Archived: Trinity Health

Updated 10 December 2015

The Trinity Health (New Chapel Surgery) is situated in Long Crendon area. The practice is located in a converted church building. There was ramp access for patients and visitors who had difficulty managing steps. The practice comprises of two consulting rooms, one treatment room, one healthcare assistant room, a patient waiting area, a dispensary and administrative and management office and a meeting room. The practice also has two branch surgeries in the Brill and Thame area.

There are five GP partners, two salaried GPs and one trainee doctor at the practice. Three GPs are male and four female. The practice employs two practice nurses, one nurse practitioner and a nurse manager. There are three dispensers and a senior dispenser. The practice manager is supported by a lead receptionist and a team of administrative and reception staff. Services are provided via a General Medical Services (GMS) contract (GMS contracts are negotiated nationally between GP representatives and the NHS).

The practice has approximately 11,250 patients registered and patients can attend any of the three practice locations. We only visited Trinity Health (New Chapel Surgery) as part of this inspection. Long Crendon surgery has a patient population of approximately 3,400. The practice population of patients aged between 40 and 69 years is higher than national and clinical commissioning group (CCG) averages and there are a higher number of patients over 75 years old. This is a training practice and a trainee doctor was not available at the time of the inspection.

Services are provided from following three locations:

Trinity Health (New Chapel Surgery)

High Street, Long Crendon

Aylesbury

HP18 9AF

Trinity Health (Brill Surgery)

22 Thame Road, Brill

Aylesbury

HP18 9SA

Trinity Health (Thame Health Centre)

East Street, Thame

Oxfordshire

OX9 3JZ

The practice has opted out of providing out of hours services to their patients. There are arrangements in place for services to be provided when the surgery is closed and these are displayed at the practice, in the practice information leaflet and on the patient website. Out of hours services are provided during protected learning time and 30 minutes before opening and after closing (between 8am and 8:30am and 6pm and 6:30pm) by Bucks Urgent Care or after 6:30pm, weekends and bank holidays by calling NHS 111.

We carried out an announced comprehensive inspection of the practice on 7 October 2015. We visited Trinity Health (New Chapel Surgery) during this inspection.

Updated 10 December 2015

Letter from the Chief Inspector of General Practice

We carried out an announced comprehensive inspection at Trinity Health, New Chapel Surgery, High Street, Long Crendon, Aylesbury, HP18 9AF on 7 October 2015. Overall the practice is rated as good.

Specifically, we found the practice was good for providing safe, effective, responsive, caring and well led services. The population groups are rated as good for the patients registered at the practice.

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. The majority of information about safety was recorded, monitored and reviewed.
• Risks to patients were assessed and well managed. Fire and legionella risk assessments had been carried out recently and the practice was in the process of implementing the action plans arising from these assessments.
• Data showed positive patient outcomes from care and treatment provided. Audits had been carried out and we saw evidence that audits were driving improvement in patient outcomes.
• 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 decisions about their care and treatment.
• Information about services and how to complain was available and easy to understand.
• Urgent appointments were available on the day they were requested. However patients said that they sometimes had to wait for non-urgent appointments with a named GP.
• The practice had good facilities and was well equipped to treat patients and meet their needs. However, the waiting area was congested and there was no low level desk at the front reception.

• 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.

We saw one area of outstanding practice including:

• Innovative treatment has been developed such as, a live well project involving an in-house psychologist providing training and support to the nurses conducting reviews to improve consultation skills and provide health empowerment to the patients. This project has improved the outcomes for patients with long term conditions.

The areas where the provider should make improvements are:

• Ensure repairs are carried out to the faulty automatic door at the main entrance.
• Ensure an induction pack is available to locum and trainee GPs.

Professor Steve Field (CBE FRCP FFPH FRCGP) 

Chief Inspector of General Practice

Updated 10 December 2015

The practice is rated as good for the care of people with long-term conditions. There were clinical leads for chronic disease management and patients at risk of hospital admission were identified as a priority. Longer appointments and home visits were available when needed. The practice nurses were running specialist clinics for managing long term conditions, weight management and attending regular review meetings with local cancer support nurses. The practice was offering in-house anti-coagulation clinic (An anticoagulant is a medicine that stops blood from clotting). The practice was one of the pioneers of ‘live well’ which is a local programme that recognised the links between physical and psychological well-being. The practice nurses were well supported by in-house psychologists to run this programme by improving the consultation skills of the nurses so they can carry out effective reviews for the patients with long term conditions. Data showed the care of this group of patients was regularly reviewed.

Updated 10 December 2015

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. 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. Staff were aware of the legal requirements of gaining consent for treatment for those under 16. Chlamydia testing kits were available for under 25s. Appointments were available outside of school hours. The uptake of childhood immunisations was above the national and local clinical commissioning group (CCG) averages. Antenatal appointments and postnatal clinics were available. The practice worked with health visitors to share information and provide a continuity of care for new babies and families. The practice manager was attending local children’s centre advisory board meetings.

Updated 10 December 2015

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. For example, the practice had launched a ‘care and support planning programme’ and developed a frail elderly assessment and recording system which included discussions for end of life care. Patients aged over 75 had a named GP to promote continuity of care. Flu vaccinations rates for over 65 were similar to the national average. The premises were accessible to those with limited mobility but the automatic main door was not working and the waiting area was congested. The practice was responsive to the needs of older people and offered home visits and rapid access appointments for those with enhanced needs. One of the nurse practitioners was working as a practice link person between practice and local nursing home. There was a register to manage end of life care and unplanned admissions. There were good working relationships with external services such as district nurses.

Updated 10 December 2015

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 (one third of registered patient population) 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 appointments were available one late evening from 6pm to 7:50pm (alternative Tuesday and Wednesday at the Brill and Thame branch practices) and every Saturday from 8:30am to 10:30am at Long Crendon surgery . 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 10 December 2015

The practice is rated as good for the care of patients experiencing poor mental health (including people with dementia). Sixty two per cent of patients experiencing poor mental health were involved in developing their care plan in last 12 months. The practice regularly worked with multi-disciplinary teams in the case management of people experiencing poor mental health, including those with dementia. The practice had identified 202 patients at early risk of dementia and after initial screening referred 18 patients to memory clinic. The practice was recently awarded ‘dementia friendly practice’ status which included the construction of sensory garden (only in the Brill surgery), setting up of dementia friendly consulting rooms, dementia resources for patients and carers in each site and dementia awareness training for all staff.

The practice had told patients experiencing poor mental health about how to access various support groups and voluntary organisations. It had a system in place to follow up patients who had attended accident and emergency (A&E) where they may have been experiencing poor mental health. Clinical staff had received training on Mental Capacity Act.

Updated 10 December 2015

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 homeless people, travellers and those with a learning disability. It offered annual health checks for people with learning disabilities, for example, there was evidence that health checks were completed for 11 patients out of 18 patients on the learning disability register. It offered longer appointments for people with a learning disability.

The practice regularly worked with multi-disciplinary teams in the case management of vulnerable people. It had told vulnerable patients about how to access various support groups and voluntary organisations. Most staff knew how to recognise signs of abuse in vulnerable adults and children. Most 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. A translation service was available for patients who did not speak English. Flu vaccination uptake was 50% for carers. The practice was due to participate in a ‘carers community event’ in the week after inspection in Long Crendon area.