Water Meadow Surgery

Updated 3 June 2016

Water Meadow Surgery is a large semi-rural surgery in Chesham, Buckinghamshire. The practice is located within purpose built premises that were originally built in 1995 and then extended in 1998; a commercial pharmacy is located within the same building.

Water Meadow Surgery is one of the practices within Chiltern Clinical Commissioning Group and provides general medical services to approximately 12,400 registered patients.

All services are provided from:

• Water Meadow Surgery, 31A Red Lion Street, Chesham, Buckinghamshire HP5 1ET.

The ground floor of the premises consists of the reception and seven GP consulting rooms, two nurse rooms and the pharmacy.

The first floor is split into two distinct areas. The first houses three further consulting rooms, the pharmacy office, medical records room and a small store room. The second area has offices for the practice manager, assistant practice manager, secretaries, general office, a store room and a large meeting room.

According to data from the Office for National Statistics, Buckinghamshire has a high level of affluence and minimal economic deprivation. However, Chesham is in the most deprived fifth of the population for Buckinghamshire. People in this most deprived fifth generally have poorer health and lower life expectancy than the Buckinghamshire average.

The practice population has a higher proportion of patients aged 40-59 compared to the national average. Ethnicity based on demographics collected in the 2011 census shows the population of Chesham is predominantly White British and 9% of the population of Chesham is composed of people with an Asian background.

The practice population also has a proportion of patients in a local care home (approximately 18 registered patients) and a care home for adults with severe learning and physical disabilities (approximately 12 registered patients).

The practice comprises of seven GP Partners (two male and five female), two female salaried GPs and two GP Registrars (one male and one female). The practice is a training practice for GP Registrars. GP Registrars are qualified doctors who undertake additional training to gain experience and higher qualifications in general practice and family medicine.

The all-female nursing team consists of four practice nurses and one health care assistant.

A practice manager and a team of reception and administrative staff undertake the day to day management and running of the practice.

The practice has core opening hours between 8am and 6.30pm Monday to Friday with appointments available from 8.20am to 5.50pm daily. Extended opening hours were on alternate Saturday mornings when the practice was open between 8am and 11am, alternate Tuesday and Wednesday evenings when the practice was open until 8.30pm. In addition, two mornings each week had pre-bookable appointments available from 7am.

The practice has opted out of providing the out-of-hours service. This service is provided by the out-of-hours service accessed via the NHS 111 service. Advice on how to access the out-of-hours service is clearly displayed on the practice website, on the practice door and over the telephone when the surgery is closed.

Updated 3 June 2016

Letter from the Chief Inspector of General Practice

We carried out an announced comprehensive inspection at Water Meadow Surgery on 12 May 2016. 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 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, working with other local providers to share best practice. For example the practice had recently commenced diabetes care planning.

• Feedback from patients about their care was consistently positive. Results from the national GP patient survey showed the majority of patients said they were treated with compassion, dignity and respect and they were involved in their care and decisions about their treatment when compared to the local and national averages. All feedback (verbal and written) from patients received on the day of inspection confirmed this.

• 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. For example, the practice website had recently been revised increasing the information content.

• The practice had good facilities and was well equipped to treat patients and meet their needs.

• Patients said they found it easy to make an appointment with a named GP, with urgent appointments available the same day.

• 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 strategy to deliver this vision had been produced with stakeholders and was regularly reviewed and discussed with staff.

• The practice had clear and visible clinical and managerial leadership and supporting governance arrangements.

However, there were areas of practice where the provider needs to make improvements. Importantly the provider should:

• Review how carers are identified and recorded on the patient record system to ensure information, advice and support is made available to them.

Professor Steve Field CBE FRCP FFPH FRCGP 

Chief Inspector of General Practice

Updated 3 June 2016

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

• Nursing staff had lead roles in chronic disease management and patients at risk of hospital admission were identified as a priority.

• Performance for diabetes related indicators showed the practice had achieved 93% of targets which was similar when compared to the CCG average (93%) and the national average (89%).

• 97% of patients with diabetes, on the register, have had influenza immunisation in the preceding 1 August to 31 March (01/04/2014 to 31/03/2015). This was higher when compared to the CCG average (93%) and national average (94%).

• Water Meadow Surgery had recently commenced diabetic care planning for patients with diabetes. The care plans allow patients to be more involved in decisions about how their diabetes is managed and gives patients a say in the care they receive for their diabetes.

• Longer appointments and home visits were available when needed.
• All patients had a named GP and those with long term conditions had a structured annual review to check their health and medicines needs were being met. 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 3 June 2016

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

• 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 people who had a high number of A&E attendances. Immunisation rates were relatively high for all standard childhood immunisations.

• Patients told us that children and young people were treated in an age-appropriate way and were recognised as individuals, and we saw evidence to confirm this.

• The practice’s uptake for the cervical screening programme was 83%, which was comparable to the CCG average (84%) and the national average (82%).

• Appointments were available outside of school hours and the premises were suitable for children and babies.

Updated 3 June 2016

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

• The practice offered proactive, personalised care to meet the needs of the older patients in its population.

• The practice worked with the multi-disciplinary teams in the care of older vulnerable patients.

• The practice was responsive to the needs of older patients, and offered home visits and urgent appointments for those with enhanced needs.
• 100% of patients aged 50 or over (who had not attained the age of 75,) with osteoporosis, were treated with an appropriate bone-sparing agent. This was higher when compared to the CCG average (89%) and national average (92%).

Updated 3 June 2016

The practice is rated as good for the care of working-age people (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.

• Extended opening hours suitable for working age people were available on alternate Saturday mornings when the practice was open between 8am and 11am, alternate Tuesday and Wednesday evenings when the practice was open until 8.30pm. In addition, two mornings each week had pre-bookable appointments available from 7am.

• 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.

• The practice offered the convenience of a daily phlebotomy service, contraception clinic, minor conditions management and travel immunisations.

Updated 3 June 2016

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

• 88% of people experiencing poor mental health had received an annual physical health check. This was comparable to the CCG average (89%) and national average (88%).

• 90% of patients diagnosed with dementia had their care reviewed in a face to face meeting in the last 12 months. This was higher when compared to the CCG average (86%) and national average (84%).

• The practice regularly worked with multi-disciplinary teams in the case management of patients experiencing poor mental health, including those with dementia.

• The practice carried out advance care planning for patients with dementia.

• The practice had told patients experiencing poor mental health about how to access various support groups and voluntary organisations.

• The practice had a system in place to follow up patients who had attended accident and emergency where they may have been experiencing poor mental health.

• Staff had a good understanding of how to support patients with mental health needs and dementia. We saw and heard plans that the practice was seeking advice from Alzheimer's Society (the leading UK care and research charity for people with Alzheimer’s disease and other dementias) to make adjustments to make the practice ‘dementia friendly’.

Updated 3 June 2016

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

• 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.