This practice is rated as Good overall.

The previous inspection was in April 2016 and the practice was rated Good.

The key questions at this inspection are rated as:

Are services safe? – Good

Are services effective? – Good

Are services caring? – Good

Are services responsive? – Good

Are services well-led? - Good

We carried out an announced comprehensive at Dr Dickson and Partners, more commonly known as Norden House Surgery in Buckinghamshire on 14 May 2018. We carried out this inspection under Section 60 of the Health and Social Care Act 2008 as part of our regulatory functions. This inspection was planned to check whether the practice was meeting the legal requirements and regulations associated with the Health and Social Care Act 2008.

At this inspection we found:

• The practice had clear systems to manage risk so that safety incidents were less likely to happen. When incidents did happen, the practice learned from them and improved their processes.

• The practice routinely reviewed the effectiveness and appropriateness of the care it provided. It ensured that care and treatment was delivered according to evidence- based guidelines.

• Staff involved and treated patients with compassion, kindness, dignity and respect.

• Patients found the appointment system easy to use and reported that they were able to access care when they needed it.

• There was a focus on continuous learning and improvement at all levels of the organisation. The practice was fully aware of the developments within North Buckinghamshire and local health economy.

• The practice worked closely with other organisations and with the local community in planning how services were provided to ensure that they meet patients’ needs.

The areas where the provider should make improvements are:

• Continue to review and seek to improve the leadership arrangements, staff engagement and staff satisfaction within the dispensary team.

Professor Steve Field CBE FRCP FFPH FRCGP
Chief Inspector of General Practice

Letter from the Chief Inspector of General Practice

We carried out an announced comprehensive inspection at Dr Dickson and Partners, more commonly known as Norden House Surgery on 27 April 2016. Overall the practice is rated as good.

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

• We found the practice had made improvements since our last inspection on 17 December 2014 and they were meeting regulations, relating to the management of medicines and assessing and monitoring the quality of service, that had previously been breached.

• Staff understood and fulfilled their responsibilities to raise concerns and report incidents and near misses. All opportunities for learning from internal and external incidents were maximised.

• The practice used innovative and proactive methods to improve patient outcomes. For example the designated GP for a local care home had developed an IT link with the computer system at the care home. This provided immediate access to care records, helped with the construction of health care plans, and created continuity in care.

• Feedback from patients about their care was consistently positive.

• Patients said following the recently changed appointment system they now found it easy to make an appointment with a named GP and that there was continuity of care, with urgent appointments available the same day.

• The practice worked closely with other organisations and with the local community in planning how services were provided to ensure that they meet patients’ needs. For example, the practice led a collaborative project with seven local practices. The aim of the project was to transform care of the elderly in the locality.

• The practice actively reviewed complaints and how they are managed and responded to, and made improvements as a result.

• The practice had a clear vision which had quality and safety as its top priority. The practice was fully aware of the developments within the village and local health economy.

• The practice had an effective governance system in place, was well organised and actively sought to learn from the previous Care Quality Commission inspection, performance data, complaints, incidents and feedback.

We saw several areas of outstanding practice, notably practice which impacts the care and treatment received by older people including:

• The practice supported older people within the locality to live healthier independent lives through a targeted and proactive approach to health promotion and prevention of ill health. For example, there was a designated GP who point of contact for the care home which the practice provides GP services for. Contact details of the designated GP were shared with the relevant staff, patients and their families, enabling continuity of care and quick access to the right staff at the practice. Furthermore, the designated GP for the care home had developed an IT link with the computer system at the home. This provided immediate access to care records, helped with the construction of health care plans, and created continuity in care. The GP had also set up procedures and protocols for the home to contact GPs in and out of hours.

• Norden House Surgery commenced the management of North Bucks over 75’s team in January 2016. This was a collaborative project with seven local practices with Norden House Surgery leading the project. The aim of the project was to transform care of the elderly in the locality and included supporting those aged over 75 to live independently in their own homes. It was also targeted to reduce unplanned admissions and decrease the feelings of isolation. Since the service moved to Norden House, 44 patients in the locality had been referred to the service. In April 2016, the over 75’s team had 115 patients who had all had a full assessment.

Professor Steve Field CBE FRCP FFPH FRCGP 

Chief Inspector of General Practice

Letter from the Chief Inspector of General Practice

We inspected Dr Fairfield and partners on 17 December 2014. This was a comprehensive inspection. The practice is based in two buildings separated by a small car park. We inspected both Norden House Surgery and the areas of Winslow Health Centre occupied by the practice. The practice was seeking to move to larger premises and had made planning applications for such a move in the past.

We have rated the practice as requires improvement although we found many examples of good care and treatment being offered. The practice must make improvements in safeguarding and the administration of medicines. In addition action needs to be taken to reduce the risk of confidential information being overheard by others.

Our key findings were as follows:

• The practice offered effective care and treatment. Most national targets were achieved in the care of patients with long term conditions and for older patients. Where the practice had identified the need for improvements action was taken to make changes. For example recruitment of an additional practice nurse was underway.
• Appropriate systems for management of the dispensary were in place. A dispensary patient satisfaction survey was undertaken in 2014 and this showed patients rated the service highly.
• The practice made efforts to deliver services to vulnerable patients and those who sometimes found it difficult to access services. Joint visits with local midwives were undertaken to expectant and new mother in the local traveller community.
• The practice was active in a plan to improve services for patients over the age of 75.

There were areas of practice where the provider needs to make improvements.

Importantly, the provider must:

• Ensure health care assistants obtain authorisation from an approved prescriber before administering flu immunisations to meet legal requirements.
• Respond to feedback from patients in regard to undertaking a strategic review of the appointments system and ensuring sufficient appointments are offered to meet demand.
• Make provision to reduce the opportunity for discussions with patients in Norden House reception, and reception office, being overheard by others. This had been reported as an issue of concern by patients and the practice had not responded by taking appropriate action to reduce risk.

The provider should also

• Ensure all GPs have achieved, or are working towards, the appropriate level of training in safeguarding of children.
• Promote the availability of chaperones.
• Operate a consistent monitoring process to ensure standards of cleanliness are maintained.

Professor Steve Field (CBE FRCP FFPH FRCGP) 

Chief Inspector of General Practice