Watling Street Practice

Updated 18 February 2016

Stony Medical Centre provides a range of primary medical services from its location at The Health Centre, Market square, Stony Stratford, Milton Keynes, MK11 1YA, the first purpose built health centre in Milton Keynes, having opened in 1974. The building is owned by NHS property services and the practice shares these premises with another GP practice and Trust community staff. The practice serves a population of approximately 11388 patients with higher than average populations of both males and females aged 49 to 74 and lower than average populations aged 0 to 39 years. The practice population is largely white British. National data indicates the area served is less deprived in comparison to England as a whole.

The clinical staff team consists of two male and four female GP partners, a female salaried GP, one trainee GP five nurses and five health care assistants. Trainee GPs are qualified doctors training to become GPs. The team is supported by a business manager and a team of administrative support staff. The practice holds a GMS contract for providing services and is a training practice with one GP registrar who we did not meet on the day of our inspection.

The practice is open from 8am to 6.30pm Monday to Friday. In addition to these times, the practice operates extended hours on Tuesdays and Thursdays from 6.30pm to 7.30pm and from 8am to 12pm on Saturdays. Patients requiring a GP outside of normal hours are advised to phone the NHS 111 service.

Updated 18 February 2016

Letter from the Chief Inspector of General Practice

We carried out an announced comprehensive inspection at Stony Medical Centre on 5 January 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 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.
• Patients said they were able to make an appointment with a named GP and that there was continuity of care, with urgent appointments available the same day.
• The practice engaged with the CCG to provide additional services to improve outcomes for patients.
• 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 practice recognised the needs of vulnerable patients aged over 75 and provided them with tailored care and support through a nurse led case management project.
• The provider was aware of and complied with the requirements of the Duty of Candour.

We saw two areas of outstanding practice:

• The practice was involved in two pilot schemes providing two Primary Care Outpatient Clinics (PCOCs) for dermatology and gynaecology enabling patients across the locality (including those registered at other practices) to receive services they would normally only receive in secondary care.
• The practice was one of seven POCT (point of care testing) hub practices in the locality, enabling them to receive referrals from other practices to provide patient care that would normally be provided in a secondary care setting. For example, the practice were able to test patients presenting symptoms of blood clots.

However, there was one area where the provider should make improvement:

• To review arrangements for the security of emergency medicines when the practice is closed to ensure newly implemented systems are sustained.

Professor Steve Field (CBE FRCP FFPH FRCGP) 

Chief Inspector of General Practice

Updated 18 February 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 was higher than the national average. For example, the percentage of patients on the diabetes register, with a record of having had a foot examination and that had been risk classified within the preceding 12 months was 93.7% compared to the national average was 88.3%.
• 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 18 February 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 GP safeguarding lead liaised and met regularly with the health visitor to discuss issues and concerns about a child and how they could be supported. 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 85%, which was higher than the national average of 82%.
• Appointments were available outside of school hours and the premises were suitable for children and babies.
• The practice provided enhanced gynaecology services to patients through its involvement in the PCOC (Primary Care Outpatient Clinics) enabling patients to receive care within the practice rather than through referral to secondary care services.

Updated 18 February 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.
• It was responsive to the needs of older people, and offered home visits and urgent appointments for those with enhanced needs.
• Vulnerable patients over the age of 75 benefitted from a nurse led case management project which provided them with tailored care and support, including referrals to third sector support such as Age UK.
• Flu vaccination rates for the over 65s were 74.7% compared to the national average of 73.2%.

Updated 18 February 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).
• Patients were able to book appointments with GPs and nurses online.

Updated 18 February 2016

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

• There were 54 patients on the dementia register, of which 43 had received face to face reviews in the last 12 months, seven had appointments scheduled for reviews to be completed.
• The practice regularly worked with multi-disciplinary teams in the case management of people 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.
• 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 received regular training and had a good understanding of how to support patients with mental health needs and dementia.

Updated 18 February 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 those with a learning disability.
• Electronic records alerted staff to patients requiring additional assistance.
• The practice telephoned patients with a learning disability to invite them to annual face to face reviews.
• The practice regularly worked with multi-disciplinary teams in the case management of vulnerable people.
• 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.