The Red House Surgery

Updated 14 July 2016

The Red House Surgery provides a range of primary medical services, including minor surgical procedures from its location on Queensway in Bletchley, Milton Keynes.

The practice serves a population of approximately 13,600 patients with slightly higher than average populations of females aged 65 to 69 years. There are marginally lower than average populations of patients aged 5 to 24 years. The practice population is largely White British. National data indicates the area served is one of average deprivation in comparison to England as a whole.

The clinical team consists of three male and two female GP partners, four female salaried GPs, four practice nurses; one of which was an Independent Prescriber and two health care assistants. The team is supported by a practice manager, a deputy practice manager and a team of administrative staff. The practice holds a General Medical Services (GMS) contract for providing services, which is a nationally agreed contract between general practices and NHS England for delivering general medical services to local communities.

The practice operates from a three storey converted property and patient consultations and treatments take place on the ground level and first floor. There is a car park to the rear of the surgery, which is shared with the neighbouring pharmacy, with adequate disabled parking available.

The Red House Surgery is open between 8am and 6.30pm Monday to Friday. In addition, pre-bookable appointments are available from 7am on Thursdays.

The out of hours service is provided by Milton Keynes Urgent Care Services and can be accessed via the NHS 111 service. Information about this is available in the practice and on the practice website and telephone line.

Updated 14 July 2016

Letter from the Chief Inspector of General Practice

We carried out an announced comprehensive inspection at The Red House Surgery on 8 June 2016. Overall the practice is rated as good.

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

• 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.
• Staff assessed patients’ needs and delivered care in line with current evidence based guidance. Staff had been trained to provide them with 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 was available and easy to understand. Improvements were made to the quality of care as a result of complaints and concerns.
• 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 was working collaboratively with another local practice to promote the Living in the Moment Group, which ran from a local community hall. The group offered support and advice to people who found themselves feeling isolated or lonely.
• The practice had good facilities and was well equipped to treat patients and meet their needs.
• The practice was involved in supporting patients recovering from cancer treatment once they were discharged from hospital care through a group called ‘Cancer and Beyond’.
• 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.

We saw two areas of outstanding practice:

• The practice was classed as a POCT (point of care testing) hub practice within the locality, and alongside six other practices was offering patients additional services not normally found within a GP setting. For example, the Red House Surgery was able to offer D-dimer and deep vein thrombosis (DVT) testing for patients. (D-dimer tests are used to rule out the presence of a blood clot).
• A specialist nurse for patients with learning disabilities was available to offer support and conduct health checks. At the time of our inspection there were 56 patients on the learning disability register supported by this nurse.

The area where the provider should make improvement is:

• Continue with efforts to improve the support offered to patients with dementia and actively encourage patients to attend regular reviews.

Professor Steve Field (CBE FRCP FFPH FRCGP) 

Chief Inspector of General Practice

Updated 14 July 2016

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

• Nursing staff had lead roles in chronic disease management and patients at risk of hospital admission were identified as a priority.
• Performance for diabetes related indicators was comparable to the clinical commissioning group (CCG) and national averages. For example, the percentage of patients with diabetes, on the register, in whom the last blood glucose reading showed good control in the preceding 12 months, was 72%, where the CCG average was 74% and the national average was 78%.
• Longer appointments and home visits were available when needed.
• All these patients had a named GP and a structured annual review to check 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.
• The practice was involved in a pilot scheme with the British Lung Foundation (BLF) to improve the respiratory function of patients with COPD. The practice had written to a specific group of patients encouraging them to attend a local 12 week programme to improve their diet and lifestyle in an effort to improve their health.

Updated 14 July 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. Immunisation rates were relatively high for all standard childhood immunisations.
• 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 83%, which was comparable to the CCG average and national averages of 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, health visitors and school nurses.
• Family planning and contraceptive advice was available.
• The practice had provided classes for children and their families to teach them how to use their inhalers.

Updated 14 July 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, and offered home visits and urgent appointments for those with enhanced needs.
• The practice supported frail elderly patients in local nursing and residential homes.
• The practice provided influenza, pneumonia and shingles vaccinations.
• A phlebotomy clinic ran daily enabling patients to have blood tests conducted locally rather than at the local hospital.
• The practice offered health checks for patients over the age of 75.
• All patients over the age of 75 had a named GP.
• A member of the patient participation group (PPG) was the Older Person Champion for the locality and was available to support people in attending local groups when needed.

Updated 14 July 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.
• The practice provided health checks to all new patients and carried out routine NHS health checks for patients aged 40-74 years.
• Pre-bookable appointments were available from 7am on Thursdays.
• The practice had enrolled in the Electronic Prescribing Service (EPS) in 2015. This service enabled GPs to send prescriptions electronically to a pharmacy of the patient’s choice.
• The practice was proactive in offering online services as well as a full range of health promotion and screening that reflected the needs of this age group.

Updated 14 July 2016

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

• The percentage of patients with dementia whose care had been reviewed in a face-to-face review in the preceding 12 months (01/04/2014 to 31/03/2015) was 61% where the CCG average was 78% and the national average was 84%.
• The practice supported patients with dementia and we saw that several members of staff had undergone additional training to become dementia friends. These staff members wore badges to make them easily identifiable to patient requiring additional support.
• Performance for mental health related indicators were otherwise comparable to local and national averages. For example, the percentage of patients with diagnosed psychoses who had a comprehensive agreed care plan was 84% where the CCG average was 86% and the national average was 88%.
• 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 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.
• Staff had a good understanding of how to support patients with mental health needs and dementia.

Updated 14 July 2016

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

• The practice held a register of patients living in vulnerable circumstances including those with a learning disability.
• A specialist nurse for patients with learning disabilities was available to offer support and conduct health checks. At the time of our inspection there were 56 patients on the learning disability register supported by this nurse.
• The practice offered longer appointments for patients with a learning disability.
• The practice regularly worked with other health care professionals in the case management of vulnerable patients.
• The practice informed vulnerable patients about how to access various support groups and voluntary organisations.
• The practice held palliative care meetings in accordance with the national gold standards framework involving district nurses, GP’s and the local Willen Hospice nurses.
• 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.
• The practice had identified 1.5% of the practice list as carers. The practice made efforts to identify and support carers in their population.
• Two members of staff had been trained as Carers Champions
• The practice worked collaboratively with another local practice to promote the Living in the Moment Group, which ran from a local community hall. The group offered support and advice to people who found themselves feeling isolated or lonely.
• The practice was involved in supporting patients recovering from cancer treatment once they were discharged from hospital care through a group called ‘Cancer and Beyond’.