this individual is specially trained and certified to provide basic medical services, including the diagnosis of some ailments, but is not able to independently prescribe medicines.

The practice is open between 8am and 6.30pm Monday to Friday. Appointments are available from 8.30am to 5.50pm with GPs and nurses. In addition to these times the practice operates extended hours on three Thursdays each month from 6.30pm to 8pm, every Friday from 7am to 8am and on the third Saturday of every month from 8.30am to 12.30pm. Patients requiring a GP outside of normal hours are advised to phone Care UK or the NHS 111 service.

The registration of Salisbury House Surgery was not accurate at the time of inspection; we had not been notified of changes made to the partners at the practice, as required under the CQC (Registration) Regulations 2009. The practice has now taken steps to complete the necessary application to ensure their registration with us is accurate.

Updated 7 April 2016

Letter from the Chief Inspector of General Practice

We carried out an announced comprehensive inspection at Salisbury House Surgery on 23 February 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 mitigating actions were implemented, however not all records were filed centrally.

• Staff assessed patients’ needs and delivered care in line with current evidence based guidance. Staff had 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.
• Patients said they found it easy to make an appointment, 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.

The area where the provider should make improvement is:

• Ensure that all records for significant events are centrally held to ensure accessibility when required.
• Ensure that all staff receive timely renewal of basic life support training.
• Formalise checks on water temperatures ensuring they are documented and available for viewing.

Professor Steve Field (CBE FRCP FFPH FRCGP) 

Chief Inspector of General Practice

Updated 7 April 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 was generally better than the CCG and national average. For example, the percentage of patients on the diabetes register, with a record of a foot examination and risk classification within the preceding 12 months was 98% where the CCG average was 90% and the national average was 88%.
• 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 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 7 April 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.
• The percentage of patients with asthma who had received an asthma review in the preceding 12 months was 73% which was comparable to the national average of 75%.
• The practice’s uptake for the cervical screening programme was 81%, which was comparable to the CCG average of 76% and the national average of 74%
• 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 7 April 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.
• The practice had introduced advanced care plans for patients in a local care home to ensure that their preferences for treatment were considered and recorded with a focus on maintaining dignity and ensuring that patients and their carers were involved in treatment planning.

Updated 7 April 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 ensured that appointments were available early in the morning, in the evenings and on Saturdays.
• 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 7 April 2016

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

• 77% of patients diagnosed with dementia had had their care reviewed in a face to face meeting in the last 12 months, which is comparable to the national average.
• Performance for mental health related indicators was generally better than the CCG and national averages. For example the percentage of patients with diagnosed psychoses who had a comprehensive agreed care plan was 93% where the CCG average was 87% and the national average was 88%.
• The practice regularly worked with multi-disciplinary teams in the case management of people experiencing poor mental health, including those with dementia.
• The practice offered enhanced services for patients with dementia, facilitating timely diagnosis.
• The practice had told patients experiencing poor mental health about how to access various support groups and voluntary organisations.
• Staff had a good understanding of how to support patients with mental health needs and dementia.

Updated 7 April 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 those with caring responsibility and those with a learning disability.
• The practice offered longer appointments for patients with a learning disability and/or complex needs.
• The practice regularly worked with multi-disciplinary teams in the case management of vulnerable people.
• 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.