Archived: Drayton Road Surgery

Updated 11 August 2017

Drayton Road Surgery is located in Bletchley in Milton Keynes. It is part of the NHS Milton Keynes Clinical Commissioning Group (CCG). The total practice population is approximately 3,053.

Available information shows the practice to have a higher than average population of males aged between 30 to 54 years and females aged between 30 to 49 years. There are significantly lower than average populations of both males and females aged from 70 years to over 85 years. Whilst the percentage of its patient population that are in employment is similar to national averages, the percentage unemployed is significantly higher. The national average across England is 6% in comparison to the practice figure of 13 %. National data indicates that the area is one of moderate deprivation, with a higher than national average value for children affected by deprivation.

This is a singled handed GP practice with one male GP, one female salaried GP and one female practice nurse (qualified as an Independent Prescriber) working alongside a health care assistant, the practice manager, three receptionists and three administration staff. There is also a female long term locum GP who attends the surgery once a week. The practice holds a General Medical Services (GMS) contract; a nationally agreed contract with NHS England for providing services.

The practice operates from a two storey converted property. Patient consultations and treatments take place on the ground level. There is a car park outside the surgery, with disabled parking available.

The practice is open from 8am to 8pm on Mondays and from 8am to 6.30pm Tuesday to Friday. Appointments with a GP are available from 9am to 12pm and from 4pm to 6pm Monday to Friday. Extended hours appointments are available on Mondays between 6.30pm and 8pm. Appointments with a nurse are available from 8am to 1.30pm Monday, Tuesday, Wednesday, Friday and from 7.30am to 1pm on Thursdays.

The out of hours service is provided by Milton Keynes Urgent Care Services and can be accessed via the NHS 111 service. Information about this is available in the practice and on the practice website and telephone line.

Updated 11 August 2017

Letter from the Chief Inspector of General Practice

We carried out an announced comprehensive inspection at Drayton Road Surgery on 12 July 2017. 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 a system in place for reporting and recording significant events.
• The practice had clearly defined and embedded systems to minimise risks to patient safety.
• Staff were aware of current evidence based guidance. Staff had been trained to provide them with the skills and knowledge to deliver effective care and treatment.
• Results from the national GP patient survey published in July 2017 showed patients were treated with compassion, dignity and respect and were involved in their care and decisions about their treatment. However, some results were below local and national averages, for example 79% of patients said the GP was good at listening to them compared with the clinical commissioning group (CCG) average of 85% and the national average of 89%.
• Information about services and how to complain was available. Improvements were made to the quality of care as a result of complaints and concerns.
• Patients we spoke with said they found it easy to make an appointment with a GP and there was continuity of care, 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 the requirements of the duty of candour. Examples we reviewed showed the practice complied with these requirements.

The areas where the provider should make improvement are:

• Monitor systems developed to record actions taken in response to safety alerts, to ensure they are effectively implemented.
• Ensure routine monitoring of significant events to analyse trends.
• Implement systems to ensure monitoring of the quality of care and continuous improvement. For example, through clinical audit and improved training for staff on computer systems to ensure patient registers are accurately maintained.
• Develop systems to identify and support more carers in their patient population.
• Continue to monitor and ensure improvement to national GP patient survey results, in particular those relating to GP consultations.
• Continue to monitor and encourage patient uptake of childhood vaccination programmes.
• Continue with efforts to ensure sustainability and security for the practice and document plans in a formal business plan.
• Continue to develop the patient participation group (PPG) to ensure the practice seek feedback from patients.

Professor Steve Field (CBE FRCP FFPH FRCGP) 

Chief Inspector of General Practice

Updated 11 August 2017

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

• The nurse had a lead role in long-term disease management and patients at risk of hospital admission were identified as a priority.
• Performance for diabetes related indicators was generally below the Clinical Commissioning Group (CCG) and national averages. For example, the percentage of patients with diabetes, on the register, in whom the last blood pressure reading showed good control in the preceding 12 months, was 84%, where the CCG average was 92% and the national average was 91%. The practice recognised diabetes as an area in need of improvement. We were told that with the recruitment of the HCA and introduction of specific clinics had reduced pressures and improved the management of all long term conditions within the practice including diabetes. The practice informed us that data collected since April 2017 demonstrated this (although this data was not verified).
• The practice followed up on patients with long-term conditions discharged from hospital and ensured that their care plans were updated to reflect any additional needs.
• There were emergency processes for patients with long-term conditions who experienced a sudden deterioration in health.
• Longer appointments and home visits were available when needed.
• The practice provided an insulin initiation service for diabetic patients.
• A recall system was utilised to manage these patients; which included telephoning patients who had not responded to letters or SMS messages to arrange appointments.
• Patients with long term conditions benefitted from continuity of care with their GP or nurse. 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 more complex needs, the named GP worked with relevant health and care professionals to deliver a multidisciplinary package of care.
• All discharge summaries were reviewed on the day they were received ensuring medicines were adjusted and appropriate primary care follow-up was arranged.

Updated 11 August 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 may be at risk, for example, children and young people who had a high number of A&E attendances.
• 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 78%, which was comparable to the CCG average of 82% and the national average of 81%.
• Appointments were available outside of school hours and the premises were suitable for children and babies.
• Children and infants who were unwell were always seen on the same day.
• Childhood immunisations were carried out in line with the national childhood vaccination programme. The practice achieved the required 90% standard for childhood immunisation rates between April 2016 and March 2017 for children up to two years of age.
• Performance for immunisations for children up to the age of five years was below average at 80% for the same period. We saw that the nurse had attended a training course which included training on methods for increasing uptake of childhood immunisations.
• We saw positive examples of joint working with midwives and health visitors.
• Family planning and contraceptive advice was available. The practice provided a variety of health promotion information leaflets and resources for this population group for example coil insertion and contraceptive implants.

Updated 11 August 2017

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

• Staff were able to recognise the signs of abuse in older patients and knew how to escalate any concerns.
• The practice offered proactive, personalised care to meet the needs of the older patients 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 provided influenza, pneumonia and shingles vaccinations.
• A phlebotomy clinic ran daily enabling patients to have blood tests conducted locally rather than at the local hospital.
• The practice ran an anticoagulant clinic for patients to monitor their treatment. (Anticoagulants are medicines used to prevent blood from clotting). This clinic had been well received by patients as it reduced the need for them to travel to secondary care for the service.
• The practice offered health checks for patients over the age of 75.

Updated 11 August 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 adjusted the services it offered to ensure these were accessible, flexible and offered continuity of care.
• The practice provided telephone consultations if needed.
• The practice had enrolled in the Electronic Prescribing Service (EPS). This service enabled GPs to send prescriptions electronically to a pharmacy of the patient’s choice.
• The practice encouraged the use of the on line services to make it easier to book appointments and order repeat prescriptions.
• The practice encouraged screening for working age people such as bowel screening and cervical screening.

Updated 11 August 2017

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

• 100% of patients diagnosed with dementia had their care reviewed in a face to face meeting in the last 12 months, which is comparable to the national average.
• We noted that the practice only had six patients on its dementia register. However we were reassured that the practice planned to expand the register through active searches of patient records to ensure that more patients were identified and supported.
• The practice provided dementia screening services for patients identified as at risk of developing dementia to allow for early intervention and support if needed.
• The practice regularly worked with multi-disciplinary teams in the case management of patients experiencing poor mental health, including those with dementia.
• The practice held a register of patients experiencing poor mental health and invited them to attend annual reviews. The practice had told patients experiencing poor mental health about how to access support groups and voluntary organisations.
• The practice had a system in place to follow up patients who had attended A&E where they may have been experiencing poor mental health.
• Staff interviewed had a good understanding of how to support patients with mental health needs and dementia.

Updated 11 August 2017

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

• The practice had developed a register of patients in vulnerable circumstances including patients with no fixed address and those from traveller communities.
• 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 support groups and voluntary organisations.
• Staff interviewed 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 less than 1% of the practice list as carers. We saw that the provision for carers was managed by an individual member of staff, who was committed to ensuring the practice maintained contact with carers. They rang carers every four weeks to offer them support and ensure they were coping with their responsibilities. The practice recognised the need to identify more carers and was making continued efforts to do so.
• End of life care was delivered in a coordinated way which took into account the needs of those whose circumstances may make them vulnerable.