Drs Czerniewski, Reynolds, Chesser & Harris Also known as Dunchurch Surgery

Updated 28 October 2016

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

• The nursing team offered chronic disease management clinics at flexible times. A retinal screening van visited the practice on approximately 10 days over a period of several months. Appointments for patients with a diagnosis of diabetes were scheduled for the same dates for patient convenience.
• Longer appointments and home visits were available for patients with long term conditions.
• Performance for diabetes related indicators was similar to the national average range. 85% of patients with diabetes’ last blood pressure reading within an acceptable range which was significantly higher than CCG and national averages of 79% and 78%. 94% of patients on the register had had a foot examination and risk classification in the previous 12 months, higher than the national average of 88%.
• Patients with a long term condition had a care plan in place where appropriate.
• House-bound patients were offered a flu vaccination which was administered in their own home.

• The practice had appointed an end of life care lead who held quarterly palliative care meetings with district and Macmillan nurses. This helped the practice to provide a coordinated package of care to people with terminal illnesses. The practice followed the Gold Standards Framework (GSF) in end of life care. The GSF encourages clinicians to focus on providing high quality, coordinated care to people nearing the end of their lives.

Updated 28 October 2016

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

• The practice had a safeguarding lead who held quarterly child safeguarding meetings.
• Childhood immunisation rates for the vaccinations given were comparable to CCG and national averages.
• Staff told us that children and young people were treated in an age-appropriate way and were recognised as individuals. Clinical staff showed a clear understanding of Gillick competence and Fraser guidelines. Gillick competence is concerned with determining a child’s capacity to consent. Fraser guidelines are used specifically to decide if a child can consent to contraceptive or sexual health advice and treatment.
• Appointments were available outside of school hours and the premises were suitable for children and babies.
• The practice told us they targeted pregnant women with health promotion such as smoking cessation and pertussis (whooping cough) immunisation.
• Postnatal and baby checks were offered to mothers during an extended appointment for convenience.

Updated 28 October 2016

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

• The practice recognised that it had a higher than average population of older people, with 29% of the patient list aged 65 or over. The practice offered personalised care to meet their needs. For example the practice offered a phlebotomy service to older patients who were unable to travel independently to local hospitals.
• The practice was responsive to the needs of older people, and offered home visits and urgent appointments for those with enhanced needs.
• Clinical staff maintained care plans for older patients at higher risk of admission to hospital.
• The practice had patients who lived in three local care homes. We spoke with staff at the care homes who described the service the practice provided to people as responsive, helpful and very professional. GPs carried out medication reviews and dealt appropriately with patients’ relatives.

Updated 28 October 2016

The practice is rated as good for the care of working-age people (including those recently retired and students).

• The practice remained open at lunchtime to assist patients who worked during the day.
• Appointments could be booked up to six weeks in advance. Patients could register with the online booking service to book routine GP appointments at a time that was convenient for them. The practice was trialling a system of offering later afternoon appointments online to help address the needs of working patients. 
• The practice offered a range of screening and health promotions to meet the needs of working age people. For example, heart health checks were available to those aged 40 to 74. QOF indicators showed that the practice’s patient uptake of cervical screening was in line with national averages. 
• The practice offered flu vaccination clinics on Saturday mornings at the appropriate times of year to try to improve uptake by working age patients with long term conditions.

Updated 28 October 2016

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

• Clinical staff at the practice liaised with local multi-disciplinary teams to provide continuity of care to patients experiencing poor mental health, including those with dementia.
• The practice used mental health care plans and offered annual health checks for patients with ongoing mental health issues.
• Longer appointments were available to patients experiencing poor mental health if requested or known to be needed.
• Performance for mental health related indicators was similar to CCG and national averages. For example, 90% of patients experiencing poor mental health had a comprehensive agreed care plan documented within the last 12 months. This was 2% above the national average and 6% above the CCG average.
• The practice maintained personalised care plans for patients on their dementia register.
• 82% of patients diagnosed with dementia had a face to face care review in the past 12 months, compared with 84% nationally and 82% in the CCG area overall.
• The practice held an in-house presentation chaired by a member of the Alzheimers Society on how to become a Dementia Friend. The Dementia Friends programme is aimed at improving people’s understanding of dementia and the ways they can help people living with the condition. The presentation was attended by the Patient Participation Group (PPG), and resulted in a number of practice staff and PPG members becoming Dementia Friends. A PPG is a group of patients registered with the practice who worked with the practice to improve services and the quality of care.
• Weekly counselling sessions were offered at the surgery through Improving Access to Psychological Therapies (IAPT). IAPT are NHS services for people with mild, moderate and moderate to severe symptoms of anxiety or depression.

Updated 28 October 2016

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

• The practice held registers of patients living in vulnerable circumstances including those with a learning disability. Potentially vulnerable patients were identified via new patient health checks, consultations, and interactions with staff.
• The practice used a case management register to help manage potentially vulnerable patients and reduce avoidable or unplanned admissions or re-admissions to hospital. For example, the practice had a number of older patients on its case management register who were considered to be at risk and lived alone. The practice informed us that all of these patients had either had an annual health check or had been given an appointment to attend one within the year.
• The practice offered longer appointments for patients who required them.
• Patients considered to be at risk, for example those with a severe learning disability, had personalised care plans.
• The practice had a lead for its patients in a local care home for people with a learning disability. The lead visited six monthly to carry out reviews.
• The practice asked patients with mobility difficulties if they had someone who could collect their prescriptions for them, and offered to help if needed.
• Staff knew how to recognise signs of abuse in vulnerable adults and children and were aware of their responsibilities and how to contact relevant agencies. There were lead members of staff for children’s and adults’ safeguarding, and GPs were trained to an appropriate level in safeguarding adults and children.
• The practice offered patients who did not speak the English language with confidence access to translation services where appropriate.
• Disabled facilities were available at the practice including parking, step free access to consultation rooms and a hearing loop.
• The practice had no travellers or homeless people on their patient list at the time of our visit but explained they would accept and register people from these groups as temporary patients.