Background to this inspection
Updated
5 July 2019
Symphony Health Services Limited (SHS) is the registered provider of Oaklands Surgery. SHS is an NHS health care provider, based in Somerset that was developed as part of the South Somerset Symphony Programme – a project which aims to create new and innovative ways to delivering high quality care to patients, strengthening and supporting primary care in the local area. At the time of this inspection, SHS were delivering services from eight registered locations and one branch surgery.
SHS have been providing a service from Oaklands Surgery since August 2017. Oaklands Surgery service is provided from two addresses: (the registered address) Birchfield Road, Yeovil, Somerset, BA21 5RL; and a branch surgery, Yeovil Health Centre, (first floor of Boots the Chemist) Middle Street, Yeovil, Somerset BA20 1LS. General medical services are provided to approximately 10,516 patients. The main practice is situated in a purpose-built building in a residential area of the town of Yeovil. Information about Oaklands Surgery can be found on the practice website
According to information from Public Health England the practice area population is in the fifth least deprived decile in England. The practice population of children is above local and national averages by 8%. Likewise, the practice population of working age is above to local and national averages by at least 10%. The practice population of patients living with a long-term condition was below the local and national averages at 52%, the CCG being 58% and national being 54%. Of patients registered with the practice, 98% are White or White British, 1% are Asian or Asian British, 1.4% are Black or Black British, 0.2% are mixed British and 0.2% considered themselves as ‘Other’.
The provider has told us the practice team is made up of four salaried GPs, one being the Registered Manager, which means overall the practice has the equivalent of 2.5 WTE (whole time equivalent) GPs. There are three advanced nurse practitioners (ANP) equivalent to 2.3 WTE; one practice nurse and a long-term locum practice nurse; and two health care assistants. The practice had recently employed a practice pharmacist; and there is one health coach employed by the practice. The practice manager is supported by administrators, secretaries, and reception staff.
When the practice is not open patients can access treatment via the NHS 111 service.
The practice provides family planning, surgical procedures, maternity and midwifery services, treatment of disease, disorder or injury and diagnostic and screening procedures as their regulated activities.
Updated
5 July 2019
This practice is rated as Good overall. (Previous rating October 2018 – Requires Improvement)
We based our judgement of the quality of care at this service on a combination of:
- what we found when we inspected
- information from our ongoing monitoring of data about services and
- information from the provider, patients, the public and other organisations.
We have rated this practice as good overall and good for all population groups other than long-term conditions and
people experiencing poor mental health (including people with dementia)
which we rated as requires improvement.
We carried out an announced comprehensive inspection at Oaklands Surgery on 14 May 2019. This inspection was carried out to follow up on breaches of regulations and areas identified for improvement where we had rated the key questions of safe, effective and well led and the patient population groups of people with long-term conditions and mental health needs as requires improvement. We had implemented two regulatory requirements, Regulation 12 – Safe care and treatment and Regulation 17- Good governance and identified areas the provider should take action to improve.
These were:
Safe
The areas where the provider must improve were:
- Ensure the necessary information is available regarding staff immunisation status in line with Public Health England (PHE) guidance.
- Ensure there are safe systems in place for fire safety, checks for safe equipment, including calibration, training for persons undertaking health and safety audits and risk assessments, for infection prevention and control and for chemicals used by the practice.
- Ensure medicines are stored safely.
- Ensure there is a system of safe storage and handling of prescription stationery.
The areas where the provider should make improvements were:
- Review and continue to monitor the progress to bring employment information up to date regarding staff transferred to the provider organisation such as training, skills and qualifications.
- Review and continue to monitor regular audits for health and safety.
- Review and develop an auditable system for managing safety alerts received at the practice.
Effective
Areas where the provider must improve:
- Ensure they monitor and address the gaps in clinical staff available required to maintain meeting the patients’ needs including patients with long term conditions, mental health and dementia.
Well Led
- Ensure that patient confidential information at the branch surgery at Yeovil Health Centre is kept securely and in line with General Data Protection Regulation (GDPR) 2018.
- Ensure there are governance systems for clinical oversight of the advance nurse practitioners and health care assistants.
The areas where the provider should make improvements are:
- The practice should continue to proactively identify carers and respond to patient feedback regarding access to appointments.
At the inspection on 14 May 2019 we found:
- The necessary information was available regarding staff immunisation status was in line with Public Health England (PHE) guidance. Where there were minimal gaps in information this was risk assessed and strategies put in place to protect patients and staff.
- There were safe systems in place for fire safety, checks for safe equipment, including calibration, training for persons undertaking health and safety audits and risk assessments, for infection prevention and control and for chemicals used by the practice.
- Medicines were stored and managed safely.
- There was a system of safe storage and handling of prescription stationery.
- Employment records had been reviewed and updated to ensure the necessary information was retained regarding staff transferred to the provider organisation such as training, skills and qualifications. Where information could not be obtained this was monitored and risk assessed.
- There was a process for managing and sharing safety alerts across all of the locations.
- There was a system to monitor and address the level of clinical staff available required to maintain meeting the patients’ needs including patients with long term conditions, mental health and dementia.
- Patient confidential information at Yeovil Health Centre was kept securely and in line with General Data Protection Regulations (GDPR) 2018.
- There were governance systems for clinical oversight of the advance nurse practitioners and health care assistants.
- Staff dealt with patients with kindness and respect and involved them in decisions about their care.
- The practice staff were responsive to meeting patients which included the work carried out by health coaches to improve patients well being and for the practice to be part of the local community.
Areas where the provider should continue to develop:
- The practice should continue to resolve meeting the needs of the patients with long term conditions and with mental health concerns.
- The practice should continue with formalising a monitoring system for referrals.
- The practice should continue with developing flexible access to meet patient’s needs.
- The practice should continue to proactively identify carers in order to provide them with appropriate support.
- The practice should continue to monitor cervical smear screening to meet Public Health England screening target rates.
Details of our findings and the evidence supporting our ratings are set out in the evidence tables.
Dr Rosie Benneyworth BM BS BMedSci MRCGP
Chief Inspector of Primary Medical Services and Integrated Care