Greensand Surgery - Ampthill

Updated 21 January 2016

Greensand Surgery Ampthill provides a range of primary medical services from semi-rural premises at The Health Centre, Oliver Street, Ampthill, Bedfordshire, MK45 2SB. It shares these premises with another practice and Trust community staff. The practice has 7414 patients with an above average population of those aged from 40 to 59. There are lower than average populations of males aged from 20 to 34 years and females aged from 25 to 39 years. The population is largely white British with a minority ethnic community. National data indicates the area served is less deprived in comparison to England as a whole.

The clinical staff team consists of one male and two female GP partners, one female salaried GP, five nurses (two of whom are nurse practitioners), two health care assistants and a phlebotomist. The team is supported by a practice manager, finance administrator and team of administrative support staff. The practice holds a PMS contract for providing services.

The practice is open from 8am to 6.50pm Monday to Friday. Appointments are available with a GP from 8.30am to 12pm and 3pm to 6pm daily. Nurse appointments are available from 8.10am to 1pm and 2pm to 6.50pm daily. A duty doctor is available for same day urgent appointments from 8am to 6.30pm Monday to Friday. When the practice is closed out-of-hours services are provided by Care UK.

Updated 21 January 2016

Letter from the Chief Inspector of General Practice

We carried out an announced comprehensive inspection at Greensand Surgery Ampthill on 17 November 2015. 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 a system in place for reporting and recording significant events. However, records were not always kept up to date and completed.
• Staff assessed patients’ needs and delivered care in line with current evidence based guidance. Staff had 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.
• Access to the service was monitored to ensure it met patients’ needs. Patients said they found it easy to make an appointment with a named GP and that there was continuity of care, with urgent appointments available the same day.
• 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.

However there were areas where the provider should make improvements.

• Ensure that risk assessments of staff to determine their suitability for DBS checks are formalised and documented.
• Risk assess stocks of emergency medicines kept to ensure they are suitable and that up to date protocols for their use are maintained to enable the practice to respond appropriately to a medical emergency.

Professor Steve Field CBE FRCP FFPH FRCGPChief Inspector of General Practice

Updated 21 January 2016

The practice is rated as good for the care of people with long-term conditions. The practice held information about the prevalence of specific long term conditions within its patient population such as diabetes and chronic obstructive pulmonary disease (COPD). This information was reflected in the services it provided, for example, reviews of conditions and treatment, vaccinations programmes and screening programmes. A diabetic retinal screening van was hosted by the practice once a year at the practice. These patients had a named GP and a structured annual review. Interim six monthly reviews were available to patients with enhanced needs. Patients who were housebound were visited at home. The practice had multi-disciplinary meetings to discuss the needs of palliative care patients and patients with complex needs. These patients were sent invitation letters offering them vaccinations they are entitled to such as flu and shingles vaccines.

Updated 21 January 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, the safeguarding lead GP liaised and met regularly with the health visitor to discuss any concerns about a child and how they could be supported. The practice computer system clearly identified and alerted staff to those children subject to a child protection plan, living in looked after conditions or who had been identified as at risk. Immunisation rates were relatively high for all standard childhood immunisations. Appointments were available outside of school hours and the premises were suitable for children and babies, with a specific children’s area in the waiting room. There were no set immunisation clinics for babies and children. The practice had recognised the risk of errors occurring with the complexity of the current immunisation programme and a specific clinic will operate from January 2016. We saw evidence of joint working with midwives, health visitors and school nurses. Contraceptive and sexual health advice was provided.

Updated 21 January 2016

The practice is rated as good for the care of older people. The practice was knowledgeable about the number of older patients using the service and their health needs, offering them proactive and personalised care. Nationally reported data showed that outcomes for patients were good in conditions commonly found in older people. They kept up to date registers of patients’ health conditions and used this information to plan reviews of health care and to offer services such as vaccinations for flu and a Doppler service for patients who needed stockings for prevention and management of wound care. (A Doppler ultrasound is a non-invasive test used for estimating blood flow through blood vessels) .The practice worked with other agencies and providers to provide support and access to specialist help when needed. It was responsive to the needs of older people, and offered home visits and urgent appointments for those with enhanced needs.

Updated 21 January 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 was registered with the electronic prescribing service (EPS) and had plans to extend the online services available to patients via its website. There were no set times for clinics ensuring that patients could receive the reviews and treatment they needed at times that were suitable for them. Patients were able to book appointments with GPs and nurses online.

Updated 21 January 2016

The practice is rated as good for the care of people experiencing poor mental health (including people with dementia). The practice maintained a register of patients receiving support with their mental health. Of the 47 people on the dementia register 87% had had their care reviewed in a face to face meeting in the last 12 months. The practice regularly worked with multi-disciplinary teams in the case management of people experiencing poor mental health, including those with dementia. The practice’s flexible appointment system benefitted these patients who could arrange appointments according to their individual needs. The practice had told patients experiencing poor mental health about how to access various support groups and voluntary organisations. The practice monitored prescriptions for patients with poor mental health, for example providing weekly prescriptions for patients at risk of an overdose.

Updated 21 January 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 those with a learning disability. Patients electronic records alerted staff to patients requiring additional assistance .The practice worked with local drug and alcohol services to provide tailored care for patients who were drug or alcohol dependent. One of the GPs made monthly visits to a local facility providing care for individuals with severe physical and learning disabilities, to enable them to receive continuity of care in an environment they recognised. Staff we spoke with had appropriate knowledge about safeguarding vulnerable adults and they had access to the practice’s policy and procedures and had received training in this.