Rothschild House Surgery

Updated 27 February 2017

Rothschild House Surgery is located in Tring, Hertfordshire. The practice is registered with the Care Quality Commission (CQC) as a partnership provider and holds a General Medical Services contract with NHS England. The GMS contract is a contract agreed nationally between general practices and NHS England for primary care services to local communities. At the time of our inspection, Rothschild House Surgery was providing medical care to approximately 19,457 patients. The practice has a branch site, Little Rothschild Surgery, at Pitstone, which shares the same patient list as the main site. We did not visit the branch surgery during the inspection.

The Rothschild House Surgery has a dispensary on site and there is a smaller dispensing facility at the branch site.

There is limited car parking available onsite and on the road outside. A public car park is about five minutes’ walk from the practice. The practice has facilities for disabled patients and a wheelchair is provided for patients’ use. There is an aquarium in the reception area on the ground floor and a separate children’s area with a play table, chairs and books. A children’s play table, chairs and books are also provided in the upstairs reception area. Air conditioning units are situated on the upper floors.

There are screens in each reception area, which are updated monthly with information that is personalised for the practice. The information includes topics such as opening hours, survey results, health promotion advice and flu clinic details. The screens are also used as calling screens for patient appointments, although the practice also has an intercom system for those patients with poor eyesight.

There are five male GP partners and four female partners, plus two salaried female GPs. They are supported by the practice manager, assistant practice manager, the nursing, dispensary, reception and administrative teams.

Rothschild House Surgery is an approved training practice for trainee GPs and student doctors. A trainee GP is a qualified doctor who is training to become a GP through a period of working and training in a practice. There are currently three trainee GPs and one foundation year two doctor working at the practice.

The practice is also a teaching practice for postgraduate medical students from Oxford University. Medical students have not yet qualified as doctors. The practice accepts two to four students each term in the academic year.

The practice opens from 8am to 8pm from Monday to Thursday. On Fridays the practice is open from 8am until 6.30pm. Appointments are available during these times. The practice is open on Saturdays from 8.30am until 10am. The branch surgery is open from 8am until 1pm and from 2pm until 4.30pm from Monday to Thursday. On Fridays, the branch site is open from 8am until 1pm. The telephone is diverted to the main site when the branch site is closed.

Out of hours cover is provided by Buckinghamshire Urgent Care. Patients can also use the Hemel Hempstead Urgent Care Centre, which is open seven days a week from 8am until 10pm.

Updated 27 February 2017

Letter from the Chief Inspector of General Practice

We carried out an announced comprehensive inspection at Rothschild House Surgery on 11 January 2017. Overall the practice is rated as good.

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

• There were effective systems to monitor and maintain patient safety in the practice.
• Staff understood their responsibilities to raise concerns and to report incidents and near misses. Incidents were regarded as opportunities for learning across the practice team and for improving patient care.
• Staff had the skills, knowledge and experience to deliver effective care and treatment in line with current evidence based guidance.
• Patients said they were treated with kindness, dignity and courtesy and that 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.
• All patients had a nominated GP, which provided continuity of care.
• Patients said that it was easy to make an appointment with a named GP and that they appreciated the continuity of care. Patients could get urgent appointments the same day.
• There was an active Patient Participation Group.
• 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 area where the provider should make improvement is:

• Consider introducing a regular programme of dispensary audits as part of the quality improvement programme.

Professor Steve Field (CBE FRCP FFPH FRCGP) 

Chief Inspector of General Practice

Updated 27 February 2017

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.
• Longer appointments and home visits were available when needed.
• The percentage of patients with diabetes on the register in whom the last diabetic reading was at an appropriate level in the preceding 12 months was 89%, which was 12% above the CCG average and 11% above the national average.
• 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 nursing team provided healthy lifestyle advice and NHS health checks.
• A consultant rheumatologist visited once a month.

Updated 27 February 2017

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

• There were systems 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.
• 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 82.2% which was in line with the to the CCG average of 82.4%and slightly above the national average of 81%.
• The practice hosted a children’s speech and language therapy service and a children’s physiotherapy service.
• Appointments were available outside of school hours and the premises were suitable for children and babies. There was a separate children’s area in the main reception area and facilities for children in the first floor reception area.
• We saw positive examples of joint working with midwives, health visitors and school nurses. 

Updated 27 February 2017

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 had signed up to the admissions avoidance service, which identified patients who were at risk of inappropriate hospital admission.
• The practice provided care for patients in a local care home which was visited weekly by the nominated GP.
• The practice hosted a weekly podiatry service.

Updated 27 February 2017

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.
• Patients could book routine GP appointments online as well as request repeat prescriptions at a time that was convenient for them.
• Patients could sign up to a text messaging service, which sent appointment reminders and enabled patients to cancel appointments by text, which was convenient for working people.
• Extended hours appointments were provided which provided flexibility for those patients who could not attend during core opening hours.
• General contraceptive advice was available at the practice as well as coil fittings.
• Health promotion information was available in the reception areas and on the practice website.

Updated 27 February 2017

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

• 94% of patients diagnosed with dementia had their care reviewed in a face to face meeting in the last 12 months, which was 9% above the CCG average and 10% above the national average.
• 95% of patients with poor mental health had a comprehensive care plan documented in the last 12 months, which was 3% above the CCG average and 6% above the national average.
• 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.
• Staff had undertaken online dementia friendly training to increase their awareness.
• The practice hosted a Cognitive Behavioural Therapy clinic once a week, which meant that patients could attend the clinic in familiar surroundings.
• The practice had told patients experiencing poor mental health about how to access various support groups and voluntary organisations.
• The practice had a system 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. For example, reception staff telephoned patients with dementia on the day before their appointment as a reminder.

Updated 27 February 2017

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 regularly worked with other health care professionals in the case management of vulnerable patients.
• There were 74 patients on the learning disability register and 17 had a review since April 2016.
• The practice had appointed a member of the reception team to be a Learning Disabilities Champion. The practice was working towards attaining the Purple Star accreditation, which was sponsored by Hertfordshire County Council. This award would be recognition of the staff’s achievements in making the practice more accessible for patients with learning disabilities. The assessment visit was scheduled during the week after the inspection, and we were subsequently informed that formal accreditation had been awarded.
• The practice offered longer appointments for patients with a learning disability.
• Letters were sent to patients with learning disabilities in large font, so that they were easier to read.
• The practice informed vulnerable patients about how to access various support groups and voluntary organisations.
• There was a flexible shared care substance misuse clinic to accommodate the needs of patients with chaotic lifestyles.
• Staff had attended a female genital mutilation learning event to increase their awareness.
• 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. There was a GP lead for safeguarding adults and a GP for safeguarding children.