Highfield Surgery

Updated 9 November 2016

Letter from the Chief Inspector of General Practice

In July 2016 during a comprehensive inspection of Highfield Surgery in Hazlemere, Buckinghamshire, we found concerns related to systems and processes which managed the safe and effective delivery of services. Following the inspection the provider sent us an action plan detailing how they would improve the areas of concern. The previous inspection in July 2016 had found two breaches of the regulations relating to the safe and effective delivery of services.

Using information provided by the practice we carried out a desktop review of Highfield Surgery on 2 November 2016 to ensure these changes had been implemented and that the service was meeting regulations.

The ratings for the practice have been updated to reflect our findings following the improvements made since our last inspection in July 2016; the practice was now meeting the regulations that had previously been breached.

Specifically the practice was:

• Operating safe systems in relation to health and safety. The practice had established and was now operating an effective system to assess, manage and mitigate the risks identified relating to legionella and the storage of liquid nitrogen.

• Training arrangements were consistent; there was a system to identify when staff had training and when it would need to be refreshed. Appropriate appraisal arrangements were now in place, appraisals had been completed and there was evidence of performance monitoring and identification of personal and professional development.

Highfield Surgery had taken full heed of the findings of the inspection undertaken in July 2016 and is now rated good for the provision of safe, effective, caring, responsive and well led services. All six population groups have also been re-rated following these improvements and are also rated as good.

Professor Steve Field CBE FRCP FFPH FRCGP

Chief Inspector of General Practice

Updated 9 November 2016

Highfield Surgery had taken full heed of the findings of the inspection undertaken in July 2016 and is now rated good for the provision of safe, effective, caring, responsive and well led services. All six population groups have also been re-rated following these improvements and are also rated as good.

• 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 87% of targets which was lower when compared to the CCG average (93%) and similar when compared to the national average (89%).

• Performance for Chronic Obstructive Pulmonary Disease (known as 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%).

• Longer appointments and home visits were available when needed.

• In June 2016, Highfield Surgery implemented a care planning approach for patients with diabetes. The aim was to empower and support patients to make decisions about their health.

Updated 9 November 2016

Highfield Surgery had taken full heed of the findings of the inspection undertaken in July 2016 and is now rated good for the provision of safe, effective, caring, responsive and well led services. All six population groups have also been re-rated following these improvements and are also rated as good.

• 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 high for all standard childhood immunisations. For example, 100% of children under 24 months had the full programme of childhood immunisations. The CCG averages ranged between 95% to 97% for the same age group.

• 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 81%, which was similar when compared to the CCG average (84%) and the national average (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 9 November 2016

Highfield Surgery had taken full heed of the findings of the inspection undertaken in July 2016 and is now rated good for the provision of safe, effective, caring, responsive and well led services. All six population groups have also been re-rated following these improvements and are also rated as good.

• The practice offered proactive, personalised care to meet the needs of the older people in its population.

• Highfield Surgery was responsive to the needs of older people, and offered home visits and rapid access appointments for those with enhanced needs. The practice identified if patients were also carers; information about support groups was available in the waiting areas.

• The practice worked with the multi-disciplinary teams in the care of older vulnerable patients.
• The majority of nationally reported data showed that outcomes for patients for conditions commonly found in older people were in line with local and national averages. However, Highfield Surgery performance for stroke and transient ischaemic attack (mini strokes) indicators was lower than both the local and national averages. For example, the practice had achieved 80% of targets which was lower when compared to the CCG average (98%) and the national average (97%).

Updated 9 November 2016

Highfield Surgery had taken full heed of the findings of the inspection undertaken in July 2016 and is now rated good for the provision of safe, effective, caring, responsive and well led services. All six population groups have also been re-rated following these improvements and are also rated as good.

• 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 had core opening hours between 8.30am and 6.30pm Monday to Friday with appointments available from 8.30am to 5.50pm daily. The practice did not offer any extended hours opening in the evenings, early mornings or weekends.
• Phlebotomy services were available at the practice which meant patients did not have to attend the hospital for blood tests.

Updated 9 November 2016

Highfield Surgery had taken full heed of the findings of the inspection undertaken in July 2016 and is now rated good for the provision of safe, effective, caring, responsive and well led services. All six population groups have also been re-rated following these improvements and are also rated as good.

• 92% of people experiencing poor mental health had a comprehensive care plan documented in their record, in the preceding 12 months, agreed between individuals, their family and/or carers as appropriate. This was better when compared to the CCG average (89%) and national average (88%).

• 89% of patients diagnosed with dementia had their care reviewed in a face to face meeting in the last 12 months, which was similar when compared to the local CCG average (86%) and higher than the national average (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 had told patients experiencing poor mental health about how to access various support groups and voluntary organisations.
• Staff had a good understanding of how to support patients with mental health needs and dementia. Highfield Surgery had recently submitted an action plan to the local CCG with a view to become a dementia friendly practice. The action plan had five key principles to become a dementia friendly practice. One of the completed actions was the nomination and implementation of a dementia lead and a dementia champion. Extra hours had been created to enable this additional work to ensure there was a strong focus on improving the diagnosis, treatment and support for people with dementia.

Updated 9 November 2016

Highfield Surgery had taken full heed of the findings of the inspection undertaken in July 2016 and is now rated good for the provision of safe, effective, caring, responsive and well led services. All six population groups have also been re-rated following these improvements and are also rated as good.

• The practice held a register of patients living in vulnerable circumstances including homeless people, travellers and those with a learning disability.

• Highfield Surgery had carried out annual health checks for 63% of people with a learning disability and there was evidence that these had been followed up.

• The practice offered longer appointments for patients with a learning disability.

• 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.
• 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.