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Whaddon House Surgery Outstanding Also known as whaddon medical centre

Inspection Summary


Overall summary & rating

Outstanding

Updated 22 September 2016

Letter from the Chief Inspector of General Practice

We carried out an announced comprehensive inspection at Whaddon House Surgery on 2 August 2016. Overall the practice is rated as

outstanding

.

Our key findings across all the areas we inspected were as follows:

  • Staff understood and fulfilled their responsibilities to raise concerns and report incidents and near misses. All opportunities for learning from internal and external incidents were maximised.
  • The practice used innovative and proactive methods to improve patient outcomes, working with other local providers to share best practice. For example, the practice had pioneered services to deliver point of care testing (POCT) for D-Dimer and BNP across the locality. (D-dimer tests are used to rule out the presence of a blood clot and BNP tests help with early diagnosis of heart failure).
  • Services were tailored to meet the needs of individual patients and were delivered in a way to ensure flexibility, choice and continuity of care.
  • Patients said they were treated with compassion, dignity and respect and they were involved in their care and decisions about their treatment.
  • The practice worked closely with other organisations and with the local community in planning how services were provided to ensure that they meet patients’ needs. For example, all patients suffering from COPD were invited to join the Milton Keynes Pulmonary Maintenance Group (a support group initiated by the respiratory lead GP at the practice). In addition the practice hosted the local ‘Breathe Easy Group’ meetings which provided support and educational talks for patients with COPD.
  • 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.
  • The practice had good facilities and was well equipped to treat patients and meet their needs.
  • The practice employed an innovative use of technology to provide services to its patients.
  • The practice actively reviewed complaints and how they are managed and responded to, and made improvements as a result.
  • The practice had a clear vision with quality and safety as its top priority. High standards were promoted and owned by all practice staff and teams worked together across all roles.
  • The practice had strong and visible clinical and managerial leadership and governance arrangements.
  • The provider was aware of and complied with the requirements of the Duty of Candour.

We saw several areas of outstanding practice including:

  • The practice had invested considerably in the provision of the Community Cardiology service which had many positive outcomes for patients in the locality. For example, they had pioneered services to provide point of care testing (POCT) for Troponin T testing which was used for patients presenting with chest pain in the surgery. An audit demonstrated that up to 88% of potential emergency hospital admissions were avoided through the use of these tests.
  • In collaboration with the PPG the practice facilitated regular patient education evenings led by a member of the clinical team or a guest speaker. These sessions were used as an opportunity to provide information on a range of general health topics as well as dedicated evenings for specific groups. The practice demonstrated a commitment to supporting vulnerable patients in their population, developing initiatives with the support of the PPG to work compassionately with patients who may be isolated. For example, in 2013, with the support of the local Community Safety Officer and the PPG, the practice had developed a group known as ‘Living in the Moment’, focused on reaching out to patients who may have become isolated.
  • The practice had purchased a number of Sleep Apnoea testing monitors to support patients presenting with sleep problems. Monitors were fitted by trained health care assistants and patients returned the following day to see the GP for results to be analysed. If required the patient would be referred on to the Oxford Sleep Clinic for further investigations. Providing testing in house reduced the need for patients to be seen in secondary care locally before referral to a specialist facility in Oxford. The practice demonstrated a reduction in referrals of 70% for the period May 2014 to July 2016. Patients not referred received further support from the practice to ascertain and treat the underlying causes of their sleep difficulties, for example, poor chronic disease management.

Professor Steve Field (CBE FRCP FFPH FRCGP) 

Chief Inspector of General Practice

Inspection areas

Safe

Good

Updated 22 September 2016

The practice is rated as good for providing safe services.

  • There was an effective system in place for reporting and recording significant events.
  • Lessons learnt were shared to make sure action was taken to improve safety in the practice.
  • When things went wrong patients received support, an explanation of events, and a written apology. They were told about any actions to improve processes to prevent the same thing happening again.
  • The practice had clearly defined and embedded systems, processes and practices in place to keep patients safe and safeguarded from abuse.
  • The practice maintained effective working relationships with other safeguarding partners such as health visitors.
  • There were systems in place to protect patients from the risks associated with medicines management and infection control.

Effective

Outstanding

Updated 22 September 2016

The practice is rated as outstanding for providing effective services.

  • Our findings at inspection 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. For example, the lead GP for respiratory care at the practice had been involved in developing NICE guidelines for asthma care and had introduced advanced asthma testing known as FENO (Fractional Exhaled Nitric Oxide) testing into the practice in August 2013. This identified inflammation of the lung which helped to diagnose new asthma patients and also to identify when complex patients required more support. We saw that since October 2014, 210 patients had received this testing.

  • We also saw evidence to confirm that the practice used these guidelines to positively influence and improve practice and outcomes for patients.
  • The practice used innovative and proactive methods to improve patient outcomes and working with other local providers to share best practice.

  • Data from the Quality and Outcomes Framework (QOF) showed patient outcomes were at or above average compared to the national average.
  • Clinical audits demonstrated quality improvement.
  • Staff had the skills, knowledge and experience to deliver effective care and treatment.
  • There was evidence of appraisals and personal development plans for all staff.
  • Staff worked with other health care professionals to understand and meet the range and complexity of patients’ needs.

Caring

Outstanding

Updated 22 September 2016

The practice is rated as outstanding for providing caring services.

We observed a strong patient-centred culture:

  • Staff were motivated and inspired to offer kind and compassionate care.
  • Data from the national GP patient survey showed patients rated the practice higher than others for several aspects of care.
  • Patients said they were treated with compassion, dignity and respect and they were involved in decisions about their care and treatment.
  • Information for patients about the services available was easy to understand and accessible.
  • We found positive examples to demonstrate how patient’s choices and preferences were valued and acted on.
  • We saw staff treated patients with kindness and respect, and maintained patient and information confidentiality.
  • In collaboration with the PPG the practice facilitated regular patient education evenings led by a member of the clinical team or a guest speaker. These sessions were used as an opportunity to provide information on a range of general health topics as well as dedicated evenings for specific groups.
  • The practice demonstrated a commitment to supporting vulnerable patients in their population, developing initiatives with the support of the PPG to work compassionately with patients who may be isolated. For example, in 2013, with the support of the local Community Safety Officer and the PPG the practice had developed a group known as ‘Living in the Moment’, focused on reaching out to patients who may have become isolated.

Responsive

Outstanding

Updated 22 September 2016

The practice is rated as outstanding for providing responsive services.

  • The practice worked closely with other organisations and with the local community in planning how services were provided to ensure that they meet patients’ needs. For example, all patients suffering from COPD were invited to join the Milton Keynes Pulmonary Maintenance Group (a support group initiated by the respiratory lead GP at the practice). In addition the practice hosted the local ‘Breathe Easy Group’ meetings which provided support and educational talks for patients with COPD.
  • There were innovative approaches to providing integrated patient-centred care. For example, the practice had invested considerably in the provision of the Community Cardiology service which had many positive outcomes for patients in the locality. They had pioneered services to provide point of care testing (POCT) for Troponin T testing which was used for patients presenting with chest pain in the surgery. An audit demonstrated that up to 88% of potential emergency hospital admissions were avoided through the use of these tests.
  • The practice had purchased a number of Sleep Apnoea testing monitors to support patients presenting with sleep problems. Monitors were fitted by trained health care assistants and patients returned the following day to see the GP for results to be analysed.

  • 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.
  • Practice staff reviewed the needs of its local population and engaged with the NHS
  • Patients said they were able to make an appointment with a named 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.
  • Information about how to complain was available and easy to understand and evidence showed the practice responded quickly to issues raised. Learning from complaints was shared with staff and other stakeholders.
  • A Phlebotomy clinic ran daily enabling patients to have blood tests conducted locally rather than at the local hospital

Well-led

Outstanding

Updated 22 September 2016

The practice is rated as outstanding for being well-led.

  • The practice had a clear vision with quality and safety as its top priority. High standards were promoted and owned by all practice staff and teams worked together across all roles.
  • The management at the practice regularly reviewed and discussed services and future plans with staff to encourage a fully engaged and motivated practice team.

  • Governance and performance management arrangements had been proactively reviewed and took account of current models of best practice.
  • The practice had a well-structured meetings system which covered all recommended areas.
  • There was a high level of constructive engagement with staff and a high level of staff satisfaction.

  • The practice gathered feedback from patients and it had a very engaged patient participation group (PPG) which influenced practice development. For example, the PPG had actively supported many of the practice’s community initiatives such as the walking group, living in the moment scheme and patient education evenings.

  • The provider was aware of and complied with the requirements of the duty of candour. The partners encouraged a culture of openness and honesty. The practice had systems in place for notifiable safety incidents and ensured this information was shared with staff to ensure appropriate action was taken

  • There was a strong focus on continuous learning and improvement at all levels.
  • The practice demonstrated clinical innovation, for example through the vast array of additional services it provided. It had been at the forefront of developments to clinical services for the locality and was committed to diversifying services available in primary care.
Checks on specific services

People with long term conditions

Outstanding

Updated 22 September 2016

The practice is rated as outstanding 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.
  • The practice offered a Community Cardiology service, developed in 2004, for the practice population and those across Milton Keynes and parts of Bedfordshire. We saw evidence that the practice had invested heavily in developing this service, ensuring they were at the forefront of technology and expertise to provide the best possible outcomes for patients.
  • The practice had pioneered services to deliver ‘point of care testing’ (POCT) for D-Dimer and BNP. (D-dimer tests are used to rule out the presence of a blood clot and BNP tests help with early diagnosis of heart failure).
  • Performance for diabetes related indicators was comparable to the clinical commissioning group (CCG) and national averages. For example, the percentage of patients with diabetes, on the register, in whom the last blood glucose reading showed good control in the preceding 12 months was 76%, where the CCG average was 74% and the national average was 78%.
  • 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 GP worked with relevant health and care professionals to deliver a multidisciplinary package of care.
  • All patients suffering from COPD were invited to join the Milton Keynes Pulmonary Maintenance Group (a support group initiated by the respiratory lead GP at the practice). In addition the practice hosted the local ‘Breathe Easy Group’ meetings which provided support and educational talks for patients with COPD.
  • The practice was involved in a pilot scheme with the British Lung Foundation (BLF) to improve the respiratory function of patients with COPD. The practice had written to a specific group of patients encouraging them to attend a local 12 week programme to improve their diet and lifestyle in an effort to improve their health.
  • In corroboration with the PPG the practice facilitated regular patient education evenings led by a member of the clinical team or a guest speaker. These sessions were used as an opportunity to provide information on a range of general health topics as well as dedicated evenings for specific groups, including those suffering from long term conditions such as asthma and diabetes.
  • The lead GP for respiratory care at the practice had been involved in developing NICE guidelines for asthma care and had introduced advanced asthma testing known as FENO (Fractional Exhaled Nitric Oxide) testing into the practice. This identified inflammation of the lung which helped to diagnose new asthma patients and also to identify when complex patients required more support. We saw that since October 2014, 210 patients had received this testing.

Families, children and young people

Outstanding

Updated 22 September 2016

The practice is rated as outstanding 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. Immunisation rates were relatively high for all standard childhood immunisations.
  • 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 83%, which was comparable to the CCG average and national averages 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, health visitors and school nurses.
  • Family planning and contraceptive advice was available.
  • The practice had developed a highly successful walking group. We were told that the group regularly raised funds for a local school for children with learning disabilities. Two of the children were also able to participate in some walks.
  • The practice provided Primary Care Outpatient Clinics (PCOCs) which enabled patients to receive care they would normally receive in secondary care at Whaddon House Surgery. At the time of our inspection the practice were able to offer PCOC clinics for respiratory, dermatology and gynaecology each of which was led by a GP with Specialist interest (GPwSI) from within the existing practice team (with an external Consultant gynaecologist supporting the gynaecology clinic). We saw evidence that in the 12 months preceding our inspection a total of 988 patients, who would otherwise have been referred to secondary care, had received care at the practice (395 for dermatology, 118 for respiratory and 475 for gynaecology).

Older people

Outstanding

Updated 22 September 2016

The practice is rated as outstanding 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.
  • The practice had developed a group known as ‘Living in the Moment’, focused on reaching out to patients who may have become isolated for an array of reasons, including bereavement or retirement.
  • The practice supported frail elderly patients in local nursing and residential homes. In addition, the practice provided ‘elderly peoples assessments’, a programme developed in 2014 to support patients over the age of 75 years to ensure they were receiving support and information on services available. The target group for the practice were referred to as ‘hidden patients’, who had not attended the practice for over 12 months.
  • 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 offered health checks for patients over the age of 75.
  • Between January 2015 and July 2016 the practice had completed 571 of the 928 (62%) eligible health checks for people aged 75 years and over.
  • All patients over the age of 75 had a named GP.
  • Since 2014, the practice had been providing GP services to a local nurse led intermediate care unit providing rehabilitation for frail elderly patients. Staff told us that this had enabled the practice to increase their knowledge of elderly care and enabled them to provide better care for their patients.

Working age people (including those recently retired and students)

Outstanding

Updated 22 September 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 provided health checks to all new patients and carried out routine NHS health checks for patients aged 40-74 years.
  • The practice was committed to improving the health and lifestyle of its patients and we saw that they worked collaboratively with the a local football team to provide wellbeing assessments for patients under the age of 40 years with a body mass index (BMI) higher than 30. The assessment included both health and lifestyle measurements and patients were signposted to a range of exercise facilities. Coaches then provided ongoing support to patients to help them achieve their weight loss goals.
  • Pre-bookable appointments were available from 7am on Tuesdays, Wednesdays and Thursdays.
  • 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.
  • A HIV quick test was available for all new patients registering at the practice (that met specified criteria). This had been developed by the practice and others within the locality in response to public health concerns.
  • The practice was proactive in offering online services as well as a full range of health promotion and screening that reflected the needs of this age group. The practice website was fully managed by an external company ensuring patients always had access to up to date information.

People experiencing poor mental health (including people with dementia)

Outstanding

Updated 22 September 2016

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

  • Staff had a good understanding of how to support patients with mental health needs and dementia. We saw that all staff had undergone additional training to become dementia friends.
  • Performance for mental health related indicators were comparable to local and national averages. For example, the percentage of patients with diagnosed psychoses who had a comprehensive agreed care plan was 94% where the CCG average was 86% and the national average was 88%.
  • The practice regularly worked with multi-disciplinary teams in the case management of patients experiencing poor mental health, including those with dementia.
  • The practice worked with the Memory Assessment Service in 2015 to support patients identified as at risk of memory loss.
  • The practice had told patients experiencing poor mental health about how to access various 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.
  • In corroboration with the PPG, the practice facilitated regular patient education evenings. These sessions were used as an opportunity to provide information on a range of general health topics as well as dedicated evenings for specific groups. We saw that a session entitled ‘Mental Health Matters’ was being planned for September 2016, to specifically support patients suffering from poor mental health.
  • The practice had developed a self-help leaflet for patients experiencing poor mental health which provided a directory of support resources .The practice had also purchased some self-help books which could be given out or loaned to patients.
  • All staff had received ‘Dementia friends’ training to help them support patients appropriately.

People whose circumstances may make them vulnerable

Outstanding

Updated 22 September 2016

The practice is rated as outstanding 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.
  • 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 various support groups and voluntary organisations.
  • The practice held palliative care meetings in accordance with the national Gold Standards Framework involving district nurses, GP’s and the local MacMillan Hospice nurses.
  • 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.
  • The practice had identified 2.5% of the practice list as carers. The practice made efforts to identify and support carers in their population. A member of staff had been trained as Carers Champion.
  • The practice demonstrated a commitment to supporting vulnerable patients in their population, developing initiatives with the support of the PPG to work compassionately with patients who may be isolated. For example, in 2013, with the support of the local Community Safety Officer and the PPG the practice had developed a group known as ‘Living in the Moment’, focused on reaching out to patients who may have become isolated.
  • The practice had established a successful walking group in 2011, with the support of the PPG and a retired member of staff. At the time of our inspection there were over 100 people participating in these walks each week, not only providing valuable health benefits but equally enabling participants to develop social relationships and engage in the community.
  • The practice was working with Milton Keynes Cancer Patient Partnership (MKCPP) to develop a group called 'Cancer and Beyond' aimed at supporting people recovering from Cancer once they had been discharged from hospital or other clinical services.
  • The practice provided regular ward rounds at a local residential rehabilitation centre for patients with an acquired brain injury to ensure that both staff and patients at the centre are well supported.