13 October 2016
The Walnut Tree Health Centre provides a range of primary medical services, including minor surgical procedures from its location at Blackberry Court, Walnut Tree, Milton Keynes.
The practice serves a population of approximately 10,600 patients with slightly higher than average populations of both males and females aged 30 to 54 years. The practice population is largely White British with small populations of Polish and Somalian patients. National data indicates the area served is one of less than average deprivation in comparison to England as a whole.
The clinical team consists of three female GP partners, two nurse practitioners (qualified as Independent Prescribers), two practice nurses, one health care assistant and a phlebotomist. The practice employs locums where possible to provide additional access, successfully securing two regular locums for two days.The team is supported by a practice manager, a deputy practice manager, two patient care co-ordinators, a reception manager and a team of administrative staff. In addition, the practice employs its own pharmacist to support effective medicines optimisation within the practice.
The practice recently changed its contract with NHS England and now 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 is a training practice with an accredited GP trainer and a nurse practitioner also accredited as a GP trainer. A junior doctor had been in situ since September 2016. The practice was due to receive its new registrar in February 2017. (A registrar is a qualified doctor training to become a GP). In addition, it was providing support to a cohort of medical students from the new Buckingham University Medical School.
The practice had experienced some difficulties with staffing due to the departure of two out of five GP partners along with members of the administration team and the retirement of the practice manager. The practice was actively undergoing a recruitment process for new GPs to join the partnership and had successfully recruited a new practice manager and deputy.
The practice operates from a single storey purpose built property and patient consultations and treatments take place on ground level. There is a car park outside the surgery, with disabled parking available.
The Walnut Tree Health Centre is open between 8am and 6.30pm Monday to Friday. In addition, pre-bookable appointments are available from 6.30pm to 9pm on Mondays. The practice is a member of the local ‘Prime Ministers Challenge fund’ (PMCF) collaboration called MKExtra, enabling their patients, wishing to be seen outside of the practice’s extended and core hours, to receive routine GP care at a network of practices across the locality.
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.
13 October 2016
Letter from the Chief Inspector of General Practice
We carried out an announced comprehensive inspection at Walnut Tree Health Centre on 24 August 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.
- Whilst the majority of patients said they found it easy to make an appointment some commented on difficulty accessing appointments on occasion. The practice was actively recruiting for new GP partners and was aware of occasional difficulties accessing appointments. They were proactive in making changes to improve access.
- Urgent appointments were available the same day.
- The practice had good facilities and was well equipped to treat patients and meet their needs.
- 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 one area 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 practice 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).
The areas where the provider should make improvements are:
- Develop systems to identify and support more carers in their patient population.
- Continue to monitor and ensure improvement to patient access to GP appointments.
Professor Steve Field (CBE FRCP FFPH FRCGP)
Chief Inspector of General Practice
13 October 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, with a record of a foot examination and risk classification within the preceding 12 months was 95%, where the CCG average was 91% and the national average was 88%.
- 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 more complex needs, the named GP worked with relevant health and care professionals to deliver a multidisciplinary package of care.
13 October 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 may be 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 82%, 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.
13 October 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 registered frail elderly patients in a local nursing home.
- 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, personalised care plans and priority access to GP care if needed.
- The practice recognised that some elderly patients were at risk of becoming isolated and had encouraged these patients to partake in an annual charity cake stall held during the flu vaccine clinics in an effort to encourage and develop social contact
13 October 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. For the period January 2013 to August 2016, the practice had completed 1,801 of 3,445 (52%) eligible health checks
- Pre-bookable appointments were available from 6.30pm till 9 pm on Mondays.
- The practice had increased the number of telephone consultations available daily.
- 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. We saw plans to introduce an advanced website which would increase online services, including the option to email queries to the practice.
13 October 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 73% where the CCG average was 78% and the national average was 84%.
- The practice provided dementia screening services for patients identified as at risk of developing dementia to allow for early intervention and support if needed.
- 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 comparable to local and national averages. For example, with diagnosed psychoses who had a comprehensive agreed care plan was 94% 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 support groups and voluntary organisations.
- The practice had a system in place to follow up patients who had attended A&E 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.
13 October 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 homeless people and those with a learning disability.
- 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 support groups and voluntary organisations.
- The practice held palliative care meetings in accordance with the national Gold Standards Framework (GSF) 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 24 patients (0.2% of the practice list) as carers. The practice was making efforts to identify and support carers in their population.