Hughenden Valley Surgery Also known as Dr M J Mitchell & Partners

Updated 30 December 2016

Letter from the Chief Inspector of General Practice

In March 2016 we found concerns related to the management of medicines, specifically medicines that required refrigeration during a comprehensive inspection of Hughenden Valley Surgery in Buckinghamshire. Following the inspection the provider sent us an action plan detailing how they would improve the area of concern. At the previous inspection in March 2016, we found one breach regulations relating to the safe delivery of services.

Using information provided by the practice we carried out a desktop review of Hughenden Valley Surgery on 15 December 2016 to ensure these changes had been implemented and that the service was meeting regulations.

The ratings for the practice have been updated to reflect our findings following the improvements made since our last inspection and the practice was now meeting the regulations that had previously been breached.

Specifically the practice was:

• Operating safe systems in relation to the management of medicines including effective supporting processes. This included an updated cold chain policy and cold chain awareness training to ensure all practice staff were updated on the practices processes for medicines that required refrigeration.

• Furthermore, the practice had also reviewed the arrangements for temporary members of staff, ensuring there was a full induction training programme and access to practice policies.

Hughenden Valley Surgery had taken full heed of the findings of the inspection undertaken in March 2016 and is now rated good for the provision of safe, effective, caring, responsive and well led services.

Professor Steve Field CBE FRCP FFPH FRCGP

Chief Inspector of General Practice

Updated 17 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.

• Data available demonstrated that the monitoring and management of patients with diabetes was comparable to CCG and national averages.

• Longer appointments and home visits were available when needed.

• All these patients had a named GP and 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.

• The practice undertook annual screening for patients with pre-diabetes or a history of gestational diabetes in pregnancy.

• The practice undertook opportunistic screening for conditions including chronic obstructive pulmonary disease (COPD), atrial fibrillation, obesity and diabetes.

• The practice provided information packs for patients with COPD or diabetes.

• The practice undertook care planning for patients with diabetes to support patients in managing the condition.

Updated 17 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 accident and emergency attendances. Immunisation rates were relatively high for all standard childhood immunisations.

• 76% of patients diagnosed with asthma had their condition reviewed in the last 12 months, in line with CCG and national averages.

• 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.

• 84% of female patients aged 25-64 had attended for a cervical screening test in the last five years, in line with CCG and national averages.

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

• The practice had piloted a series of CU2day daily winter clinics for children, allowing extended emergency appointments during which multiple issues could be addressed or siblings seen together. The clinics had a dedicated child-friendly waiting area, and provided education for parents on child health issues.

• We saw positive examples of joint working with midwives, health visitors and school nurses.

• The families of newborns were sent “birthday” cards which included a jaundice reference chart.

Updated 17 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 was responsive to the needs of older patients, and offered home visits and urgent appointments for those with enhanced needs.

• The practice had a VALIANT (Vulnerable Adults Living Independently Advanced Nursing Team) nurse providing home-based welfare support for vulnerable and complex needs patients, including the elderly.

• The practice undertook reviews on patients aged 75 and over when discharged from hospital.

• The practice offered a volunteer driver service to enable elderly patients to attend appointments and a medicines delivery service.

Updated 17 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.

• 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’s website was designed so that it could be used easily via a smartphone or tablet, and an app (an application available on smartphones) had been designed for appointment booking and repeat prescription requests.

• The practice offered telephone consultations and evening and weekend flu clinics for those who could not easily attend appointments during daytime hours.

• The practice checked pathology reports on a monthly basis to identify any blood tests which had been requested more than three months previously but not been undertaken by patients.

Updated 17 June 2016

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

• 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. Staff were motivated and inspired to offer kind and compassionate care and worked to overcome obstacles to achieving this. Forty three staff members had completed training to become Alzheimer’s Society Dementia Friends, and the dementia support packs provided to patients with dementia had been adopted by the CCG for use in other practices.

• The practice had run a series of carer clinics to provide emotional support and practical advice for patients identified as carers.

• The practice had a telephone call reminder system to support patients with dementia in attending appointments.

• The practice helped patients complete “This Is Me” leaflets detailing healthcare and other needs prior to hospital admissions.

• The practice made referrals to the county council’s Prevention Matters advice service for vulnerable patients, the local fire service’s project for vulnerable housebound smokers.

• The practice was a member of the county council’s “Safe Place” scheme to provide support for any vulnerable community member in an emergency.

• Vulnerable patients were offered daily or weekly dosette boxes to manage their medicine use as required.

Updated 17 June 2016

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

• The practice had appointed a VALIANT (Vulnerable Adults Living Independently Advanced Nursing Team) nurse providing home-based welfare support for vulnerable and complex needs patients.

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

• The practice offered longer appointments for patients with a learning disability, and had provided patients with health passports detailing healthcare needs and preferences.

• The practice regularly worked with multi-disciplinary teams 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.

• The practice held a register of carers, had appointed a staff member as carers’ champion, and had held a series of carers’ clinics to provide support and advice.

• The practice had a volunteer driver and medicines delivery service, and staff had previously provided additional support for patients when required, including helping with shopping in a crisis, and assisting with pets during unplanned hospital admissions.

• The practice had been registered as a Safe Haven by the county council, to provide support to vulnerable people, including those with dementia, a learning or physical disability, or a severe medical condition, if they found themselves at risk or experiencing an emergency when out on their own.