The Stonedean Practice

Updated 14 March 2016

The Stonedean Practice provides a range of primary medical services, including minor surgical procedures from its location at The Health Centre, Market Square, Stony Stratford, Milton Keynes. 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 7071 patients with higher than average populations of both males and females aged 30 to 44 and lower than average populations aged between 15 and 29 years and 70 to 85 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 three male and two female GP partners, two female trainee GPs, one nurse practitioner, three practice nurses and three health care assistants. Trainee GPs are qualified doctors training to become GPs. The team is supported by a practice manager and a team of administrative support staff. The practice holds a general medical services (GMS) contract for providing services and is a training practice.

The practice is open between 8am and 6.30pm Monday to Friday. Appointments are available from 8.30am with GPs and nurses. In addition to these times, the practice operates extended surgery hours on Mondays, Tuesdays and Thursdays from 6.30pm to 8pm. Patients requiring a GP outside of normal hours are advised to phone the NHS 111 service.

The registration of The Stonedean Practice was not accurate and we had not been notified of changes made to the partners at the practice, as required under the CQC (Registration) Regulations 2009. The practice has now taken steps to complete the necessary application to ensure their registration with us is accurate.

Updated 14 March 2016

Letter from the Chief Inspector of General Practice

We carried out an announced comprehensive inspection at The Stonedean Practice on 1 February 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 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.
• Access to the service was monitored to ensure it met the needs of patients. Outreach clinics were held for a local village to enable elderly and vulnerable patients to receive care and services.
• 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.

The areas where the provider should make improvements are:

• To ensure the business continuity plan accurately reflects planned actions to be taken in the event of practice closure or inaccessibility.
• Ensure that evidence of appropriate disclosure and barring service checks for staff are readily accessible.

Professor Steve Field (CBE FRCP FFPH FRCGP) 

Chief Inspector of General Practice

Updated 14 March 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 generally higher than the CCG and national average. For example, the percentage of patients on the diabetes register, with a record of a foot examination and risk classification within the preceding 12 months was 97% where the CCG average was 91% and the national average was 88%.
• 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 14 March 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 relatively high for all standard childhood immunisations.
• The practice’s uptake for the cervical screening programme was 80%, which was comparable to the CCG and national averages of 74%.
• 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. Health visitors attended weekly practice meetings.

Updated 14 March 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.
• It provided outreach clinics to patients in a local village where transport links were poor, to ensure that the vulnerable elderly were able to access services.
• The practice provided an enhanced service tailored to the needs of patients aged over 75. Supported by regular audits which identified the risks these patients faced which could result in emergency hospital admission, the practice provided regular assessments and support to reduce these risks. For example, dementia and fall assessments.

Updated 14 March 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.
• Evening appointments were available three nights a week to enable patients unable to attend during normal working hours to receive access to services.
• The practice offered some online services as well as a full range of health promotion and screening that reflected the needs for this age group.

Updated 14 March 2016

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

• There were 27 patients on the dementia register, of which 26 had received face to face reviews in the last 12 months, the remaining patient had an appointment scheduled for review the day after our inspection.
• Performance for mental health related indicators was better than the CCG and national average. For example, the percentage of patients with diagnosed psychoses who had a comprehensive agreed care plan was 100% where the CCG average was 82% and the national average was 88%.
• The practice regularly worked with multidisciplinary teams in the case management of people experiencing poor mental health, including those with dementia.
• It offered enhanced services for patients with dementia, facilitating timely diagnosis.
• 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.

Updated 14 March 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 caring responsibility and those with a learning disability.
• The practice offered longer appointments for patients with a learning disability if needed.
• 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.