Stokenchurch Medical Centre

Updated 23 June 2016

Stokenchurch Medical Centre is a large, two storey purpose built dispensing practice in Stokenchurch, Buckinghamshire located on the edge of the Chiltern Hills mid-way between High Wycombe and Oxford.

Stokenchurch Medical Centre is one of the practices within Chiltern Clinical Commissioning Group and provides general medical services to approximately 6,800 registered patients.

All services are provided from:

• Stokenchurch Medical Centre, Oxford Road, Stokenchurch, Buckinghamshire HP14 3SX.

Data from the Office for National Statistics, suggests this area of Buckinghamshire has a high level of affluence and minimal economic deprivation.

The practice population has grown significantly in the last 12 months and has a higher proportion of patients aged 40-69 compared to the national average. Ethnicity based on demographics collected in the 2011 census shows the population of Stokenchurch is predominantly White British and 4% of the population is composed of people with an Asian or Black background.

The practice population provides GP services for the Travelling community who reside in the area for six months each year (approximately 40 registered patients) and also has a proportion of patients in a local nursing home (approximately 75 registered patients) and two homes for adults with severe learning disabilities (approximately 13 registered patients).

The practice comprises of four GP Partners (two male and two female) who are occasionally supported by six long term locum GPs.

The all-female nursing team is led by a nurse prescriber and the full nursing team consists of one practice nurse, one specialist diabetic nurse and two health care assistants, one of which also works as a phlebotomist within the practice.

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

One of the GPs is the designated dispensary lead and the dispensary team consists of three dispensers, two of which also undertake reception duties.

The practice has core opening hours between 8.30am and 7pm Monday to Friday with appointments available from 8.30am to 6.30pm daily. Extended opening hours were on one Saturday morning each month when the practice was open between 8am and 10am.

The dispensary has core opening hours between 9am and 6.30pm every weekday.

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 23 June 2016

Letter from the Chief Inspector of General Practice

We carried out an announced comprehensive inspection at Stokenchurch Medical Centre on 25 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 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 invited the mobile breast screening unit to Stokenchurch.

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

• Feedback from patients and external stakeholders including the local nursing home and two care homes for adults with severe learning and physical disabilities which Stokenchurch Medical Centre provided the GP service for was consistently positive.

• The majority of patients said they found it easy to make an appointment with their named GP, with urgent appointments available the same day. There was mixed feedback about the new urgent clinics which commenced in October 2015.

• 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 where the provider needs to make improvements. Importantly the provider should:

• Continue to encourage patient participation in completing the NHS Friends and Family Test whilst reviewing results from the GP national survey. Notably results on satisfaction scores for Stokenchurch Medical Centres opening hours and patient satisfaction of the revised appointment process, specifically the urgent clinics which commenced in October 2015.

Professor Steve Field (CBE FRCP FFPH FRCGP) 

Chief Inspector of General Practice

Updated 23 June 2016

The practice is rated as good for the care of patients 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 100% of targets which was better when compared to the CCG average (93%) and the national average (89%).

• 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.

• A nurse trained in anticoagulant (blood thinning) management and held weekly clinics to monitor patients’ blood to determine the correct dose of anti-coagulant medicine. This provided improved access and standardised delivery in monitoring dosage. It also meant there was a ‘one-stop-visit’ that offered testing obtaining results and adjustments in dose, with the opportunity to discuss results during the same visit.

Updated 23 June 2016

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

• 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 patients 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.
• We saw positive examples of joint working with midwives and health visitors.

Updated 23 June 2016

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

• 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 a local nursing home. One of the GPs held a weekly session at the 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 medical secretary from Stokenchurch Medical Centre was the designated point of contact for the care home.

• 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 national averages. For example, This was better when compared to the CCG average (92%) and national average (93%).

Updated 23 June 2016

The practice is rated as good for the care of working-age patients (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 6.30pm Monday to Friday. The practice was open one Saturday morning each month specifically for patients not able to attend outside normal working hours but there were no restrictions to other patients accessing these appointments. The Saturday morning clinics were supported by the health care assistants who completed NHS health checks for patients unable to attend their health check during traditional working hours.

• 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 and the results were reviewed by their named GP.

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

Updated 23 June 2016

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

• 100% of patients experiencing poor mental health had received an annual physical health check. This was better when compared to the CCG average (89%) and national average (88%).
• 95% of patients diagnosed with dementia had their care reviewed in a face to face meeting in the last 12 months. This was better when compared to the CCG (86%) and national average (84%).

• 82% of newly diagnosed patients with depression had a depression review, 10-56 days after diagnosis. This was better when compared to the CCG average (70%) and national average (64%).

• 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. All practice staff had completed dementia training and dementia awareness workshops. Training provided by Dementia Academic Action Group and the Alzheimer’s Society had resulted in the practice having a network of ‘dementia friends’ (Dementia Friends is an Alzheimer’s Society initiative that aims to give patients a greater understanding of the impact of dementia and ways to help patients with dementia live well in their community).

Updated 23 June 2016

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

• Stokenchurch Medical Centre 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.