This practice is rated as Good overall.

The previous inspection was in November 2015 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? – Requires Improvement

Are services well-led? - Good

We carried out an announced comprehensive at Whitehill Surgery in Aylesbury, Buckinghamshire on 12 June 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.

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

• Patients and external stakeholder feedback advised they had difficulty in accessing care and treatment. Patients told us although the appointment system had improved there were still delays and barriers accessing the service.

• There was a focus on continuous learning and improvement at all levels of the organisation.

• There was a clear leadership structure and staff felt supported by management.

• The practice regularly reviewed the safety of the premises to deliver health care.

• Patients taking repeat medicines received regular review of their prescriptions.

The areas where the provider must make improvements are:

• Establish effective systems and processes to ensure good governance in accordance with the fundamental standards of care. (Please refer to the requirement notice section at the end of the report for more detail).

The area where the provider should make improvement is:

• Continue to review the number of patients attending the cervical screening programme, with a view to increase uptake rates.

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 of Whitehill Surgery on 17 November 2015. Overall the practice is rated as good.

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. Information about safety was recorded, monitored, appropriately reviewed and addressed.

• Patients’ needs were assessed and care was planned and delivered following best practice guidance. Staff had received training appropriate to their roles and any further training needs had been identified and planned.

• Patients said they were treated with compassion, dignity and respect and they were involved in their care and decisions about their treatment. Information was provided to help patients understand the care available to them.

• The practice implemented suggestions for improvements and made changes to the way it delivered services as a consequence of feedback from patients and from the Patient Participation Group (PPG).

• The practice had an effective governance system in place, was well organised and actively sought to learn from performance data, incidents and feedback.

We saw several areas of outstanding practice including:

• The practice were committed in raising people’s awareness of dementia. Most practice staff had completed dementia training and dementia awareness workshops. Training provided by Dementia Academic Action Group and the Alzheimer’s Society had resulted in the practice having a network of ‘dementia friends’ (Dementia Friends is an Alzheimer’s Society initiative that aims to give people a greater understanding of the impact of dementia and ways to help people with dementia live well in their community.) Staff told us this training had helped them to understand how they could help people living with this condition more effectively.

• There was specific designated GP point of contacts for the three care homes (approximately 147 patients) which the practice provided GP services for. Contact details of the designated GPs were shared with the relevant staff, patients and their families, enabling continuity of care and quick access to the right staff at the practice.

• The practice was proactive in its support of carers. For example, the computer system alerted GPs if a patient was also a carer and a member of staff carried out the role of a “carers champion”. This staff member made annual contact with every carer on the register to personally ensure they were receiving the care and support they required. The carers register was then updated based on this contact.

• The practice was part of a local apprentice programme and had been awarded with the “Best Employer” award. There were two current apprentices at the practice on a two-year apprenticeship to gain a level 2 diploma in business administration. The scheme has led to employment for previous apprentices, either in this practice or other local practices.

Professor Steve Field CBE FRCP FFPH FRCGP 

Chief Inspector of General Practice

Patients told us they were treated with dignity and respect when they called or visited the practice. They said they were involved in making decisions about the treatment they received.

Patients described their GP as being “very good”, and “professional”. “My doctor is a perfect gentleman and always has been. He takes time to listen to your problems. You feel better when you can talk through things. It somehow makes things seem not so bad after all. You feel safe when you lessen your burden.” “My doctor is excellent. He takes a personal interest in your well-being… I’d say he goes above and beyond what a GP needs to do.”

The practice took a positive approach to ensure the needs of the most vulnerable patients were met. People’s care and treatment reflected relevant research and guidance. Where a patient's diagnosis could not be treated by the GP, they were effectively referred on to another service such as a consultant at a hospital.

All staff employed were subjected to character checks and qualified staff had their registration to practice verified.

Quality monitoring systems were in place. A Patient Representative Group supported people to make suggestions and raise concerns about the practice. This helped the provider to monitor the quality of service provided for people. Improvements were noted and their continuing work impressive.

Patients we spoke with told us they would know how to make a complaint should they need to do so.