Priory Surgery

Updated 12 October 2016

Priory Surgery provides services from a converted three storey Victorian town house to patients living in and around High Wycombe. There are patient areas on two floors with the ground floor being accessible to patients with mobility issues, as well as parents with children and babies. It is a town centre practice with approximately 12,300 patients on the practice list and is an area of medium deprivation.

The practice has a population distribution which is similar to the national average, although they have a higher number of patients aged 25-49 years. Life expectancy is comparable to the national average and the practice population has around 25% mixed ethnic origins. There is a higher percentage of patients that are unemployed.

The practice holds a General medical service contract and consists of six GP partners (three female and three male). There is an advanced nurse practitioner, two practice nurses (female), a healthcare assistants and a pharmacist. The practice is a training practice for GP Registrars (since 2013). GP Registrars are qualified doctors who undertake additional training to gain experience and higher qualifications in general practice and family medicine.

The GPs and nurses are supported by a practice manager and a team of administration and reception staff. A wide range of services and clinics are offered by the practice including: asthma, diabetes, and minor surgery and child health/baby clinics.

The practice is open from 8.30am to 7pm Monday to Friday with phone lines opening at 8am.

An out of hour’s service is provided by Care UK, outside of the practices open hours, and there is information available to patients on how to access this at the practice, in the practice information leaflet and on the website.

Services are delivered from: 24 Priory Avenue, High Wycombe, Buckinghamshire, HP13 6SH.

Updated 12 October 2016

Letter from the Chief Inspector of General Practice

We carried out an announced comprehensive inspection at Priory surgery on 25 July 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. Although, they had not ensured that there was a failsafe system to monitor all cervical screening results were received back in the practice. However, the practice implemented a change in process the day of inspection.
• The practice had responded to their vulnerable population group and had worked effectively to ensure that their needs were fully met. All staff within the practice showed that they recognised the signs when further support may be needed.
• 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 did not find it easy to make an appointment; the practice had recognised and put measures in place to respond to this.
• 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.

The areas where the provider should make improvements are:

• Ensure the system in place to promote the benefits of cervical screening is reviewed to increase uptake.
• Ensure the practice continues to engage with patients whilst reviewing the outcomes of the national GP patient survey to determine appropriate action with a view to improving the patient experience.

Professor Steve Field (CBE FRCP FFPH FRCGP) 

Chief Inspector of General Practice

Updated 12 October 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.
• The practice employed a pharmacist to assist with the health and medication reviews of patients with long term conditions.
• Performance for diabetes related indicators was 88% which was comparable to the clinical commissioning group average of 92% and national average of 89%.
• 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.
• Performance for Chronic Obstructive Pulmonary Disease (COPD, a collection of lung diseases including chronic bronchitis and emphysema) indicators showed the practice had achieved 100% of targets which was similar when compared to the CCG average (99%) and higher when compared to the national average (96%).

Updated 12 October 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.
• The practice’s uptake for the cervical screening programme was %, which was below the CCG average of and the 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 12 October 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 identified older patients and coordinated the multi-disciplinary team (MDT) for the planning and delivery of palliative care for patients 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 national averages. For example, 100% of patients aged 50 or over (and who have not attained the age of 75) with a fragility fracture and confirmed diagnosis of osteoporosis, were currently treated with an appropriate bone-sparing agent. This is higher when compared to the local Clinical Commissioning Group (CCG) average (89%) and national average (92%).

Updated 12 October 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 surgery offered extended late appointments every week day until 7pm.
• Although patients were unhappy with the opening times this had not been responded to. Patients commented that they found it difficult to take triage calls for same day appointments as they were commuting or working when the GP called them. If they missed this call they had to call the surgery back to be offered another.
• 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.

Updated 12 October 2016

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

• 85% of patients diagnosed with dementia that had their care reviewed in a face to face meeting in the last 12 months, which is comparable to the local average of 86% and the national average of 84%.
• 95% of patients diagnosed with a severe mental health issue who had a comprehensive, agreed care plan documented in the last 12 months, which was higher than the local average of 89% and the 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.
• The practices care of a patient with complex mental health issues was used as a teaching opportunity of excellent clinical care and liaison with other services within the clinical commissioning group and local schools.

Updated 12 October 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.
• An audit was completed to highlight areas of development with uptake of learning disability health checks.
• The practice had designed an easy read format (easy read refers to the presentation of text in an accessible, easy to understand format) invitation letter to improve the uptake of learning disability health checks. The number of health checks undertaken was 62%, which is above the national average of 44%.
• Practice staff were trained to recognise signs of abuse within their vulnerable patients. This resulted in reception staff highlighting particular individuals to GP’s that they felt needed further support. For example, when a patient with a learning disability deteriorated, the whole family was given a welfare assessment to enable extra support services to be put in place.
• GPs worked within a multi-disciplinary team to ensure the best outcomes for vulnerable patients. For example, the practice supported a vulnerable patient to understand their legal rights and capacity to make decisions. The surgery successfully dealt with challenging confidentiality and mental capacity issues.
• The practice regularly worked with other health care professionals in the case management of vulnerable patients.
• The practice had a number of patients who were considered homeless and they provided support them by offering longer appointments and allowing them to use the surgery to receive their mail. The practice had a number of patients registered who were staying in supported living and temporary accommodation.
• 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.