Dr G C Francis and Partners (Linden Medical Centre)

Updated 24 August 2016

Dr G C Francis & Partners (also known locally as Linden Medical Centre) is situated in Maidenhead, Berkshire within a purpose built premises with car parking for patients and staff. All patient services are offered on the ground and first floors. The practice comprises of seven consulting rooms, three treatment rooms, a patient waiting area, a reception area, administrative and management office.

The practice has core opening hours from 8am to 6.30pm Monday to Friday. The practice offers a range of scheduled appointments to patients every weekday from 8.30am to 5.30pm including open access appointments with a duty GP throughout the day. The practice offers family planning appointments during extended hours every Tuesday evening from 6.30pm to 8pm. The practice offers extended hours appointments Tuesday evening (once a month) from 6.30pm to 8pm and every second Saturday from 9am to 11.30am at the premises. In addition, the practice offers extended hours appointments Monday to Friday from 6.30pm to 9pm, Saturday from 9.30am to 4pm and Sunday from 11am to 4pm at Kings Edward Hospital and Saint Marks Hospital (funded by Prime Minister’s Access Fund).

The practice has a patient population of approximately 9,750 registered patients. The practice population of patients aged between 40 to 54 and 65 to 69 years old is higher than the national average and there are lower number of patients aged between 0 to 4 and 20 to 34 years old compared to national average.

Ethnicity based on demographics collected in the 2011 census shows the patient population is predominantly White British and 15% of the population is composed of patients with an Asian, Black or mixed background. The practice is located in a part of Maidenhead with the lowest levels of income deprivation in the area.

There are three GP partners, two salaried GPs and two locum GPs at the practice. Five GPs are female and two male. The practice employs five practice nurses and a health care assistant. The practice manager is supported by a reception manager, 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).

Services are provided from following location:

9a Linden Avenue

Maidenhead

Berkshire

SL6 6JJ

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 practice 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 by East Berkshire Primary Care service or after 6.30pm, weekends and bank holidays by calling NHS 111.

Updated 24 August 2016

Letter from the Chief Inspector of General Practice

We carried out an announced comprehensive inspection at Dr G C Francis & Partners (also known locally as Linden Medical Centre) on 27 July 2016. Overall the practice is rated as good.

Specifically, we found the practice good for providing safe, effective, caring, responsive and well led services.

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.
• We found that completed clinical audit cycles were driving positive outcomes for patients.
• Staff assessed patients’ needs and delivered care in line with current evidence based guidance. Staff had the skills, knowledge and experience to deliver effective care and treatment.
• Patients said they were treated with compassion, dignity and respect and they were involved in their care and decisions about their treatment.
• Information about services and how to complain were available and easy to understand.
• Patients said they found it easy 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.
• There was an anti-coagulation clinic (an anti-coagulant is a medicine that stops blood from clotting) offered onsite, resulting in 162 patients who required this service not having to travel to local hospitals.
• 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.
• The provider was aware of and complied with the requirements of the Duty of Candour.

The areas where the provider should make improvements are:

• Improve the recording of discussions and actions during practice meetings including significant events.
• Review and improve the system in place to promote the benefits of smoking cessation in order to increase patient uptake.
• Review the process of identifying carers to enable them to access the support available via the practice and external agencies.

Professor Steve Field (CBE FRCP FFPH FRCGP) 

Chief Inspector of General Practice

Updated 24 August 2016

The practice is rated as good for the care of patients 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.
• All patients with long term conditions had a named GP and the practice carried out a structured annual review to check that 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.

Updated 24 August 2016

The practice is rated as good for the care of families, children and young patients.

• 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 patients who had a high number of A&E attendances.
• Immunisation rates were high for all standard childhood immunisations.
• Patients told us that children and young patients were treated in an age-appropriate way and were recognised as individuals.
• The practice’s uptake for the cervical screening programme was 89%, which was higher than the national average of 82%.
• Appointments were available outside of school hours and the premises were suitable for children and babies.
• We saw good examples of joint working with midwives, health visitors and school nurses.
• The practice offered family planning clinic appointment during extended hours every Tuesday evening from 6.30pm to 8pm.

Updated 24 August 2016

The practice is rated as good for the care of older patients.

• The practice offered proactive, personalised care to meet the needs of the older patients in its population. For example, the practice informed us that they were working closely with a local Community Matron to deliver personalised speedy service to elderly patients.
• It was responsive to the needs of older patients, and offered home visits and urgent appointments for those with enhanced needs.
• There was a register to effectively support patients requiring end of life care.
• There were good working relationships with external services such as district nurses.
• The premises was accessible to those with limited mobility. However, the practice did not have an automatic door activation system at the front door used to enter the premises but there was a bell to alert staff to help with accessing the practice.

Updated 24 August 2016

The practice is rated as good for the care of working-age patients (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 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 also offered extended hours appointments Tuesday evening (once a month) from 6.30pm to 8pm and every second Saturday from 9am to 11:30am at the premises. In addition, the practice offered extended hours appointments Monday to Friday from 6.30pm to 9pm, Saturday from 9:30am to 4pm and Sunday from 11am to 4pm at Kings Edward Hospital and Saint Marks Hospital (funded by Prime Minister’s Access Fund).

Updated 24 August 2016

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

• Data from 2014-15 showed, performance for dementia face to face reviews was comparable to the CCG and national average. The practice had achieved 84% of the total number of points available, compared to 83% locally and 84% nationally.
• However, the practice provided us with recent data which had shown improvement and 91% of 53 patients with dementia were involved in developing their care plans.
• The practice was pro-actively screening for dementia and identified 39 new patients with dementia in last two years.
• 81% of patients experiencing poor mental health were involved in developing their care plan in last 12 months. Health checks were completed for 88% of patients experiencing poor mental health.
• The practice regularly worked with multi-disciplinary teams in the case management of patients experiencing poor mental health, including those with dementia.
• The practice had told patients experiencing poor mental health how to access various support groups and voluntary organisations.
• Systems were in place to follow up patients who had attended accident and emergency, when experiencing mental health difficulties.
• Staff had a good understanding of how to support patients with mental health needs and dementia.

Updated 24 August 2016

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

• The practice held a register of patients living in vulnerable circumstances including homeless patients, travellers and those with a learning disability.
• It offered annual health checks for patients with learning disabilities. Health checks and care plans were completed for 15 patients out of 21 patients on the learning disability register. Two days after the inspection the practice informed us they had adapted a new care plan template for patients with learning disabilities. This template was imported on to the clinical system to improve accessibility and to monitor patients effectively on the learning disability register.
• Longer appointments were offered to patients with a learning disability.
• The practice regularly worked with multi-disciplinary teams in the case management of vulnerable patients.
• It had told 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.