John Hampden Surgery Also known as Dr Mallard-Smith and Partners

Updated 1 April 2016

John Hampden Surgery is based in a converted residential dwelling in Prestwood village near Great Missenden in Buckinghamshire. The practice is one of 34 practices within Chiltern Clinical Commissioning Group. The practice provides general medical services to approximately 3,330 registered patients in Prestwood and the surrounding villages.

All services are provided from:

• John Hampden Surgery, 97 High Street, Prestwood, Great Missenden, Buckinghamshire HP16 9EU

There are three female GP partners at the practice who are occasionally supported by locum GPs.

The all-female nursing team consists of a nurse prescriber, a practice nurse and a vulnerable patient and dementia support nurse, all three nurses contributing with a mix of skills and experience.

A practice manager is supported by a deputy practice manager and a team of five administrative staff who undertake the day to day management and running of the practice.

The practice population has a higher proportion of patients aged 40-69 compared to the national average. There is minimal deprivation according to national data. The prevalence of patients with health-related problems in daily life is 39% compared to the national average of 49%.

The practice has core opening hours between 8.30am and 6.00pm every weekday and was also open one Saturday morning a month.

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 and over the telephone when the surgery is closed.

Updated 1 April 2016

Letter from the Chief Inspector of General Practice

We carried out an announced comprehensive inspection at John Hampden Surgery on 27 January 2016. The practice is rated as outstanding for the care and treatment of three population groups – families, children and young people, people whose circumstances may make them vulnerable and people experiencing poor mental health (including people with dementia). As a result of three outstanding population groups and outstanding caring and responsive domains, overall the practice is rated as outstanding.

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

• The practice had a clear vision which had quality and safety as its top priority. The strategy to deliver this vision had been produced with stakeholders and was regularly reviewed and discussed with staff.

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

• Risks to patients were assessed and well managed, this included plans to action areas for improvement from the recent Infection Control audit.

• Feedback from patients about their care was consistently and strongly positive. However, not all patients were aware of the extended hours and several commented on recent difficulties accessing appointments.

• Outcomes for patients who use services were consistently very good. Nationally reported Quality and Outcomes Framework (QOF) data, for 2014/15, showed the practice had performed excellently in obtaining almost all of the total points available to them for providing recommended care and treatment to patients.

• Staff were consistent in supporting patients to live healthier lives through a targeted and proactive approach to health promotion.
• We found there was good staff morale in the practice, with high levels of team spirit and motivation. There was a strong learning culture evident in the practice. This came across clearly through discussions with staff members and in the approach to adopting and championing new initiatives.

We saw several areas of outstanding practice including:

• In February 2015, the practice was successful in a bid to make the practice ‘dementia friendly’. The practice has identified dementia patients early, supported them to access good quality care, improve their quality of life and prolong independent living. There was a named dementia support nurse ensuring a personalised care plan for all dementia patients, all staff had additional training in recognising and supporting people with dementia, double appointments for dementia patients were routine and the practice environment was dementia friendly with appropriate signage and a ‘quiet space’.

• The practice had recognised that carer’s health often takes second best, or neglected and was offering designated clinics every Friday for carers. Of the 70 carers, 38 (54%) had attended a carers clinic and the remaining 32 had been contacted and an appointment scheduled providing support through community settings to enable patients to live independently for longer.

• The practice supported patients to live healthier lives through a targeted and proactive approach to health promotion and prevention of ill health. For example, there was a designated staff member who arranged and scheduled childhood immunisations. This was evident as immunisation rates were higher when compared to the CCG and national averages.

• In partnership with Bucks County Council, the practice was awarded a 'Safe Place' status. This scheme provides reassurance to vulnerable people, and to their families and carers, so that they have a means to alert someone of any potential risk or emergency if they are out alone. Having access to the practice as a place for safety within the village helps vulnerable people lead independent lives and feel safe. There was a Duty GP available should a vulnerable person accessing the practice as a ‘Safe Place’ require urgent care and treatment. Although only recently awarded the practice has supported a vulnerable patient recently seeking refuge at the practice whilst experiencing an episode of panic and confusion.

However, there was an area of practice where the provider needs to make improvements. Importantly the provider should:

• Review how patients can have appointments to see a male GP and have a male chaperone if wanted.

Professor Steve Field CBE FRCP FFPH FRCGP 

Chief Inspector of General Practice

Updated 1 April 2016

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

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

• Longer appointments and home visits were available when needed.

• Patients at risk of hospital admission were identified as a priority.

• Outcomes for patients who use services were consistently very good. Nationally reported Quality and Outcomes Framework (QOF) data, for 2014/15, showed the practice had performed very well in the management of long-term conditions. For example:

• QOF performance for diabetes related indicators was 100%, higher when compared to the CCG average (93%) and the national average (89%).

Updated 1 April 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.

• There was a designated staff member who arranged and scheduled immunisations. This was evident as immunisation rates were higher when compared to the CCG and national averages.

• 81% of patients diagnosed with asthma, on the register, had an asthma review in the last 12 months. This was higher when compared to the national average, 75%.

• 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 84%, which was higher when compared to the CCG average (77%) and the national average (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 and health visitors.

Updated 1 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.

• Nationally reported data showed that outcomes for patients for conditions commonly found in older people were higher than national averages. For example, 100% of patients aged 75 or over with a record of a fragility fracture on or after 1 April 2014 and a diagnosis of osteoporosis, who were currently treated with an appropriate bone-sparing agent. This is higher when compared to the CCG average (92%) and national average (93%).

Updated 1 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.

• Appointments were available between 9.00am and 5.00pm Monday to Friday. The practice was open one Saturday morning each month specifically for patients not able to attend outside normal working hours but there were no restrictions to other patients accessing these appointments.

• 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. This included email correspondence with some patients and home blood pressure monitoring.

Updated 1 April 2016

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

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

• 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 has identified dementia patients early, supported them to access good quality care, improve their quality of life and prolong independent living. All staff had additional training in recognising and supporting people with dementia, double appointments to dementia patients were routine and the practice environment was dementia friendly with appropriate signage and a ‘quiet space’.

• The vulnerable patient and dementia support nurse visited dementia patients at home and was supporting their carers by producing advanced care plans and person-centered ‘This is Me’ documents.

• 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.

Updated 1 April 2016

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

• There were policies and arrangements to allow people with no fixed address to register and be seen at the practice.

• The practice offered longer appointments for patients with a learning disability. It had carried out annual health checks for 100% of people (17 patients) with a learning disability and there was evidence that these had been followed up.

• The practice regularly worked with multi-disciplinary teams in the case management of vulnerable people.

• In partnership with Bucks County Council, the practice was awarded a 'Safe Place'  status. This scheme provides reassurance to vulnerable people, and to their families and carers, so that they have a means to alert someone of any potential risk or emergency if they are out alone. Having the practice as access a place of safety within the village helps vulnerable people lead independent lives and feel safe.

• There was a ‘carer’s champion’ providing support through the community to enable patients to live independently for longer. The practice worked closely with the local social care team and Carers Bucks (an independent charity to support unpaid, family carers in Buckinghamshire) to support carers including the promotion of completing a regular carers risk assessments. The practice had recognised that carer’s health often takes second best, is neglected and was offering designated clinics every Friday for carers. Of the 70 carers, 38 (54%) had attended a carers clinic and the remaining 32 had been contacted and an appointment scheduled.

• There was a Vulnerable Patient Nurse who supported vulnerable patients at home and liaised with relevant services to prolong independence. 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.