Dr Gabe & Partners Also known as Amersham Health Centre

Updated 3 August 2016

Dr A Wood and Partners is more commonly known as Amersham Health Centre and is a large, purpose built practice in Amersham, Buckinghamshire.

Amersham Health Centre is one of the practices within Chiltern Clinical Commissioning Group (CCG) and provides general medical services to approximately 13,000 registered patients.

All services are provided from:

• Amersham Health Centre, Chiltern Avenue, Amersham, Buckinghamshire HP6 5AY.

According to data from the Office for National Statistics, Buckinghamshire has a high level of affluence and minimal economic deprivation.

The practice population has grown significantly over the last five years and has a higher proportion of patients aged 5-14 and patients aged over 85 compared to the national average.

Amersham is located on the Metropolitan London Underground line and had a high percentage of practice patients commute in and out of London.

Ethnicity based on demographics collected in the 2011 census shows the population of Amersham is predominantly White British and 6% of the population is composed of people with an Asian background.

The practice population has a proportion of patients in five local care homes (approximately 104 registered patients).

The practice comprises of 10 GPs (seven female and three male) five of which are GP Partners (three female and two male). 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. No GP Registrars were working at the practice at the time of the inspection.

The all-female nursing team consists of two nurse prescribers, four practice nurses, one vulnerable patient nurse and two health care assistants who also provide phlebotomy services.

A practice manager and a team of reception, administrative and secretarial staff undertake the day to day management and running of Amersham Health Centre.

The practice had core opening hours between 8.30am and 6pm (a GP remained on site until 7pm) Monday to Friday with appointments available from 8.30am to 5.40pm daily. In agreement with the clinical commissioning group the out-of-hours service provide a message handling service between the hours of 8am and 8.30am and 6pm and 6.30pm.

Extended opening hours were available every Monday morning when appointments for the ‘sunrise clinic’ mainly aimed at commuters start at 7.20am. In addition, the practice was open between 8.30am and 12 noon every Saturday morning.

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 August 2016

Letter from the Chief Inspector of General Practice

We carried out an announced comprehensive inspection at Dr A Wood and Partners, more commonly known as Amersham Health Centre on 7 June 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 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 had revised their extended hours following patient feedback.

• Amersham Health Centre had good facilities and was well equipped to treat patients and meet their needs.

• Feedback from external stakeholders, notably the local care homes which Amersham Health Centre provided the GP service for was positive.

• Written feedback from patients said they found it easy to make an appointment. Patient satisfaction for the ‘express nurse clinics’ was highly positive.

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

• The practice used innovative and proactive methods to improve patient outcomes, working with other local providers to share best practice. For example, one of the GPs had led a falls prevention pilot. The aim of this pilot project was to utilise existing guidance and best practice in order to develop a comprehensive multidisciplinary community based falls prevention service for older people.

• 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.

We saw several areas of outstanding practice including:

• Amersham Health Centre had reviewed the needs of its local population and was providing a highly responsive service. For example, extended hours for the London commuters within the practice population,  enhanced safeguarding training for nurses, a vulnerable patient nurse for patients with complex needs, weekly ward rounds by a designated GP at the local care homes and daily ‘express nurse clinics’.

Professor Steve Field CBE FRCP FFPH FRCGP

Chief Inspector of General Practice

Updated 3 August 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 94% of targets which was similar when compared to the CCG average (93%) and better when compared to the national average (89%).

• One of the GPs had a special interest and further qualifications in the management of diabetes. We saw comprehensive and detailed diabetic care plans and the practice provided insulin initiation to all insulin dependent diabetic patients.

• Longer appointments and home visits were available when needed.
• All patients 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 practice staff worked with relevant health and care professionals to deliver a multidisciplinary package of care.

Updated 3 August 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 Accident and Emergency 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.
• We saw positive examples of joint working with midwives, health visitors and school nurses.

Updated 3 August 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 provided GP services to four local care homes. A designated GP held a weekly session at each home to review patients with non-urgent health problems; this time was also used to proactively identify and manage any emerging health issues and undertake medication reviews.

• The practice was responsive to the needs of older patients, and offered home visits and urgent appointments for those with enhanced needs.
• Nationally reported data showed that outcomes for patients for conditions commonly found in older people were higher than local and national averages. For example, 100% of patients with a stroke or TIA (a transient ischaemic attack also known as a mini stroke, with stroke like symptoms, except that the symptoms last for a short amount of time), diagnosed on or after 1 April 2014, had a referral for further investigation between three months before or one month after the date of the latest recorded stroke or the first TIA. This was higher when compared to the local CCG average (85%) and national average (88%).

Updated 3 August 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.

• Appointments were available between 8.30am and 5.40pm daily. Extended opening hours were available every Monday morning when appointments for the ‘sunrise clinic’ mainly aimed at commuters start at 7.20am. In addition, the practice was open between 8.30am and 12 noon every Saturday morning.

• All appointments with GPs at Amersham Health Centre were scheduled for 12.5 minutes. This was 25% longer than the national average GP appointment length (10 minutes).

• 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.

• Patients who wished to check their own blood pressure and their weight and height were encouraged to do so.
• The practice offered the convenience of a daily phlebotomy service, contraception clinic, minor conditions management, cryotherapy services and travel immunisations.

Updated 3 August 2016

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

• 97% of people experiencing poor mental health had a comprehensive care plan documented in their record, in the preceding 12 months, agreed between individuals, their family and/or carers as appropriate. This was better when compared to the CCG average (89%) and national average (88%).

• 83% of patients diagnosed with dementia had their care reviewed in a face to face meeting in the last 12 months. This was similar when compared to the CCG average (86%) and national average (84%).

• There was a Vulnerable Patient Nurse who supported vulnerable patients at home and liaised with relevant services to prolong independence. The practice informed vulnerable patients about how to access various support groups and voluntary organisations.

• The Vulnerable Patient Nurse visited dementia patients and their carers at their homes. Between April 2015 and March 2016, the Vulnerable Patient Nurse had completed 329 home visits; 86 of these included a face to face dementia review.

• 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.
• Staff had a good understanding of how to support patients with mental health needs and dementia.

Updated 3 August 2016

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

• People’s individual needs and preferences are central to the planning and delivery of tailored services. Services are flexible, provide choice and ensure continuity of care for example, telephone consultations were available for patients that chose to use this service.

• The practice held a register of patients living in vulnerable circumstances including homeless people, travellers and those with a learning disability.

• All Amersham Health Centre nurses had completed additional safeguarding training and Female Genital Mutilation awareness training.

• Amersham Health Centre practice offered longer appointments for patients with a learning disability. It had carried out annual health checks for 93% of people (28 out of 30 patients) with a learning disability and there was evidence that these had been followed up.

• There was a ‘Learning Disability Champion’ who liaised with patients and their support workers to promote regular and timely access to GP services.

• There was a Vulnerable Patient Nurse who supported vulnerable patients at home and liaised with relevant services to prolong independence. The practice, specifically the Vulnerable Patient Nurse 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.