Dr Bajwa and Partners Also known as Little Chalfont Surgery

Updated 12 April 2016

Dr Bajwa and Partners is more commonly known as Little Chalfont Surgery and is a small semi-rural surgery in Little Chalfont, Buckinghamshire. The practice is located within a converted residential dwelling that was extended in 2005; a dental practice is located within the same building. Little Chalfont Surgery is one of the practices within Chiltern Clinical Commissioning Group and provides general medical services to approximately 5,600 registered patients.

All services are provided from:

• Little Chalfont Surgery, 200 White Lion Road, Little Chalfont, Buckinghamshire HP7 9NU.

The practice comprises of two GP Partners (both male), one female GP Retainer (a GP working up to four sessions a week in an educationally protected environment) and two GP Registrars (both 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 two practice nurses and a phlebotomist. The phlebotomist also undertakes reception and administration duties. In addition, the practice is supported by a midwife who runs clinics on the practice premises.

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

According to data from the Office for National Statistics, Little Chalfont has a high level of affluence, significantly low overall mortality, low incidence of substance misuse and severe mental health problems and low but increasing levels of deprivation.

The practice population has a lower proportion of patients with a reported long-standing health condition compared to the national averages and a higher proportion of patients aged under 19 and aged between 40 and 59 compared to the national average.

The practice has core opening hours between 8.30am and 6pm every weekday. Extended hours surgeries are available three weekday mornings a week when appointments start at 7.40am and one evening surgery when the last appointment is 7.50pm.

The practice 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 12 April 2016

Letter from the Chief Inspector of General Practice

We carried out an announced comprehensive inspection at Dr Bajwa and Partners, more commonly known as Little Chalfont Surgery on 2 March 2016. Overall the practice is rated as good.

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

• The practice had a clear vision which had quality, safety and person-centred care as its top priority. High standards were promoted and owned by all practice staff with evidence of team working across all roles.

• There was an open and transparent approach to safety and an effective system in place for reporting and recording significant events.

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

• Procedures were in place for monitoring and managing risks to patient and staff safety. During the inspection we saw assurance of further, more robust procedures planned to be completed.

• Feedback from patients about their care was consistent and highly positive.

• The practice understood the needs of the changing local population and planned services to meet those needs.

• Outcomes for patients who use services were consistently very good. Nationally reported Quality and Outcomes Framework (QOF) data, for 2014/15, showed the practice had performed excellently in obtaining 99% of the total points available to them for providing recommended care and treatment to patients.

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

However, there was an area of practice where the provider needs to make improvements. Importantly the provider should:

• Review the health and safety arrangements within the practice, ensuring all potential health and safety related risks have been identified.

Professor Steve Field CBE FRCP FFPH FRCGP

Chief Inspector of General Practice

Updated 12 April 2016

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

• The GPs and nurse team had the knowledge, skills and competency to respond to the needs of patients with long term conditions such as diabetes and COPD (Chronic obstructive pulmonary disease is the name for a collection of lung diseases including chronic bronchitis, emphysema and chronic obstructive airways disease).

• One of the GPs had a special interest in the management of long-term conditions. They had designed and implemented bespoke personalised care plans to meet the needs of individual patients; specifically patients with long-term conditions. These care plans promoted self-management and empowerment to manage their conditions through education and information.

Quality data demonstrated the monitoring of patients with long term conditions was better when compared to local and national averages. For example:

• Performance for diabetes related indicators was higher when compared to the CCG and national average. The practice achieved 96% of these targets, which was higher than the CCG average (93%) and national average (89%).

• Performance for COPD related indicators was higher when compared to the CCG and national average. The practice achieved 100% of these targets, higher when compared to the CCG average (99%) and national average (96%).

• Longer appointments and home visits were available when needed.

Updated 12 April 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 higher when compared to the CCG and national averages.

• 76% of patients diagnosed with asthma, on the register, had an asthma review in the last 12 months. This was similar to the national average, 75%.

• 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 89%, which was higher when compared to the CCG average (77%) and the national average (82%).
• Staff had received awareness training in recognising and acting upon child sexual exploitation, domestic violence and female genital mutilation.

Updated 12 April 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. Longer appointments, home visits and urgent appointments were available for those with enhanced needs.

• The practice systematically identified older patients and coordinated the multi-disciplinary team (MDT) for the planning and delivery of palliative care for people approaching the end of life.

• We saw unplanned hospital admissions and re-admissions for the over 75’s were regularly reviewed and improvements made.
• 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 aged 75 or over with a record of a fragility fracture and a diagnosis of osteoporosis, were being treated with an appropriate bone-sparing agent. This was higher when compared to the local CCG average (92%) and national average (93%). 

Updated 12 April 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.

• There was a range of appointments between 8.30am and 6pm every weekday. Extended hours surgeries were available three weekday mornings a week when appointments started at 7.40am and one evening surgery when the last appointment was 7.50pm.

• 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 provided a full travel vaccine service (excluding yellow fever).
• Phlebotomy services were available at the practice which meant patients did not have to attend the hospital for blood tests. There was an arrangement for neighbouring practices to use this service, creating a community phlebotomy service.

Updated 12 April 2016

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

Quality data demonstrated the monitoring of people experiencing poor mental health (including people with dementia) was better when compared to local and national averages. For example:

• 93% of people experiencing poor mental health had a comprehensive, agreed care plan documented in their medical record, which was higher when compared to the local average (89%) and national average (88%).

• The practice carried out advance care planning for patients with dementia. For example, 89% of patients diagnosed with dementia had their care reviewed in a face to face meeting in the last 12 months, which was higher when compared to the local average (86%) and national average (84%).
• The practice regularly worked with multi-disciplinary teams in the case management of people experiencing poor mental health, including those 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.
• All staff had a good understanding of how to support patients with mental health needs and dementia. Following a series of missed appointments, one of the reception staff proposed a revised reminder service for patients with dementia. We saw patients with dementia had an option of regular telephone reminders ranging from several hours and up to 20 minutes before the planned appointment.

Updated 12 April 2016

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

• There were policies and arrangements to allow people with no fixed address to register and be seen at the practice.

• The practice offered longer appointments for patients with a learning disability.

• It had carried out annual health checks for people with a learning disability and there was evidence that these had been followed up.

• The practice were early adopters in developing a vulnerable adult register which led to the vulnerable families register. We saw the GPs regularly worked with multi-disciplinary teams in the case management of vulnerable people.

• 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.