Letter from the Chief Inspector of General Practice

This practice is rated as Good overall.

At our previous inspection in December 2014, Haddenham Medical Centre had an overall rating as Good.

Following the November 2017 inspection, the key questions are rated as:

• Are services safe? – Good

• Are services effective? – Good

• Are services caring? – Good

• Are services responsive? – Good

• Are services well-led? - Outstanding

As part of our inspection process, we also look at the quality of care for specific population groups. The population groups are rated as:

• Older People – Outstanding

• People with long-term conditions – Good

• Families, children and young people – Good

• Working age people (including those recently retired and students) – Good

• People whose circumstances may make them vulnerable – Good

• People experiencing poor mental health (including people with dementia) - Good

We carried out an announced comprehensive inspection at Haddenham Medical Centre in Haddenham, Buckinghamshire on 29 November 2017. 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 Haddenham Medical Centre was meeting the legal requirements and regulations associated with the Health and Social Care Act 2008.

At this inspection we found:

• Staff 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 had defined and embedded systems, processes and practices to minimise risks to patient safety.

• Staff understood their responsibilities to manage emergencies and to recognise those in need of urgent medical attention. For example, there was a comprehensive sepsis toolkit. Sepsis is a rare but serious complication of an infection. Without quick treatment,sepsis can lead to multiple organ failure and death. We saw there was a proactive approach to anticipate and manage the risk of sepsis. The practice had adapted existing systems to include additional escalation prompts if patients displayed potential symptoms of sepsis.

• Staff had received training appropriate to their roles and the population the practice served. Any further training needs had been identified and planned.

• Our findings showed that systems were in place to ensure that all clinicians were up to date with both National Institute for Health and Care Excellence (NICE) guidelines and other locally agreed guidelines.

• The continued development of staff skills, competence and knowledge was recognised as integral to ensuring high-quality care. We saw evidence of and staff we spoke with told us they are supported to acquire new skills and share best practice.

• We received positive feedback from external stakeholders and patients which access GP services from the practice.

• The practice learned lessons from individual concerns and complaints and also from analysis of trends. We observed the practice proactively sought feedback from staff and patients, which it acted on.

• The practice had clear and visible clinical and managerial leadership and supporting governance arrangements. There was a high level of constructive engagement with staff and all staff we spoke with told us they felt they were an integral part of the practice and they felt valued.

• There was a strong focus on continuous learning and improvement within the practice. For example, the practice was a GP teaching and training practice, supported medical students, nursing students and apprentices.
• There were two principals in the practices ethos, one was learning and development, across all staff groups and the other was a proactive approach to health promotion and prevention of ill health.

We saw areas of outstanding practice:

• The practice leadership was committed to meeting the needs of its population. This was evidenced through themed and targeted services, clinical audits and health promotion. This included a range of initiatives to meet the needs of specific groups – for example people with dementia, older people facing isolation and transport difficulties, military veterans, carers, Deaf people, travellers and the LGBT community.

• The practice had identified that there were a number of military veterans in their patient population and had taken action to help ensure this group of patients received suitable support in line with the government’s armed forces covenant. The practice encouraged these patients to identify themselves through signage at the practice, military veteran information packs, information on the practice website and via questions on the ‘new patient’ form. As a result of the increased awareness of the armed forces covenant, there had been a significant increase in the number of patients on the military veteran register.

• Haddenham Medical Centre provided an outstanding service to patients with caring responsibilities. This service was recognised by the Carers Bucks (an independent charity to support unpaid, family carers in Buckinghamshire) and the practice was awarded an Investors in Carers GP Standard award. This was in recognition of the extra support they offer to unpaid carers who are registered at the practice.

• The practice had achieved Gold, the highest award in the NHS ‘Pride in Practice’ award from the Lesbian, Gay, Bisexual and Transgender Foundation. This included bespoke training for all patient facing staff which demonstrated the practice’s commitment and dedication to ensuring a fully inclusive patient-centred service.

Professor Steve Field CBE FRCP FFPH FRCGP

Chief Inspector of General Practice

Letter from the Chief Inspector of General Practice

Haddenham Medical Centre is located in purpose built premises which opened in 2005. There is a commercial pharmacy located in the same building. Approximately 8,000 patients are registered at the practice. We carried out an announced comprehensive inspection of the practice on 10 December 2014. This was the first inspection of the practice since registration with the CQC.

Patients we spoke with were positive about the care they received. Some of the patients we spoke with were unclear about the appointment system at the practice. The practice results for the national GP patient survey 2013 were below the clinical commissioning group (CCG) and national average. The national survey had been carried out at a time of significant change within the practice. A GP had retired and locum GPs were working until a new partner was appointed. The practice had undertaken a short satisfaction survey in August 2014 and the results of this showed a 20% increase in the satisfaction ratings compared with the previous national survey.

We spoke with six patients during the inspection. We met with three members of the patient participation group. We spoke with four GPs, a GP in training and seven members of practice staff.

Haddenham Medical Centre was rated good overall.

Our key findings were as follows:

• the practice had systems in place to identify, assess and manage risks to patient’s safety. Medicines were safely stored, recorded and administered and the practice was following relevant guidelines to reduce the risk of cross infection.
• GPs and nurses followed national guidelines when delivering care.
• patients we spoke with and those who completed comment cards told us care was delivered with compassion and dignity.
• staff were appropriately trained and demonstrated sound knowledge of their roles and responsibilities. Clear lines of management responsibility were evident.
• the practice responded to patient concerns relating to access to appointments and changes had been made to the appointment system.

We saw an area of outstanding practice:

• flexible appointments were available for patients who relied on voluntary transport to bring them to and from appointments enabling older patients and those from rural communities to receive medical advice and treatments.

In addition the provider should:

• introduce a system to confirm necessary action has been taken in relation to medicines alerts and other national safety alerts
• consider the introduction of a stock control log for the medicines held in the medicines cupboard.
• re-issue guidance for patients on how to access appointments and the availability of on the day appointments for urgent medical needs.
• review their policy on undertaking criminal records checks for administration staff who carried out chaperone duties.

Professor Steve Field (CBE FRCP FFPH FRCGP) 

Chief Inspector of General Practice