The New Surgery

Updated 27 September 2016

The New Surgery is located within a purpose built, two storey, large health centre in Chesham, Buckinghamshire. It is one of the practices within Chiltern Clinical Commissioning Group and

provides general medical services to over 10,800 patients. According to data from the Office for National Statistics, Buckinghamshire has a high level of affluence and minimal economic deprivation. However, there are pockets of deprivation within the practice boundary. Ethnicity based on demographics collected in the 2011 census shows the population of Chesham is predominantly White British and 11% of the practice population is composed of patients with an Asian background.

The practice shares the building with another GP practice, a dental surgery and a pharmacy. The New Surgery has eight consultation rooms (including two registrar rooms) and four treatment rooms, which are all accessible from the waiting room on the ground floor. Patient facilities include self-check blood pressure and weight machine, baby change area and three ground floor toilets with disabled access. The practice offer rooms to external providers to facilitate many services to patients on site, removing the need for them to attend hospital. These include, ascending aortic aneurysm screening, healthy minds, ultrasound service, falls clinic and utilities clinic. The practice also look after residents from five nursing/care homes in the local area.

There are six GP partners (three male, three female) offering a whole time equivalent (WTE) of 5.25 GPs. There are no salaried GPs and locums are rarely used. The nursing team consists of four practice nurses and a healthcare assistant (HCA) (all female). All the nurses are part time and make up a WTE of 2 full time nurses with the HCA offering a WTE of 0.56. The day to day management of the practice is supported by a large team of administration staff including a practice director, IT manager, medical secretary, summariser, administrator, reception manager and eight part time receptionists.

The practice is open between 8am and 6.30pm Monday to Friday. Appointments are from 8.20am to 11.20am every morning and 3pm to 5.20pm daily. Extended hours appointments for face-to-face consultations are offered on one Friday morning per month from 7am and one Saturday morning per month from 8am until 11am. In addition, telephone consultations are available weekly from Tuesday through to Thursday from 6.30pm to 7pm.

The practice have opted out of providing out of hours cover. This is provided by Buckingham Urgent Care (BUC). BUC can be contacted by calling the NHS 111 number.

All services are provided from:

Chess Medical Centre, 260-290 Berkhampstead Road, Chesham, HP5 3EZ

The practice has been inspected before in 2014. At the time of that inspection the practice were meeting all the fundamental standards under CQC old methodology for GP inspections.

Updated 27 September 2016

We carried out an announced comprehensive inspection at The New Surgery on 9 August 2016. Overall the practice is rated as Good.

Our key findings across all the areas we inspected were as follows:

• There was an open and transparent approach to safety and an effective system in place for reporting and recording significant events.
• Risks to patients were assessed and well managed.
• Staff assessed patients’ needs and delivered care in line with current evidence based guidance. Staff had been trained to provide them with the skills, knowledge and experience to deliver effective care and treatment.
• Patients said they were treated with compassion, dignity and respect and they were involved in their care and decisions about their treatment.
• Information about services and how to complain was available and easy to understand. Improvements were made to the quality of care as a result of complaints and concerns.
• Patients said they found it easy to make an appointment with a named GP and there was continuity of care, with urgent appointments available the same day.
• The practice had good facilities and was well equipped to treat patients and meet their needs.
• There was a clear leadership structure and staff felt supported by management. The practice proactively sought feedback from staff and patients, which it acted on.
• The provider was aware of and complied with the requirements of the duty of candour.

Professor Steve Field CBE FRCP FFPH FRCGPChief Inspector of General Practice

Updated 27 September 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.

• 76% of patients with diabetes had achieved a target blood level of below 64mmols in the preceding 12 months compared to the Clinical Commissioning Group (CCG) average of 78% and national average of 78%.

• 91% of patients with chronic obstructive pulmonary disease (a lung condition) had received a review of their condition, including an assessment of breathlessness, in the preceding 12 months compared to the CCG average of 92% and national average of 90%. However, the exception reporting for this indicator was 20%.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.

Updated 27 September 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.

• 93% of female patients aged 25 to 64 years had a cervical screening test performed compared to the CCG average of 84% and national average of 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 27 September 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 people in its population.

• The practice was responsive to the needs of older people, and offered home visits and urgent appointments for those with enhanced needs.

• The practice facilitated a hospital trust led falls prevention classes for older patients at risk of falling. This enabled patients to be assessed for falls at the practice, reducing the need to attend hospital for this.

Updated 27 September 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 offered extended hours appointments for working patients who could not attend during normal working hours.

Updated 27 September 2016

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

• 76% of patients diagnosed with dementia who had their care reviewed in a face to face meeting in the last 12 months compared to the CCG average of 86% and national average of 84%.
• 92% of patients with a diagnosed mental health condition had received a comprehensive care plan within the preceding 12 months compared to the CCG average of 89% and national average of 88%.

• 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.

Updated 27 September 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.