Archived: Dr Joseph Rizzo-Naudi

Updated 19 April 2016

Dr Joseph Rizzo-Naudi is more commonly known as Whitchurch Surgery and is a small semi-rural dispensing practice in Whitchurch, Buckinghamshire which is approximately five miles north of Aylesbury. Whitchurch Surgery is one of the practices within Aylesbury Vale Clinical Commissioning Group (CCG) and provides general medical services to approximately 4,200 registered patients.

All services are provided from:

• Whitchurch Surgery, 49 Oving Road, Whitchurch, Near Aylesbury, Buckinghamshire HP22 4JF.

The practice comprises of two GP Partners (one male, one female) and one female salaried GP.

The all-female nursing team consists of one nurse prescriber, two practice nurses and a phlebotomist. The phlebotomist also undertakes reception and administration duties.

A practice manager, an assistant practice manager and a team of five reception and administrative staff undertake the day to day management and running of the practice.

One of the GPs is the designated dispensary lead and the dispensary team consists of one dispensing technician and three dispensers.

According to data from the Office for National Statistics, Whitchurch has high levels of affluence, low incidence of substance misuse and severe mental health problems and low levels of deprivation.

The practice population has a lower proportion of patients aged under 18 when compared to the local CCG and national averages whilst there is a significantly higher proportion of patients aged 65 and over.

Whitchurch Surgery provides GP services to a local residential home (six patients) and two local care homes (12 patients) which support individuals with severe learning and physical disabilities.

The practice has core opening hours between 8am and 6pm (at least one GP remains on site until 6.30pm) every weekday, morning appointments start at 8am and cease at 1pm, afternoon appointments start at 2pm and cease at 5.50pm. There were no extended hours surgeries available. The dispensary has core opening hours between 9am and 6pm every weekday with the exception of Thursdays when the dispensary closes at 1pm.

The practice opted out of providing the out-of-hours service. This service is provided by the out-of-hours service accessed via the NHS 111 service. Advice on how to access the out-of-hours service is clearly displayed on the practice website, on the practice door and over the telephone when the surgery is closed.

Updated 19 April 2016

Letter from the Chief Inspector of General Practice

We carried out an announced comprehensive inspection at Dr Joseph Rizzo-Naudi, more commonly known as Whitchurch Surgery on 16 March 2016. Overall the practice is rated as good.

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

• High standards were promoted and owned by all practice staff with evidence of team working across all roles.

• There was an open and transparent approach to safety and an effective system in place for reporting and recording significant events.

• The practice had a clear leadership structure, effective governance system in place, was well organised and actively sought to learn from performance data, incidents and feedback.

• Procedures were in place for monitoring and managing risks to patient and staff safety.

• Feedback from patients about their care was consistent and highly positive.

• Outcomes for patients who use the service were not always consistent which may have impacted on the quality of care and treatment received. Nationally reported Quality and Outcomes Framework (QOF) data, for 2014/15, showed the practice had obtained 84% of the total number of points available to them for providing recommended care and treatment to patients. We saw low levels of exception reporting and inconsistent QOF coding which impacted the total points obtained.

• The practice had good facilities and was well equipped to treat patients and meet their needs.

However, there were areas of practice where the provider needs to make improvements. Importantly the provider should:

• Review how carers are identified and recorded on the patient record system to ensure information, advice and support is made available to them.

• Develop and implement a clear action plan, to ensure quality outcomes specifically diabetes and mental health related indicators are correctly coded and recorded.

Professor Steve Field CBE FRCP FFPH FRCGP 

Chief Inspector of General Practice

Updated 19 April 2016

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

• The GPs and nurse team had the knowledge, skills and competency to respond to the needs of patients with long term conditions such as COPD (Chronic obstructive pulmonary disease is the name for a collection of lung diseases including chronic bronchitis, emphysema and chronic obstructive airways disease).

• The nurse prescriber had a special interest in the management of long-term conditions, specifically COPD. As a result of a recent audit all COPD patients had an updated test to distinguish between stable, moderate to severe COPD. Following the grading the most appropriate treatment and education options according to local and national guidelines were implemented.

• Two of the nurses were trained in anticoagulant management and held clinics to monitor patients’ blood to determine the correct dose of anti-coagulant medicine. This provided better improved access, standardised delivery in monitoring dosage, ‘one-stop-visit’ testing obtaining results and adjustments in dose, with the opportunity to discuss results during the same visit.

• Longer appointments and home visits were available when needed.

Quality and Outcome Framework (QOF) data demonstrated monitoring of patients with long term conditions was inconsistent when compared to local and national averages. For example:

• Performance for diabetes related indicators was lower when compared to the CCG and national average. The practice achieved 75% of these targets, which was lower than the CCG average (92%) and national average (89%).

• Performance for COPD related indicators was slightly higher when compared to the CCG and national average. The practice achieved 100% of these targets, higher when compared to the CCG average (99%) and national average (96%).

Updated 19 April 2016

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.

• Childhood immunisation rates for children aged 12 months and 24 months were significantly higher when compared to the CCG and national averages.

• 76% of patients diagnosed with asthma, on the register, had an asthma review in the last 12 months. This was similar to the national average, 75%.  

• The practice’s uptake for the cervical screening programme was 87%, which was higher when compared to the CCG average (77%) and the national average (82%).

Updated 19 April 2016

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.
• The practice was responsive to the needs of older people. Longer appointments, home visits and urgent appointments were available for those with enhanced needs.

• The practice systematically identified older patients and coordinated the multi-disciplinary team (MDT) for the planning and delivery of palliative care for people approaching the end of life.

• We saw unplanned hospital admissions and re-admissions for the over 75’s were regularly reviewed and improvements made.

Updated 19 April 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.
• There was a range of appointments between 8am and 6pm every weekday. Although the practice did not provide extended hours, GPs told us they would see a patient past the normal hours if required. The practice offered telephone consultations for the working age population.
• 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.
• The practice provided a full travel vaccine service (including yellow fever).

• Phlebotomy services were available at the practice which meant patients did not have to attend the hospital for blood tests.

Updated 19 April 2016

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

Quality and Outcomes Framework (QOF) data demonstrated monitoring of people experiencing poor mental health was lower when compared to local and national averages. For example:

• 75% of people experiencing poor mental health had a comprehensive, agreed care plan documented in their medical record, which was lower when compared to the local average (94%) and national average (88%).

• However data and discussions with practice staff evidenced the practice had carried out advance care planning for patients with dementia. For example, 91% of patients diagnosed with dementia had their care reviewed in a face to face meeting in the last 12 months, which was higher when compared to the local average (89%) and national average (84%).

• 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 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 accident and emergency where they may have been experiencing poor mental health.

• All staff had a good understanding of how to support patients with mental health needs and dementia.

Updated 19 April 2016

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

• The practice offered longer appointments for patients with a learning disability.

  It had carried out annual health checks for people with a learning disability and there was evidence that these had been followed up.

• The practice provides GP services to two care homes which support individuals with severe learning and physical disabilities.

• The practice held a vulnerable adults and vulnerable families register. We saw the practice contacted every person on the vulnerable adults register and every person aged over 85 every six months. This call was either followed by a patient consultation at a flexible time and location to meet the family’s needs and/or by giving them advice on how to find a support service.
• The GPs regularly worked with multi-disciplinary teams in the case management of vulnerable people.
• The practice informed vulnerable patients about how to access various support groups and voluntary organisations.
• 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.