The Care Quality Commission
  • Doctor
  • GP practice

The Swan Practice

Overall: Good read more about inspection ratings

North End Surgery, High Street, Buckingham, Buckinghamshire, MK18 1NU (01280) 818600

Provided and run by:
The Swan Practice

All Inspections

6 July 2023

During a monthly review of our data

We carried out a review of the data available to us about The Swan Practice on 6 July 2023. We have not found evidence that we need to carry out an inspection or reassess our rating at this stage.

This could change at any time if we receive new information. We will continue to monitor data about this service.

If you have concerns about The Swan Practice, you can give feedback on this service.

12 December 2019

During an inspection looking at part of the service

We carried out an announced focused inspection at The Swan Practice, a multi-site GP practice in North Buckinghamshire on 12 December 2019 as part of our inspection programme.

We carried out an inspection of this service following our annual review of the information available to us. This inspection looked at the following key questions:

  • Are services safe?
  • Are services effective?
  • Are services well-led?

Following assurance received from our review of information we carried forward the ratings for the following key questions from the previous inspection in October 2015:

  • Are services caring?
  • Are services responsive?

We based our judgement of the quality of care at this service on a combination of:

  • What we found when we inspected

  • Information from our ongoing monitoring of data about services

  • Information from the provider, patients, the public and other organisations.

We have rated this practice as good overall. We rated the practice as good for providing safe, effective and well-led services and for the following population groups: older people; people with long term conditions, families children and young people; working age people (including those recently retired and students), people whose circumstances may make them vulnerable and people experiencing poor mental health (including dementia).

We found that:

  • It was evident the practice had gone through a period of transition. This included two mergers in the last five years, a significant increase in the patient population and changes within the GP partnership and the management team.

  • The practice provided care in a way that kept patients safe and protected them from avoidable harm.

  • Patients received effective care and treatment that met their needs.

  • The way the practice was led and managed promoted the delivery of high-quality, person-centred care.

  • Personal development and learning were actively promoted and a wide range of learning opportunities were provided for staff of all grades and disciplines.

  • Patient and stakeholder feedback was consistently positive and the practice took account of feedback in the way services were provided.

  • When changes were made to the way the service was provided the practice managed these in a sensitive and controlled manner. The views of staff and patients were sought and acted upon when changes were proposed and carried out.

Whilst we found no breaches of regulations, the provider should:

  • Continue to review clinical outcomes and interventions for patients diagnosed with long term conditions and mental health problems where national indicators identify below average performance.

We identified two areas of outstanding practice:

  • Feedback from external stakeholders was overwhelmingly positive. This included feedback from local care and nursing homes, schools and the university which accessed GP services from the practice. We spoke with representatives from each of the stakeholders, they all highlighted examples of coordinated effective care. This included examples when the practice GPs had supported staff to achieve additional clinical qualifications, including mentorship support to gain prescribing qualifications. The practice also supported the schools in providing resources (where appropriate) for the Personal, Social, Health and Economic (PSHE) lessons. PSHE is a school curriculum subject which focuses on developing the knowledge, skills and attributes to keep children and young people healthy and safe and to prepare them for life and work.

  • There was strong collaboration, team-working and support across all teams, all functions, all sites with a strong emphasis on the safety and well-being of staff. We saw many examples of positive changes to promote staff well-being, this included a review of flexible working, remote home working (where appropriate), team building exercises, an annual well-being day with an aligning budget, promotion of exercise and physical activity, relocation of some members of staff to remove isolation and creation of teams, reconfigured coffee breaks and adoption of the British Medical Association’s (BMA) safe working and workload principles. We also saw the five-year business plan for 2018-2023 included staff wellbeing and employee welfare as a theme through every component.

Details of our findings and the evidence supporting the change in rating are set out in the evidence tables.

Dr Rosie Benneyworth BM BS BMedSci MRCGP

Chief Inspector of Primary Medical Services and Integrated Care

27 October 2015

During a routine inspection

Letter from the Chief Inspector of General Practice

We carried out an announced comprehensive inspection of The Swan Practice on 27 October 2015. 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 to report incidents and near misses. Information about safety was recorded, monitored, appropriately reviewed and addressed.
  • Patients’ needs were assessed and care was planned and delivered following best practice guidance. Staff had received training appropriate to their roles and any further training needs had been identified and planned.
  • Patients said they were treated with compassion, dignity and respect and they were involved in their care and decisions about their treatment. Information was provided to help patients understand the care available to them.
  • The practice had good facilities and was well equipped to treat patients and meet their needs. Information about how to complain was available and easy to understand.
  • The practice had a vision which had quality and safety as its top priority. A business plan was in place, was monitored and regularly reviewed and discussed with all staff. High standards were promoted and owned by all practice staff with evidence of team working across all roles.
  • The practice implemented suggestions for improvements and made changes to the way it delivered services as a consequence of feedback from patients and from the Patient Participation Group (PPG).
  • The practice had an effective governance system in place, was well organised and actively sought to learn from performance data, incidents and feedback.
  • The leadership and culture within the practice were used to drive and improve the delivery of high-quality person-centred care.

We saw several areas of outstanding practice including:

  • The practice had excellent access to appointments and could demonstrate the impact of this by reduced use of secondary care services (specifically accident and emergency and out of hours GP services) and positive patient survey results.
  • The nurse team leader had recently been made a Queen’s Nurse. A Queen's Nurse is someone who is committed to high standards of practice and patient-centred care. The Queen’s Nurse Institute supports innovation and best practice, in order to improve care for patients. The title is available to individual nurses who have demonstrated a high level of commitment to patient care and nursing practice. This award reflected the work of the nurse team leader whose smoking cessation clinics resulted in a high success and cessation rate.
  • There was a specific designated GP point of contact for the four care homes, three schools and the university which the practice provide GP services for. Contact details of the designated GP were shared with the relevant staff, patients and their families, enabling continuity of care and quick access to the right staff at the practice.
  • The practice had a very active patient participation group (PPG) and actively used social media to work directly to improve patient and practice communications. Communication via a popular social media medium was updated daily and included updates including new clinic times, responses to health related news articles and the Care Quality Commission inspection details.
  • The practice had reviewed the different types of appointments available and how they were accessed via the appointment system. The practice and PPG created an appointment committee to complete a full 360 degree detailed audit of the appointment system ensuring there is the correct balance of availability for acute and chronic conditions across the whole patient list. The appointment committee was a group comprising of patients and staff.
  • The practice were aware of lone elderly patients who were vulnerable, and without request would make regular home visits to check on their welfare. GPs carried out home visits to older patients presenting with more urgent health needs and the practice provided GP services to the community hospital; completing ward rounds five times each week.

However there were areas of practice where the provider needs to make improvements. Importantly the provider should:

  • Ensure all staff are up to date with mandatory training.

Professor Steve Field CBE FRCP FFPH FRCGP

Chief Inspector of General Practice