Windrush Medical Practice, Windrush Health Centre

Letter from the Chief Inspector of General Practice

We carried out an announced comprehensive inspection at Windrush Medical Practice on 5 May 2016. Overall the practice is rated as outstanding. Specifically it is rated outstanding for the provision of safe, effective and well led services and good for the provision of caring and responsive services.

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

• Staff understood and fulfilled their responsibilities to raise concerns and report incidents and near misses. All opportunities for learning from internal and external incidents were maximised.

• The practice used innovative and proactive methods to improve patient outcomes, working with other local providers to share best practice. For example, using e-mails and photographs to communicate with specialists at the local hospital to reduce the need for patients to travel to outpatient clinics.

• Feedback from patients about their care was consistently positive.

• The practice worked closely with other organisations and with the local community in planning how services were provided to ensure that they met patients’ needs. For example by providing a floor within the practice for visiting services such as audiology and orthopaedic clinics. They also hosted the ‘hub’ which provided an overflow facility for urgent GP and nurse appointments when practices in West Oxfordshire had filled their appointments.

• The practice implemented suggestions for improvements and made changes to the way it delivered services as a consequence of feedback from patients and from the patient participation group. For example a new telephone system had been installed and staff rosters amended to make more staff available to answer patient calls at peak times.
• The practice had modern and well maintained facilities and was well equipped to treat patients and meet their needs.
• The practice actively reviewed complaints and how they were managed and responded to, and made improvements as a result.
• The practice had a clear vision which had quality and safety as top priorities. The strategy to deliver this vision had been produced with stakeholders and was regularly reviewed and discussed with staff.
• The practice had strong and visible clinical and managerial leadership and governance arrangements.

• An innovative approach to training qualified doctors. This involved running a simulated clinic with case studies to prepare the doctors for their first clinics. GPs in training reported that this made them more prepared for their first clinics.

• Provision of a wide range of additional visiting services including sexual health clinics, podiatry, orthopaedic clinics, audiology clinics and counselling. This assisted patients to access services locally and avoid time consuming trips to the general hospital or other health services. An urgent care hub was also located on the premises for patients who needed to see a GP or nurse when appointments were not available at their own practice.

• The practice recognised the importance of providing services closer to the patient. When designing the medical centre additional space was provided to accommodate a growing population and additional local services.

• An innovative approach to training qualified doctors. This involved running a simulated clinic with case studies to prepare the doctors for their first clinics. GPs in training reported that this made them more prepared for their first clinics.

• Prompt and effective response to patient feedback. When feedback from the national patient survey identified difficulty in accessing the practice by phone the practice purchased a new telephone system, revised staff rosters to provide more staff to answer the phone and monitored call response time. Feedback from patients during inspection identified improvement in accessing the practice by phone.

We saw several areas of outstanding practice including:

• Operation of enhanced recall systems to ensure patients did not miss important tests or treatments. For example, GPs and nurses used information from hospital departments to remind patients who required a repeat test or scan at infrequent intervals. The risk of patients missing an important test was reduced.

• An improved and expanded prompt system to remind patients when they required tests and treatment. This was used to support patients with complex medical needs and long term medical conditions. For example, GPs were prompted to review whether a patient diagnosed with dementia required another person to act on their behalf in making decisions about care and treatment.

• Robust arrangements for use of technology to exchange information with hospital departments. Use of both e-mail and telemedicine with a range of hospital departments in a secure transfer system. This reduced the need for some patients to visit hospital outpatients and information returned from the hospital enabled prompt follow up for the patient with their named GP.

• Provision of a health information zone managed by the PPG. This included a computer terminal for patients to access information on local services and health promotion literature. The PPG members assessed useful information, often influenced by their discussions with other patients, to hold. They agreed what could be displayed with the practice. This information zone was for patients run by patients.Provision of services to 10 Syrian refugees and two local traveller communities. Feedback from these groups was positive. Particularly from members of the travelling community who benefitted from seeing their named GP for continuity of care. The practice record system alerted staff to book 30 minute appointments for members of the Syrian community and to book a translator who spoke the appropriate dialect.

Professor Steve Field (CBE FRCP FFPH FRCGP) 

Chief Inspector of General Practice