Archived: Chiltern House Medical Centre

Updated 19 February 2018

Chiltern House Medical Centre provides primary care GP services to approximately 8,250 patients across two locations in the High Wycombe area. The list size had reduced due to a condition imposed by Care Quality Commission (CQC) not to register new patients other than new born babies without written permission from CQC.

The two locations are Chiltern House Medical Centre and the branch practice known as Dragon Cottage, the patient list is split equally between the two sites and patients can see a GP or nurse at either site.

Services are provided from two locations:

• Chiltern House Medical Centre, 45 – 47 Temple End, High Wycombe, Buckinghamshire HP13 5DN

• Dragon Cottage, 35 Browns Road, Holmer Green, High Wycombe, Buckinghamshire HP15 6SL

During our inspection we visited the main surgery (Chiltern House Medical Centre) and the branch surgery (Dragon Cottage).

The practice website is: www.chilternhousemedicalcentre.co.uk

Both practices are located in an area of low deprivation, meaning very few patients are affected by deprivation in the locality. However, there are pockets of high deprivation within the practice boundary. There are a higher number of patients aged 45 to 54 registered at this surgery and the patient population of this area is older than national average. There are a high percentage of patients from ethnic minority backgrounds at Chiltern House Medical Centre. The practice has the highest proportion of unemployed patients registered in the CCG at 6.4% compared to the England average of 4.4%.

Chiltern House Medical Centre is located in a 17th century grade II listed building and Dragon Cottage Surgery is located in an old residential dwelling in the Holmer Green area of High Wycombe.

The practice has undergone many operational and staff changes in the last four years. In the last six months the practice had appointed a new Registered Manager, a GP Partner had become the Senior GP Partner with additional management duties and the business manager was now the practice manager. A registered manager is a person who has registered with the CQC to manage the service. Like registered providers, they are 'registered persons'. Registered persons have legal responsibility for meeting the requirements in the Health and Social Care Act 2008 and associated Regulations about how the service is run.

The practice has two GP partners (both female), three salaried GPs (all female), a long term male locum GP, a female pharmacist, a nurse practitioner and a health care assistant (both female).The practice continued to utilise short term locum GPs and nurses until permanent recruitment was successful. The clinical staff are supported by a practice manager, patient services manager, IT support manager and a team of reception, administration and secretarial staff.

Chiltern House Medical Centre is open between 8.00am and 6.30pm Monday to Friday. Dragon Cottage is open between 8.00am and 6.30pm Monday to Friday with the exception of Thursdays when the branch practice closes at 1pm. Extended surgery hours are offered on Tuesday evenings until 8pm at Chiltern House Medical Centre. The practice have opted out of providing out of hours care when the practice is closed. This is offered by NHS 111 telephone service who will refer to the out of hours GP service if required.

Updated 19 February 2018

Letter from the Chief Inspector of General Practice

We carried out an unannounced comprehensive inspection at Chiltern House Medical Centre in High Wycombe, Buckinghamshire on 18 and 24 October 2016. The overall rating for the practice was inadequate. We used our enforcement powers to take action against the breaches of regulations including issuing three warning notices. We placed the practice in special measures to enable the practice to improve. The significant levels of concern led to three conditions being added to the registration of the practice. The conditions were imposed to ensure timely and sustainable improvement was made.

We undertook a second comprehensive inspection on 6 June 2017. This inspection was undertaken to determine whether the breaches of regulation requirements had been addressed following the inspection in October 2016. Whilst improvements had been made in relation to some of the concerns highlighted at the last inspection, there were areas relating to providing safe, effective, caring and well-led services which constituted continued breaches of regulations. The overall rating of the practice remained as inadequate, specifically inadequate for the provision of safe, effective, caring and well-led services. The practice was rated good for providing responsive services. The issues identified at the inspection impacted the care provided to all population groups which were also rated as inadequate.

We carried out an announced comprehensive inspection on 10 January 2017. We carried out this inspection under Section 60 of the Health and Social Care Act 2008 as part of our regulatory functions. This inspection was planned to check whether Chiltern House Medical Centre meeting the legal requirements and regulations associated with the Health and Social Care Act 2008.

At this inspection in January 2018 we found that significant improvements had been taken to improve the provision of care and treatment. Overall the practice is now rated as good.

Following the January 2018 inspection, the key questions are rated as:

• Are services safe? – Good

• Are services effective? – Good

• Are services caring? – Good

• Are services responsive? – Good

• Are services well-led? - Good

As part of our inspection process, we also look at the quality of care for specific population groups. The population groups are rated as:

• Older People – Good

• People with long-term conditions – Good

• Families, children and young people – Good

• Working age people (including those recently retired and students – Good

• People whose circumstances may make them vulnerable – Good

• People experiencing poor mental health (including people with dementia) - Good

Our key findings at this inspection were as follows:

• It was evident the practice had gone through a period of transition including the implementation of a new management team. Positive changes had been made to the leadership team. The managing GP partner had a more active role in the management and leadership of the practice. Staff we spoke with recognised the endeavours of the new leadership team and were keen to be part of the new developments.

• The practice now had a clear vision that had improvement of service quality and safety as its top priority. The practice fully embraced the need to change, high standards were promoted and there was good evidence of team working.

• Significant improvements to risk management had been made and risks to patients were now being assessed and managed. This included concerns from the previous inspections.

• Staff understood their responsibilities to manage emergencies and to recognise those in need of urgent medical attention. For example, there was a comprehensive sepsis decision support tool. Sepsis is a rare but serious complication of an infection. Without quick treatment, sepsis can lead to multiple organ failure and death. We saw there was a proactive approach to anticipate and manage the risk of sepsis.

• Improved systems now ensured patients received timely reviews where treatment or interventions may be required. This included a review of pathology results (pathology is the medical speciality relating to the diagnosis of disease based on the laboratory analysis of bodily fluids such as blood and urine), a review of patients on more than four repeat medicines and annual health checks for patients with learning disabilities.

• Data showed most patient outcomes were similar when compared to local and national averages. The practice reviewed and monitored patient outcomes through the use of a clinical effectiveness plan which planned appropriate actions to identify and improve patient’s health and well-being.

• Revised systems to seek, act and monitor feedback. The practice had undertaken various actions to identify and act on patients' concerns reflected in the July 2016 national GP survey and more recently the July 2017 national GP survey. Feedback from patients relating to access to services and the quality of care had improved. This was corroborated by written and verbal feedback collected during the inspection.

The areas where the provider should make improvements are:

• Continue to improve patient recall and reviews for patients with a learning disability. Specifically, increase uptake for patients with a learning disability attending or having a completed health check.

• Continue to seek feedback and improve engagement with patients whilst reviewing the outcomes of patient feedback including patient surveys to determine appropriate action with a view to improving the patient experience.

• The leadership team should continue to review and sustain the improvements made to the overall governance and management of the practice.

I am taking this service out of special measures. This recognises the significant improvements made to the quality of care provided by the service.

Professor Steve Field CBE FRCP FFPH FRCGP

Chief Inspector of General Practice

Updated 19 February 2018

Updated 19 February 2018

Updated 19 February 2018

Updated 19 February 2018

Updated 19 February 2018

Updated 19 February 2018