Archived: Chiltern Hills Practice Also known as IntraHealth Limited

Updated 19 April 2017

Chiltern Hills Practice provides primary medical services to approximately 2,179 patients in an area of Dunstable. Services are provided on an Alternative Provider Medical Services (APMS) contract (APMS contracts are agreed locally). The practice is also known as Chiltern Hills Surgery.

Services are delivered to patients from one registered location, 106 High Street, Dunstable, LU6 1LN.

The practice forms part of IntraHealth, a corporate group which provides primary medical services at a number of locations across England. Executive management oversight is provided by IntraHealth which includes corporate business planning, performance monitoring and central functions such as human resource management, payroll and regular review and update of policies and processes.

The Chiltern Hill Practice serves a population group with a noticeably different demographic profile to the England average. For example, the practice had higher prevalence of younger patients, with 25% of their patients under 18 years of age compared to the CCG and the England national average 21%. The practice had only 10% of patients aged over 65 years where the CCG and England average was 17%.

The area is recorded as being in the ’fifth more deprived decile’ and therefore falls in an area of average deprivation. According to national data, life expectancy for male patients at the practice is 79 years, compared to the CCG average of 80 years and the national England average of 79 years. For female patients life expectancy is 82 years, compared to the local CCG and the England average of 83 years.

The on-site practice team consists of one GP (male), one practice nurse and one health care assistant (both female). The practice manager is supported by a team of staff who provide reception and administrative functions.

The practice is open between 8.30am and 6.30pm Monday to Friday, with extended hours available until 7.10pm on Wednesday evenings. Appointments with a GP, nurse or health care assistant are available during those times. Appointments are bookable up to twelve weeks in advance. Emergency appointments are available daily. A telephone consultation and call-back service is also available for those who need urgent advice. Home visits are available to those patients who are unable to attend the surgery.

When the practice is closed, ‘out-of-hours’ services are provided by Care UK. Information about the out-of-hours services was available in the practice waiting area, on the practice website and on the practice telephone answering service.

Updated 19 April 2017

Letter from the Chief Inspector of General Practice

We carried out an announced comprehensive inspection at Chiltern Hills Practice on 13 September 2016. Overall the practice is rated as good.

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

• The practice had a clear vision and had recognised the particular needs of patients in the community it served.

• The practice team had worked to create an open and transparent approach to safety. A clear reporting system was in place for recording significant events and dealing with updates and alerts.

• Risks to patients were identified, assessed and appropriately managed. For example, the practice implemented appropriate recruitment checks for new staff, and followed up-to-date medicines management protocols. However, the practice did not have a current legionella risk assessment in place.

• We saw that the staff assessed patients’ needs and delivered care in line with current evidence based guidance. Performance was monitored using statistical analysis of national and local data and patient surveys; however, we found that the practice had not completed any clinical audits in the last 12 months.

• Staff were supported to access development learning and routine training was provided to ensure they had the skills, knowledge and experience to deliver effective care and treatment.

• Data from the Quality and Outcomes Framework (QOF) showed the practice had performed well, obtaining 97% of the total points available to them, for providing recommended care and treatment to their patients.

• The practice participated in the national awareness promotion week for carers and had raised the number of carers registered to almost four percent of the patient list.

• Feedback from patients was consistently positive. Patients we spoke with told us they were treated with compassion, dignity and respect and they were involved in their care and decisions about their treatment. Comments from patients on the 33 completed CQC comment cards confirmed these views.

• Results from the GP Patient Survey published in July 2016 showed the practice was performing higher than local and national performance averages in some areas.

• Information about services and how to complain or provide feedback was available in the waiting area and published on the practice website. The practice had a thorough process dealing with patient feedback. Outcomes from complaints were shared and learning opportunities identified as appropriate.

• Appointments were readily available.Urgent appointments were available the same day, although not always with the patients named or usual GP.

• The practice had access to good facilities and equipment in order to treat patients and meet their needs.

• There was a clear leadership structure and we noted there was a positive outlook among the staff, with good levels of moral in the practice. Staff said they felt supported by management.

• The provider was aware of and complied with the requirements of the duty of candour.

The area where the provider must make improvement is as follows:

• Ensure completion of a legionella risk assessment and implement any recommendations made.

The areas where the provider should make improvements are as follows:

• Reconsider arrangements to review quality assurance at the practice, for example targeted clinical audit.

• Continue to check the newly implemented system to log and monitor prescription stationery.

• Continue to encourage patient attendance for cancer screening including for breast and bowel cancer.

Professor Steve Field (CBE FRCP FFPH FRCGP) 

Chief Inspector of General Practice

Updated 19 April 2017

The practice is rated as good for the care of people with long-term conditions.

• Nursing staff had roles in chronic disease management and patients at risk of hospital admission were identified as a priority.

• 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 GP worked constructively with relevant health and care professionals to deliver a multidisciplinary package of care.

• The practice had clear protocols in place to support the treatment of patients with long term conditions. The practice held records of the number of patients with long term conditions. These patients were seen on a regular basis and invited to attend specialist, nurse-led clinics. Annual recall system based on patient’s anniversary of birthday.

• The practice offered longer appointments to these patients and home visits were available when needed.

• 99% of the patients on the diabetes register had influenza immunization in the preceding 01 August 2015 to 31 March 2016, compared to local CCG and national average of 95%. Effective arrangements were in place to ensure patients with diabetes were invited for a review of their condition.

• Nurse led clinics ensured annual reviews and regular checks for patients with asthma and chronic obstructive pulmonary disorder (COPD) were in place. The practice had clear objectives to reduce hospital admissions for respiratory conditions. Patients who were admitted to hospital were reviewed by the practice after discharge.

• End of life care was coordinated with Macmillan nurse, district nurse and Bedfordshire Partnership for Excellence in Palliative Support service (PEPS).

• These patients had a dedicated telephone number at the practice, for use in an emergency

Updated 19 April 2017

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.

• 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.

• 87% of women aged between 25 - 64 years of age whose notes record that a cervical screening test has been performed in the preceding five years, was higher than the national average of 81%.

• The practice provided appointments 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.

• GPs completed six week and post-natal check for mothers and new born babies.

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

• Immunisation rates for all standard childhood immunisations were comparable to both local CCG and national performance averages. The practice provided flexible immunisation appointments.

• The practice supported a number of initiatives for families with children and young people, for example the practice offered a range of family planning services.

• Baby vaccination clinics and ante-natal clinics were held at the practice on a regular basis. Positive links with the community midwife team and liaison with health visitors formed a positive and collaborative approach.

Updated 19 April 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. Home visits were offered for those patients who were incapacitated and unable to travel. On-the-day or emergency appointments were available to those patients with complex or urgent needs.

• The practice had clear objectives to avoid hospital admissions where possible. For example, when the nurse practitioner visited patients who lived in residential care homes they ensured, where possible, that patient medication was reviewed regularly and other routine tests were undertaken without the need for patient admission to hospital.

• The practice sent personal birthday cards to all patients over 80 years of age.

Updated 19 April 2017

The practice is rated as good for the care of working-age people (including those recently retired and students).

• Facilities were available for patient self-monitoring, for example with blood pressure equipment in the waiting area.

• Extended opening hours were available until 7.10pm on Wednesday evenings.

• Data showed 44% of patients aged 60 to 69 years had been screened for bowel cancer in the last 30 months compared to 59% locally and 58% nationally.

• Data showed 63% of female patients aged 50 to 70 years had been screened for breast cancer in the last three years compared to 74% locally and 73% nationally.

• The practice offered easy access to telephone appointments and telephone consultations.

• The practice provided a health check to all new patients and carried out routine NHS health checks for patients aged 40 - 74 years.

• The practice was proactive in offering an appointment reminder text messaging service and repeat prescriptions, as well as a full range of health promotion and screening that reflects the needs of this age group.

Updated 19 April 2017

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

• 83% of patients diagnosed with dementia had their care reviewed in a face-to-face meeting in the last 12 months, compared to the local CCG average of 85% and the national average of 84%.

• 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.

  For patients on the dementia register the practice had a named member of staff with lead with responsibility for developing and improving delivery of services for patients with mental health and health promotion.

• The practice had supported patients experiencing poor mental health about how to access support groups and voluntary organisations, with links with support services, such as counselling and referrals to the Improving Access to Psychological Therapies service (IAPT).

• The practice had a system in place to follow up patients who had attended A&E 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. Staff telephone patients with memory problems to remind them of appointments.

Updated 19 April 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, such as homeless people, travellers and those with a learning disability. The practice undertook visits to a local traveller’s site.

• The practice registered asylum seekers and refugees as temporary patients whilst awaiting completion of appropriate applications.

• The practice is able to issue food vouchers for those in need.

• The practice offered longer appointments for patients with a learning disability. GPs also visited patients at their homes when they were unable to travel to the practice for an appointment.

• Where possible the practice made ‘last minute’ appointments available for people who may have difficulty keeping to booked appointment times.

• The practice had recorded 80 carers on their register. The practice maintained positive links with Bedfordshire Carers and community groups.

• The practice regularly worked positively and collaboratively with other health care professionals in the case management of vulnerable patients.

• The practice informed vulnerable patients about how to access support groups and voluntary organisations.

• Staff knew how to recognise signs of abuse in vulnerable adults and children and the protocol to follow for reporting concerns.

• 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.