The Mandeville Practice

Updated 26 November 2018

The Mandeville Practice is a GP practice located in Aylesbury in Buckinghamshire and provides general medical services to approximately 15,200 registered patients. The practice is one of the practices within Buckinghamshire Clinical Commissioning Group (CCG).

The practice has been through a challenging three years with three changes in provider and a number of GPs, managers and staff leaving, which had caused instability in the practice. Primary Care Management Solutions Limited took over the contract following a procurement exercise led by the CCG in April 2018.

Clinical services are provided from:

• The Mandeville Practice, Hannon Road, Aylesbury Buckinghamshire HP21 8TR

The practice website is:

• www.mandevillesurgery.co.uk

According to national data there is minimal deprivation in Buckinghamshire; however, the practice is located within a pocket of high deprivation. People living in more deprived areas tend to have greater need for health services and people outside of the country for long periods often has an impact on screening and recall programmes.

The practice has core opening hours from 8am to 6.30pm Monday to Friday to enable patients to contact the practice. Extended hours appointments were also available from 7am each weekday morning. Pre-bookable appointments were also available every Saturday between 8am and 2.30pm.

Patients at the practice could access improved access appointments at primary care access hubs across Buckinghamshire. These improved access appointments were booked via the patients registered practice and offered a variety of appointments including up until 8pm Monday to Friday, selected hours on Saturdays and 9am until 1pm on Sunday and Bank Holidays.

The practice also provides primary care GP services for a local care home (35 patients) within the local area.

The practice comprises of eight GPs (five females, three male), a Physician Associate, a paramedic and two clinical pharmacists. The all-female nursing team consists of two advanced nurse practitioners, two specialist nurses, four practice nurses (one of which is also a social worker) and three health care assistants with a mix of skills and experience.

An assistant manager, reception manager and a team of reception and administrative staff undertake the day to day management and running of the practice. There was a visible daily onsite management team from Primary Care Management Solutions Limited who oversaw the changes in the practice. This team included a range of staff including clinical staff and the Chief Executive Officer who was also the Registered Manager.

Out of hours care is accessed by contacting NHS 111.

The practice is registered by the Care Quality Commission (CQC) to carry out the following regulated activities: Maternity and midwifery services, Family planning, Treatment of disease, disorder or injury, Surgical procedures and Diagnostic and screening procedures.

The practice has previously been inspected by CQC on a number of occasions. The most recent occasion was in January 2018, when the practice was managed by a different provider. At the January 2018 inspection, the practice was rated inadequate overall and remained in special measures following an earlier inspection with the previous provider in July 2017.

Updated 26 November 2018

This practice is rated as Good overall.

The key questions at this inspection are rated as:

Are services safe? – Good

Are services effective? – Good

Are services caring? – Good

Are services responsive? – Good

Are services well-led? - Good

We carried out an announced comprehensive inspection at The Mandeville Practice in Aylesbury, Buckinghamshire on 25 October 2018. This inspection was completed following changes in the registration of this practice to a new provider of care and treatment.

At this inspection we found:

• It was evident the practice had gone through a period of transition. Improvements had been made, systems implemented to manage and monitor risks and patient feedback was improving. Staff we spoke with recognised the endeavours of the new leadership team and were keen to be part of the new developments.

• There was a safe track record and 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.
• Our findings showed that systems were in place to ensure that all clinicians were up to date with both National Institute for Health and Care Excellence (NICE) guidelines and other locally agreed guidelines.
• Services at the practice were tailored to meet the needs of individual patients and were delivered to ensure flexibility, choice and continuity of care. In the first six months (since the new provider started) of the contract, the practice had reviewed the needs of its patient population and tailored services in response to those needs.
• The practice had a visible short term, medium term and long-term strategy and supporting business plans which reflected The Mandeville Practice values. The initial phase and short-term six month strategy was referred to as the ‘safety and stability’ plan. The six month strategy included a focus on embedding a new model of care, recruitment and clinical safety systems.
• The practice had clear and visible clinical and managerial leadership and supporting governance arrangements. There was a high level of constructive engagement with staff and all staff we spoke with told us they felt they were an integral part of the practice and they felt valued.

We saw an area of outstanding practice:

• Although only six months into the contract the leadership team drove continuous improvement and all staff were accountable for delivering safe change. We saw the practice team was committed to meeting the needs of its population. This was evidenced through specific areas of improvement, themed and targeted services, clinical audits and health promotion. This also included a range of initiatives to meet the different patient groups who accessed the practice.