The Practice Prospect House

Updated 21 October 2016

The Practice Prospect House is situated in semi-rural small town of Great Missenden, Buckinghamshire within a converted premises with car parking for patients and staff. All patient services are offered on the ground floor. The practice comprises of four consulting rooms, two treatment rooms, a patient waiting area, a reception area, administrative and management office.

The practice has core opening hours from 8.30am to 6pm Monday to Friday. The practice offers a range of scheduled appointments to patients every weekday from 8.30am to 5.40pm including open access appointments with a duty GP throughout the day. The practice offers extended hours appointments Saturday morning (once a month) from 9am to 12pm at the premises.

The practice has a patient population of approximately 3,620 registered patients. The practice population of patients aged between 5 to 14 and 40 to 59 years old is higher than the national average and there are lower number of patients aged between 0 to 4 and 20 to 39 years old compared to national average.

Ethnicity based on demographics collected in the 2011 census shows the patient population is predominantly White British and 3.5% of the population is composed of patients with an Asian, Black or mixed background. The practice is located in a part of Buckinghamshire with the lowest levels of income deprivation in the area.

There is one clinical director, two salaried GPs and one GP registrar at the practice. Three GPs are male and one female. This is a training practice, doctor who is training to be qualified as a GP has access to a senior GP throughout the day for support. We received positive feedback from the trainee we spoke with.

At the time of inspection the practice’s CQC registration was incorrect. A new CQC registered manager had not been added and a previous CQC registered manager had not been removed from the practice’s CQC registration records. However, the practice had informed us that they had contacted a previous CQC registered manager and advised to submit an appropriate application form to remove their name from the practice’s CQC registration records.

The practice employs two practice nurses and two health care assistants. The practice manager is supported by a senior administrator, a team of administrative and reception staff. Services are provided via a General Medical Services (GMS) contract (GMS contracts are negotiated nationally between GP representatives and the NHS).

Services are provided from following location:

Prospect House

108 High Street

Great Missenden

Buckinghamshire

HP16 0BG

The practice has opted out of providing out of hours services to their patients. There are arrangements in place for services to be provided when the practice is closed and these are displayed at the practice, in the practice information leaflet and on the patient website. Out of hours services are provided during protected learning time by Bucks Urgent Care out of hours service or after 6:30pm, weekends and bank holidays by calling NHS 111.

Updated 21 October 2016

Letter from the Chief Inspector of General Practice

We carried out an announced comprehensive inspection at The Practice Prospect House on 21 September 2016. Overall the practice is rated as good.

Specifically, we found the practice good for providing safe, effective, caring, responsive and well led services.

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

• Staff understood and fulfilled their responsibilities to raise concerns, and to report incidents and near misses. The majority of information about safety was recorded, monitored and reviewed.
• 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 we spoke to on the day of inspection informed us they were able to make an appointment with a named GP, with urgent appointments 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.

The areas where the provider should make improvements are:

• Consider patient feedback and improve the availability of extended hours appointments offered by the practice.
• Ensure all staff are aware that a translation service is available and information about a translation service is displayed in the reception areas.

Professor Steve Field (CBE FRCP FFPH FRCGP) 

Chief Inspector of General Practice

Updated 21 October 2016

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

• There were clinical leads for chronic disease management and patients at risk of hospital admission were identified as a priority.
• Longer appointments and home visits were available when needed.
• All patients with long term conditions had a named GP and the practice carried out a structured annual review to check that their health and medicines needs were being met.
• The practice had a dedicated member of staff to place reminders on the practice’s computer system to ensure all reviews were done in a timely manner. We noted the practice was reviewing complex cases on six monthly basis.
• A clinical lead GP had revised and developed templates with embedded links for referrals and recall system in place. The practice had created an online video to train all clinicians about how to use new templates.
• 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.

Updated 21 October 2016

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

• 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 patients who had a high number of A&E attendances.
• Immunisation rates were high for all standard childhood immunisations.
• Patients told us that children and young patients were treated in an age-appropriate way and were recognised as individuals.
• The practice’s uptake for the cervical screening programme was 84%, which was higher than the national average of 82%.
• The practice had a dedicated lead to offer support with smoking cessation and domestic violence.

• 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.

Updated 21 October 2016

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

• The practice offered proactive, personalised care to meet the needs of the older patients in its population.
• It was responsive to the needs of older patients, and offered home visits and urgent appointments for those with enhanced needs.
• There was a register to effectively support patients requiring end of life care.
• There were good working relationships with external services such as district nurses.
• The premises was accessible to those with limited mobility. However, the practice did not have an automatic door activation system at the front door used to enter the premises but there was a bell to alert staff to help with accessing the practice.

Updated 21 October 2016

The practice is rated as good for the care of working-age patients (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 offered extended hours appointments Saturday morning (once a month) from 9am to 12pm at the premises. However, three patients we spoke with said they would like to see improvements in extending hours offered by the practice.
• 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.
• We noted the practice was offering telephone consultation and remote consultation through Skype. The practice had carried out an audit and identified 27% appointments did not require face to face consultations.

Updated 21 October 2016

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

• Data from 2014-15 showed, performance for dementia face to face reviews was below the CCG and national average. The practice had achieved 80% of the total number of points available, compared to 86% locally and 84% nationally.
• 77% of patients experiencing poor mental health were involved in developing their care plan and health checks.
• 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 how to access various support groups and voluntary organisations.
• Systems were in place to follow up patients who had attended accident and emergency, when experiencing mental health difficulties.
• Staff had a good understanding of how to support patients with mental health needs and dementia.

Updated 21 October 2016

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

• The practice held a register of patients living in vulnerable circumstances including homeless people, travellers and those with a learning disability.
• It offered annual health checks for patients with learning disabilities. Health checks and care plans were completed for six out of seven patients on the learning disability register.
• 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.
• 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.