Haddenham Medical Centre

Letter from the Chief Inspector of General Practice

This practice is rated as Good overall.

At our previous inspection in December 2014, Haddenham Medical Centre had an overall rating as Good.

Following the November 2017 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? - Outstanding

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 – Outstanding

• 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

We carried out an announced comprehensive inspection at Haddenham Medical Centre in Haddenham, Buckinghamshire on 29 November 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 Haddenham Medical Centre was meeting the legal requirements and regulations associated with the Health and Social Care Act 2008.

At this inspection we found:

• Staff 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 had defined and embedded systems, processes and practices to minimise risks to patient safety.

• Staff understood their responsibilities to manage emergencies and to recognise those in need of urgent medical attention. For example, there was a comprehensive sepsis toolkit. 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. The practice had adapted existing systems to include additional escalation prompts if patients displayed potential symptoms of sepsis.

• Staff had received training appropriate to their roles and the population the practice served. Any further training needs had been identified and planned.

• Our findings 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.

• The continued development of staff skills, competence and knowledge was recognised as integral to ensuring high-quality care. We saw evidence of and staff we spoke with told us they are supported to acquire new skills and share best practice.

• We received positive feedback from external stakeholders and patients which access GP services from the practice.

• The practice learned lessons from individual concerns and complaints and also from analysis of trends. We observed the practice proactively sought feedback from staff and patients, which it acted on.

• The practice had clear and visible clinical and managerial leadership and supporting governance arrangements. There was a high level of constructive engagement with staff and all staff we spoke with told us they felt they were an integral part of the practice and they felt valued.

• There was a strong focus on continuous learning and improvement within the practice. For example, the practice was a GP teaching and training practice, supported medical students, nursing students and apprentices.
• There were two principals in the practices ethos, one was learning and development, across all staff groups and the other was a proactive approach to health promotion and prevention of ill health.

We saw areas of outstanding practice:

• The practice leadership was committed to meeting the needs of its population. This was evidenced through themed and targeted services, clinical audits and health promotion. This included a range of initiatives to meet the needs of specific groups – for example people with dementia, older people facing isolation and transport difficulties, military veterans, carers, Deaf people, travellers and the LGBT community.

• The practice had identified that there were a number of military veterans in their patient population and had taken action to help ensure this group of patients received suitable support in line with the government’s armed forces covenant. The practice encouraged these patients to identify themselves through signage at the practice, military veteran information packs, information on the practice website and via questions on the ‘new patient’ form. As a result of the increased awareness of the armed forces covenant, there had been a significant increase in the number of patients on the military veteran register.

• Haddenham Medical Centre provided an outstanding service to patients with caring responsibilities. This service was recognised by the Carers Bucks (an independent charity to support unpaid, family carers in Buckinghamshire) and the practice was awarded an Investors in Carers GP Standard award. This was in recognition of the extra support they offer to unpaid carers who are registered at the practice.

• The practice had achieved Gold, the highest award in the NHS ‘Pride in Practice’ award from the Lesbian, Gay, Bisexual and Transgender Foundation. This included bespoke training for all patient facing staff which demonstrated the practice’s commitment and dedication to ensuring a fully inclusive patient-centred service.

Professor Steve Field CBE FRCP FFPH FRCGP

Chief Inspector of General Practice