St. Bartholomew's Medical Centre Also known as St Bartholomews Medical Centre

Updated 5 January 2018

Dr Burke and Partners serves over 19,000 patients from the city of Oxford with approximately 11,000 of these students from Oxford Brookes University. All services are provided from two sites;

• St Bartholomews Medical Centre, Manzil Way, Oxford, Oxfordshire, OX4 1XB.
• Oxford Brookes University Medical Centre, 3rd Floor, The Colonnade, Gipsy Lane, Headington, OX3 0BP.

Dr Burke and Partners has two purpose built locations with good accessibility to all its consultation rooms at the main site. The practice has a very transient population with many students only residing in Oxford for part of the year and usually registering for the period of their studies before moving away. The area around the practice also has a high number of new migrants and this has contributed to a steady turnover in patient population. This poses difficulties in managing long term conditions, managing child immunisations and other services. The population is much younger than the national average with a large proportion of patients between 19 and 25 years old. There are local communities which are affected by social deprivation. There is a broad mix of ethnic backgrounds among the patient population.

There are three GP partners at the practice, one female and two male. There are four practice nurses and two health care assistants. A number of administrative staff, a deputy practice manager and a practice manager support the clinical team. The practice is open between 8.10am and 6pm Monday to Friday. There are extended hours appointments on Saturdays from 8.40am to 1pm. Out of hours GP services are available when the practice was closed by phoning NHS 111 and this is advertised on the practice website.

Updated 5 January 2018

Letter from the Chief Inspector of General Practice

We carried out an announced comprehensive inspection at Dr Burke and Partners on 17 May 2016. The practice was rated as requires improvement for providing effective services. The overall rating for the practice was good. The full comprehensive report on the May 2016 inspection can be found by selecting the ‘all reports’ link for Dr Burke and Partners on our website at www.cqc.org.uk.

This inspection was a desk-based review carried out on 20 February 2017 to confirm that the practice had carried out their plan to meet the legal requirements in relation to the breaches in regulations that we identified in our previous inspection on 17 May 2016. This report covers our findings in relation to those requirements and also additional improvements made since our last inspection.

The practice remains rated as requires improvement for effective services.

Our key findings were as follows:

• The practice had a limited risk assessment for patients attending the walk in service at the university practice site. However, they had improved the systems and processes to ensure patients who attended with an urgent medical condition were identified and prioritised.

• The practice had reviewed their diabetes care for patients. They had trained nurses and the new lead GP in enhanced skills in diabetes care. Data from the practice for 2016/17 showed an improvement in diabetes indicators, although they were still achieving below local and national averages.

• The practice had reviewed care planning systems for patients with a diagnosed mental health condition. They had improved on completed care plans from 54% to 72%.

• Health screening of patients through the national screening programme remained below local and national averages and the practice was not actively following up on patients who did not attend.

During our last inspection in May 2016 we found concerns relating to poor patient satisfaction scores for some aspects of GP and nurse care and treatment. The national GP patient survey mori poll was conducted between July and September 2015 and January to March 2016. The results were published in July 2016. There was a marked improvement in patient satisfaction scores;

• 86% of patients said the GP gave them enough time compared to the clinical commissioning group (CCG) average of 89% and the national average of 87%. This had increased from 80% in the previous survey.

• 96% of patients said the last nurse they spoke to was good at treating them with care and concern compared to the CCG average of 91% and national average of 92%. This had increased from 82% in the previous survey.

• 95% of patients said the last nurse they saw was good at listening to them compared to the CCG average of 92% and the national average of 91%. This had increased from 74% in the previous survey.

• 87% of patients said the last GP they saw was good at involving them in decisions about their care compared to the CCG average of 84% and national average of 82%. This had increased from 75% in the previous survey.

However, there were areas of practice where the provider must make improvements;

• Ensure patients are actively encouraged to attend for health screening through the national screening program and improve uptake rates.

• Continue to review and improve on mental health care planning and diabetes care indicators for patients.

• Ensure all patients on repeat medicines are reviewed for suitability of their current medicine regime.

In addition, there were areas of practice where the provider should make improvements;

• Ensure the risk assessment for the walk in service captures all areas of risk and is effective.

At our previous inspection on 17 May 2016, we rated the practice as requires improvement for providing effective services as patient uptake of the national screening programme, mental health care plans and diabetes care were all below local and national averages. At this inspection we found that although the data showed improvements in many areas the practice was still over 10% below local and national averages for many aspects of care. Consequently, the practice remains rated as requires improvement for providing effective services.

Professor Steve Field (CBE FRCP FFPH FRCGP) 

Chief Inspector of General Practice

Updated 12 July 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.
• The most recent published results were 94% of the total number of points available compared to the clinical commissioning group (CCG) average of 97% and national average of 95%.
• The practice had an exception reporting rate of 11% compared to the national average of 9% and regional average of 8%.
• All these patients had 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 12 July 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 similar to 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.
• We saw positive examples of joint working with midwives, health visitors and school nurses.
• Joint working with external organisations took place in the management of children at risk of abuse.

Updated 12 July 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.
• GPs offered home visits and urgent appointments for those with enhanced needs.
• The premises were accessible for patients with limited mobility and there was a hearing aid loop available for patients with poor hearing.
• All appointments were available on the ground floor.
• Patients over 75 had a named GP.

Updated 12 July 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.
• Patients’ feedback on the appointment system was very positive overall.
• There was a nurse walk-in service available to students. This provided flexibility. However, there was no clear tool which non-clinical staff could assess the urgency of patients’ needs.
• 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.
• Travel vaccinations were available.
• There were extended hours appointments on Saturday mornings from 8.40am to 1pm.
• The practice maintained links with the Oxford Brookes Univeristy counsellors and they were regularly invited to practice meetings to review patients who had been referred.

Updated 12 July 2016

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

• Performance for mental health related indicators was 93% compared to the national average 92% and regional average of 95%.
• Practice exception reporting for mental health indicators was 6%; this was below the national average (11%) and regional average (11%). There were 164 patients on the mental health conditions register and 89 had a care plan in place.
• 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 advanced care planning for patients with dementia and screening for those deemed at risk of the condition.
• The practice had told patients experiencing poor mental health about how to access various support groups and voluntary organisations.

Updated 12 July 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 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.
• Joint working with external organisations took place in the management of patients at risk of abuse or harm.
• The practice maintained a register of patients with drug dependency. An audit was carried out on hepatitis screening and prophylaxis among these patients.