Archived: Milton House Surgery

Updated 23 May 2016

Milton House Surgery provides a range of primary medical services from its premises at Doctors Commons Road, Berkhamsted, Hertfordshire, HP4 3BY.

The practice serves a population of approximately 9,000 and is a training practice. The area served is less deprived compared to England as a whole. The practice population is predominantly white British. The practice serves an above average population of those aged from 5 to 9 years and 40 to 69 years. There is a considerably lower than average population of those aged from 20 to 34 years.

The clinical team includes two male and four female GP partners, one female salaried GP, one nurse practitioner, two practice nurses and one healthcare assistant. The team is supported by a practice manager, a patient services manager and 15 other administration, reception and secretarial staff. The practice provides services under a General Medical Services (GMS) contract.

Milton House Surgery is staffed with the phones lines and doors open from 8am to 6.30pm Monday to Friday. There is extended opening once a week on various days from Tuesday to Thursday in rotation until 8pm. There is extended opening on the first Saturday of each month from 8.30am to 11.30am for GP pre-bookable appointments. Appointments are available from approximately 8.30am to 11.30am and 3.30pm to 6pm daily, with slight variations depending on the doctor and the nature of the appointment. An out of hours service for when the practice is closed is provided by Herts Urgent Care.

Updated 23 May 2016

Letter from the Chief Inspector of General Practice

We carried out an announced comprehensive inspection at Milton House Surgery on 16 March 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 the skills, knowledge and experience to deliver effective care and treatment.
• Patients were positive about the standard of care they received and about staff behaviours. They said staff were supportive, kind and caring and that their privacy and dignity was respected.
• Information about services and how to complain was available and easy to understand.
• Patients gave a mixed response about access to the practice and appointments. However, all patients were positive about access to urgent appointments and appointments available the same day.
• The practice had adequate facilities and was equipped to treat patients and meet their needs.
• There was a clear leadership structure and staff felt supported by management. The practice sought feedback from staff and patients, which it acted on.
• The provider complied with the requirements of the Duty of Candour.

The areas where the provider should make improvements are:

• Take steps to improve access to routine pre-bookable appointments and access to the practice by telephone.
• Take steps to ensure that in future National GP Patient Surveys the practice’s areas of below local and national average performance are improved.
• Ensure that a documented policy on patient consent is in place.
• Take steps to ensure that hot water temperatures at the practice are kept within the required levels.
• Ensure that all staff complete a formal programme of infection control training.
• Ensure that arrangements are made, wherever possible, to meet patients’ language and communication needs and that all staff are aware of the services available. Also, ensure the practice is fully conforming to NHS England’s Accessible Information Standard (AIS) by 31 July 2016.
• Ensure that, where practicable and appropriate, all reasonable adjustments are made for patients with a disability in line with the Equality Act (2010). This may include the provision of a portable hearing loop.

Professor Steve Field (CBE FRCP FFPH FRCGP) 

Chief Inspector of General Practice

Updated 23 May 2016

The practice is rated as good for the care of people with long-term conditions.

• GPs and 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 better than the CCG and national averages. The practice achieved 100% of the points available compared to the CCG average of 91% and the national average of 89%.
• All newly diagnosed patients with diabetes were managed in line with an agreed pathway.
• 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 GPs worked with relevant health and care professionals to deliver a multi-disciplinary package of care.

Updated 23 May 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 may be 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.
• 80% of patients with asthma, on the register, had a review in the preceding 12 months. This was comparable to the CCG average of 76% and the national average of 75%.
• 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 practice’s uptake for the cervical screening programme was 81% which was comparable to the CCG average of 83% and 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 and health visitors.
• There were six week post-natal checks for mothers and their children.
• A range of contraceptive and family planning services were available.

Updated 23 May 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.
• Older people had access to targeted immunisations such as the flu vaccine.
• The GPs completed regular visits to local nursing and residential homes to ensure continuity of care for those patients.

Updated 23 May 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.
• The practice offered online services such as appointment booking and repeat prescriptions as well as a full range of health promotion and screening that reflects the needs for this age group.
• There was additional out of working hours access to meet the needs of working age patients. There was extended opening once a week on various days from Tuesday to Thursday in rotation until 8pm. There was extended opening on the first Saturday of each month from 8.30am to 11.30am for GP pre-bookable appointments.

Updated 23 May 2016

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

• 95% of patients diagnosed with dementia had their care reviewed in a face to face meeting in the last 12 months. This was better than the CCG average of 85% and the national average of 84%.
• Performance for mental health related indicators was better than the CCG and national averages. The practice achieved 100% of the points available compared to the CCG average of 96% and the national average of 93%.
• The practice regularly worked with multi-disciplinary teams in the case management of people 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.
• Staff had a good understanding of how to support patients with mental health needs and dementia.
• Mental health trust well-being workers and an NHS counsellor were based at the practice every week.
• There were GP leads for mental health and dementia.

Updated 23 May 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 a learning disability.
• The practice offered longer appointments for patients with a learning disability and there was a GP lead for these patients.
• 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.
• Additional information was available for patients who were identified as carers and there was a nominated staff lead for these patients.