Tower House Surgery

Updated 9 September 2016

Tower House Surgery provides GP services to nearly 10,000 patients in a suburban area of High Wycombe. It is based in an area of mixed ethnicity and this is reflected in its patient list. The locality has a relatively low level of deprivation, with a higher working age population compared to the national average.

The practice has six GP partners, three female and three male, and one female salaried GP. It currently has three practice nurses and one health care assistant. There are 18 members of administration, reception and support staff, including a practice manager and deputy practice manager.

Tower House Surgery was established in 1937 and comprises three floors. The ground floor has four GP consulting rooms and two nurse treatment rooms. Two non clinical consulting rooms are located on the second floor which are used by outside agencies. The third floor is for administration staff. There is step free access to the main entrance, and automatic entrance doors. The surgery has been extended over the years to maximise space.

The surgery is open from 7am Monday, Tuesday and Friday and 8am Wednesday and Friday, and closes at 6.30pm. Extended hours until 8pm are available on Wednesdays.

The practice has opted out of providing out of hours services to their patients. The out of hours service is provided by Buckinghamshire Urgent Care and is accessed by calling NHS 111. Advice on how to access the out of hours service is contained in the practice leaflet, on the patient website and on a recorded message when the practice is closed.

Tower House Surgery is registered to provide services from the following location:

169 West Wycombe Road, High Wycombe, Buckinghamshire, HP12 3AF.

This is the first inspection of Tower House Surgery.

Updated 9 September 2016

Letter from the Chief Inspector of General Practice

We carried out an announced comprehensive inspection at Tower House Surgery on 22 June 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.
• 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.
• The practice used innovative and proactive methods to improve patient outcomes. For example, extra services were implemented to support children and adolescents with mental health concerns and for patients with alcohol dependency.
• 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 found it easy to make an appointment with a named GP and there was continuity of care, with urgent appointments available the same day.
• 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.

We saw one area of outstanding practice:

The practice identified a higher number of children and young people who were presenting with mental health concerns and either had a long wait for a Child & Adolescent Mental Health Service (CAMHS) referral or would not quite meet the criteria the practice had assessed the need for a supplementary service. They had applied for and received additional funding from the clinical commissioning group to commission a child psychology service. Over the last 12 months the service had seen and assessed 26 children following referral from a GP. All referrals were considered appropriate by the psychologist. The cases seen were those which did not meet the threshold for CAMHS but were in crisis. Following assessment follow on sessions were provided for each patient. The service supported patients through anxiety, low mood, behavioural and identity issues. A course of treatment was completed or used to stabilise while awaiting referral to a specialised service. We identified a number of cases were a positive impact was seen for patients in managing their health, providing social and personal support or help for the families with younger children in crisis or need of mental health support.

However there were areas of practice where the provider should make improvements:

• To review monitoring of patient care to ensure where exception reporting is high that other ways of engaging patients are explored, to ensure that minority communities and cultures are encouraged to attend for national screening procedures and health reviews.

• To ensure that the stock of emergency medicines are risk assessed and made clearer to staff.

• To explore more ways of identifying carers.

Professor Steve Field (CBE FRCP FFPH FRCGP) 

Chief Inspector of General Practice

Updated 9 September 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.

• Performance for diabetes related indicators showed the practice had achieved 75% of targets which was lower when compared to the CCG average (91%) and the national average (89%), exception reporting for diabetes related indicators was 10%, comparable to the CCG average (9%) and national average (11%).

• 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.

Updated 9 September 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 average 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.

• 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.

• Due to the number of children and young people who were presenting with mental health concerns and either had a long wait for a Child & Adolescent Mental Health Service (CAMHS) referral or would not quite meet the criteria the practice had assessed the need for a supplementary service. They acquired additional funds to commission a child psychology service which had a positive impact on their health and well being.

Updated 9 September 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 worked with multi-disciplinary teams in the care of older vulnerable patients.

• Nationally reported data showed that outcomes for patients for conditions commonly found in older people were in line with local and national averages. For example, the number of emergency admissions per 1,000 population was 12, compared to the CCG average of 12 and the national average of 14.

Updated 9 September 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’s uptake for the cervical screening programme was 92%, which was higher than the CCG average of 84% and the national average of 82%,however,exception reporting for cervical screening was high. We saw evidence of screening and recall programmes were impacted by patients not attending for screening. The practice had not considered alternative ways of engaging with patients whose first language was not English or from different Asian communities.

Updated 9 September 2016

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

• 91% of patients diagnosed with dementia who had their care reviewed in a face to face meeting in the last 12 months, which is higher than the national average of 84%.

  98% of patients with psychoses had an agreed, documented care plan. 19% of these were exception reported. The practice had failed to identify other ways of engaging with these patients.

• 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.

Updated 9 September 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 all patients.
• The practice 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.
• The practice supported patients with alcohol misuse problems by communicating and working with specialist services, including prescribing medicines to help with withdrawal symptoms.
• 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.