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Inspection Summary


Overall summary & rating

Good

Updated 25 August 2016

Letter from the Chief Inspector of General Practice

We carried out an announced comprehensive inspection Eynsham Medical Group on 22 June 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 been trained to provide them with 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. Improvements were made to the quality of care as a result of complaints and concerns.
  • Patients said they found it easy to make an appointment with a named GP and there was continuity of care, with urgent appointments available the same day.
  • 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 provider was aware of and complied with the requirements of the duty of candour.

We saw one area of outstanding practice:

The practice had designed a “pop up” alert for the records of patients at risk of acute kidney injury to assist with early diagnosis and intervention, and creating a warning card about the risk of dehydration and kidney damage to be given to patients prescribed diuretics. The cards were initially funded by the practice’s patient charity; Oxfordshire Clinical Commissioning Group has now developed and funded a similar scheme with advisory cards, and has used the experience gained by the lead partner in the practice to achieve this.

Professor Steve Field (CBE FRCP FFPH FRCGP) 

Chief Inspector of General Practice

Inspection areas

Safe

Good

Updated 25 August 2016

The practice is rated as good for providing safe services.

  • There was an effective system in place for reporting and recording significant events. Lessons were shared to make sure action was taken to improve safety in the practice.

  • The investigation of two significant events had led to the practice launching an acute kidney injury quality improvement project and introducing innovations to assist with early diagnosis, intervention and patient information.

  • When things went wrong patients received reasonable support, truthful information, and a written apology. They were told about any actions to improve processes to prevent the same thing happening again.

  • The practice had clearly defined and embedded systems, processes and practices in place to keep patients safe and safeguarded from abuse.

  • Risks to patients were assessed and well managed.

  • The dispensaries at both locations had an effective system in place to ensure the safe management and dispensing of medicines.

Effective

Good

Updated 25 August 2016

The practice is rated as good for providing effective services.

  • Data from the Quality and Outcomes Framework (QOF) showed patient outcomes were at or above average compared to the national average.

  • Staff assessed needs and delivered care in line with current evidence based guidance.

  • Clinical audits demonstrated quality improvement.

  • Staff had the skills, knowledge and experience to deliver effective care and treatment.

  • There was evidence of appraisals and personal development plans for all staff.

  • Staff worked with other health care professionals to understand and meet the range and complexity of patients’ needs.

  • One of the GP partners at the practice had co-developed an IT system to analyse and monitor QOF results. The practice had been an early adopter of the system, which was now being used by GP practices across the UK.

Caring

Good

Updated 25 August 2016

The practice is rated as good for providing caring services.

  • Data from the national GP patient survey showed patients rated the practice higher than others for several aspects of care, with 94% of respondents to the National GP Patient Survey describing their overall experience of treatment as good or very good, compared to a CCG average of 88% and a national average of 85%.

  • Patients said they were treated with compassion, dignity and respect and they were involved in decisions about their care and treatment.

  • Information for patients about the services available was easy to understand and accessible.

  • We saw staff treated patients with kindness and respect, and maintained patient and information confidentiality.

Responsive

Good

Updated 25 August 2016

The practice is rated as good for providing responsive services.

  • Practice staff reviewed the needs of its local population and engaged with the NHS England Area Team and Clinical Commissioning Group to secure improvements to services where these were identified. The practice was also part of the WestMed federation of 12 local GP practices, which provided its patients with access to the Witney Neighbourhood Hub for emergency GP appointments, and the Early Visiting Service to improve patient access to emergency home visits.

  • Patients said they found it easy to make an appointment with a named GP and there was continuity of care, with urgent appointments available the same day.

  • The practice had good facilities and was well equipped to treat patients and meet their needs.

  • Information about how to complain was available and easy to understand and evidence showed the practice responded quickly to issues raised. Learning from complaints was shared with staff and other stakeholders.

  • The dispensary had undertaken a patient survey 2016 and taken action to address concerns raised regarding privacy at the counter.

  • Dispensary staff dispensed medicines for some patients in weekly compliance aids to help them manage their medicines safely, and there was a safely managed delivery service funded by the practice’s patient charity for 92 patients who were unable to collect their medicines from the dispensary.

Well-led

Good

Updated 25 August 2016

The practice is rated as good for being well-led.

  • The practice had a clear vision and strategy to deliver high quality care and promote good outcomes for patients. Staff were clear about the vision and their responsibilities in relation to this.

  • There was a clear leadership structure and staff felt supported by management. The practice had a number of policies and procedures to govern activity and held regular governance meetings.

  • There was an overarching governance framework which supported the delivery of the strategy and good quality care. This included arrangements to monitor and improve quality and identify risk.

  • The provider was aware of and complied with the requirements of the duty of candour. The partners encouraged a culture of openness and honesty. The practice had systems in place for notifiable safety incidents and ensured this information was shared with staff to ensure appropriate action was taken

  • The practice proactively sought feedback from staff and patients, which it acted on. The patient participation group had existed in a virtual form to date, and the practice manager was in discussion with members to establish a group to hold regular meetings.

  • There was a focus on continuous learning and improvement at all levels, with clinical staff involved in a number of recent and active research projects, and non-clinical staff offered training opportunities in areas such as dementia awareness.

Checks on specific services

Older people

Good

Updated 25 August 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.

  • The practice promoted local community events relevant to older people. These included a social event in Eynsham to support residents wishing to speak about issues related to end of life and bereavement, and a tea dance in Long Hanborough for people with dementia and their carers. It also promoted local services including a community car scheme to transport patients to appointments, and a "good neighbour" network scheme.

  • charity tea dance, a community car scheme to get patients to hospital and clinic appointments and a good neighbour network scheme.’

  • Dispensary staff dispensed medicines for some patients in weekly compliance aids to help them manage their medicines safely, and there was a safely managed delivery service funded by the practice’s patient charity for 92 patients who were unable to collect their medicines from the dispensary. The dispensary also provided medicines for patients living in three local care homes.

  • We spoke to a district nurse attached to the practice who described effective information sharing and positive joint working.

People with long term conditions

Good

Updated 25 August 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.

  • 88% of patients with diabetes had received a foot examination and risk classification within the preceding 12 months, compared to a CCG average of 90% and a national average of 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.

  • The practice had launched an acute kidney injury (AKI) quality improvement project after identifying the role that AKI played in two significant events involving patients on long-term diuretic medicine. The project resulted in the practice introducing innovations to assist with early diagnosis and intervention, and designing a patient information card; the CCG had now developed and funded a similar scheme with advisory cards, and has used the experience gained by the lead partner in the practice to achieve this.

  • The practice had run a project to identify patients with atrial fibrillation, who could be at risk of stroke, by checking their pulses while attending flu immunisation clinics. The project had resulted in an increase in flu vaccination uptake in the over 65s from 72% to 84% and young ‘at risk’ patients from 44% to 71%, as well as new identification of four patients with atrial fibrillation.

  • More than 200 patients from the practice were currently participating in a national early lung and bowel cancer detection study, representing over 2% of all the volunteers so far recruited.

Families, children and young people

Good

Updated 25 August 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.

  • 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.

  • 84% of female patients aged 25 to 64 had received a cervical screening test in the preceding five years, compared to a CCG average of 83% and a national average of 82%.

  • Appointments were available outside of school hours and the premises were suitable for children and babies.

  • We spoke to a health visitor attached to the practice who described effective information sharing and positive joint working.

Working age people (including those recently retired and students)

Good

Updated 25 August 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 including enabling patients to view test results and medical notes as well as book appointments and request repeat prescriptions.
  • It also offered a full range of health promotion and screening that reflects the needs for this age group.
  • The practice offered early morning and evening GP telephone appointments for patients who could not attend during normal opening hours.

People whose circumstances may make them vulnerable

Good

Updated 25 August 2016

The practice is rated as good for the care of people whose circumstances may make them vulnerable.

  • The practice flagged the notes of patients who were considered to be vulnerable, and held a register of 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.

  • The practice gave examples of personalised care for patients with complex needs, which included close liaison with other agencies, and practical support where appropriate, funded by the practice’s patient charity.

People experiencing poor mental health (including people with dementia)

Good

Updated 25 August 2016

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

  • 89% of patients with schizophrenia, bipolar affective disorder and other psychoses had their care reviewed in a face to face meeting in the last 12 months, compared to a CCG average of 89% and a national average of 88%.
  • 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 advance care planning for patients with dementia.

  • The practice had advised 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 had a good understanding of how to support patients with mental health needs and dementia.