Archived: Oxford Street Surgery

Updated 30 January 2017

Oxford Street Surgery provides care and treatment to 7134 patients of all ages, based on a General Medical Services (GMS) contract. The practice is part of the NHS Cumbria clinical commissioning group (CCG) and provides care and treatment to patients living in the area of Workington. We visited the following location as part of the inspection: Oxford Street Surgery, 20 Oxford Street, Workington, Cumbria, CA14 2AJ.

The practice serves an area where deprivation is higher than the England average. In general, people living in more deprived areas tend to have a greater need for health services. The percentage of people with a long-standing health condition is just below the England average, but the percentage of people with caring responsibilities is above. Life expectancy for both men and women is lower than the England average. National data showed that 0.9% of the population are from non-white ethnic groups.

The practice occupies premises that have been adapted to meet the needs of patients with disabilities. There is a reception area, six consulting rooms, and two treatment rooms. The largest treatment room is equipped for minor operations, and the other is adapted for simple procedures only. Most of the upper floor consists of office and administration areas; however, there are some clinical rooms. The GP partners are considering the possibility of installing a lift to provide easier access to the first floor. The practice has two GP partners (both female), two salaried GPs (one male and one female), a nurse manager/trainee nurse practitioner (female), two practice/chronic disease nurses (female), one locum nurse practitioner (female), two healthcare assistants (female) and a team of administrative and reception staff including a practice manager, a medicines/reception manager, administrators, receptionists and cleaners.

The practice is open Monday to Friday between 8am and 6:30pm. GP appointment times are Monday to Friday between 8:30am and 11:40am, and between 2:30pm and 5:45pm. In addition, weekend appointments with a named GP are also provided intermittently. The practice is closed at weekends. It closes one afternoon a month, between 1pm and 6:30pm, for staff training.

When the practice is closed patients can access out-of-hours care via Cumbria Health On Call (CHOC), and the NHS 111 service.

Updated 30 January 2017

Letter from the Chief Inspector of General Practice

We carried out an announced comprehensive inspection at the Oxford Street Surgery on 18 October 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 promoting the safety of patients and staff and, an effective system for reporting and recording significant events. The staff team took the opportunity to learn from all internal and external incidents.

• Services were tailored to meet the needs of individual patients and were delivered in a way that ensured flexibility, choice and continuity of care. All staff were actively engaged in monitoring and improving quality and patient outcomes. Staff were committed to supporting patients to live healthier lives through a targeted and proactive approach to health promotion.

• The QOF data, for 2014/15, showed the practice had performed very well in obtaining 98.6% of the total points available to them, for providing recommended care and treatment. This was above the local clinical commissioning group (CCG) average of 96.8%, and the England average of 94.8%. (Just before we published the report, the QOF data for 2015/16 was released.

• Risks to patients and staff were assessed and well managed. Staff assessed patients’ needs and delivered care in line with current evidence based guidance. They had the skills, knowledge and experience to deliver effective care and treatment.

• The practice worked closely with other organisations when planning how services were provided, to ensure patients’ needs were met.

• Patients’ emotional and social needs were seen as being as important as their physical needs, and there was a strong, visible, person-centred culture. Patients said they were treated with compassion, dignity and respect and that they were involved in decisions about their treatment.

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

• The leadership, governance and management of the practice helped ensure the delivery of good quality person-centred care, supported learning and promoted an open culture.

However, there were also areas where the provider needs to make improvements. The provider should:

• Carry out a yearly review of significant events, to help identify common themes and patterns.

• Put in place a formal system for updating the practice’s clinical guidelines, and carry out checks to make sure they are being implemented.

Professor Steve Field (CBE FRCP FFPH FRCGP) 

Chief Inspector of General Practice

Updated 30 January 2017

The practice is rated as good for the care of people with long-term conditions.

• The QOF data, for 2014/15, showed the practice had performed above most of the local CCG and national averages, in relation to providing care and treatment for the clinical conditions commonly associated with this population group. (Just before we published the report, the QOF data for 2015/16 was released. This showed that the practice had further improved their QOF performance).

• Nursing staff had lead roles in chronic disease management and patients at risk of an unplanned hospital admission were identified as a priority.

• Patients with long-term conditions were offered annual reviews, to check their health needs were being met and that they were receiving the right medication. Longer appointments and home visits were available when needed.

• Clinical staff were good at working with other professionals, to deliver a multi-disciplinary package of care to patients with complex needs.

Updated 30 January 2017

The practice is rated as good for the care of families, children and young people.

• There were good systems in place to protect children who were at risk and living in disadvantaged circumstances. For example, monthly multi-disciplinary meetings were held where the needs of vulnerable children and families were discussed, to help manage risk and share information. All the clinical staff had completed appropriate safeguarding training.

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

• The practice offered contraceptive and sexual health advice, and information was available about how patients could access specialist sexual health services.

• Children were able to access a full range of childhood immunisations, provided by a town wide childhood immunisation service which serves all GP practices in Workington and is staffed by three experienced nurses. Publicly available information showed immunisation rates for children were above the local CCG averages, with 100% take-up rates for most.

• The practice had a comprehensive screening programme, and their performance was either above, or in line with, national averages. For example, the uptake of breast screening for females aged between 50 and 70, during the preceding three years, was above the national average, 79.5% compared to 72.2%. The uptake of cervical screening for females aged between 25 and 64, attending during the target period, was in line with the national average, 80.5% compared to 81.8%.

Updated 30 January 2017

The practice is rated as good for the care of older people.

• Nationally reported Quality and Outcomes Framework (QOF) data, for 2014/15, showed the practice had performed above most of the local clinical commissioning group (CCG) and national averages, in relation to providing care and treatment for the clinical conditions commonly associated with this population group. (Just before we published the report, the QOF data for 2015/16 was released. This showed that the practice had further improved their QOF performance).

• The practice offered proactive, personalised care which met the needs of older patients. For example, all patients over 75 years of age had a named GP who was responsible for their care. Staff worked in collaboration with the local Frail and Elderly Assessment Team, to help ensure patients with complex needs received the support they needed. Older housebound patients had access to influenza vaccinations, foot examinations, phlebotomy services and urinalysis, in their own homes.

• The practice had participated in the local enhanced service aimed at avoiding unplanned admissions into hospital. They had exceeded the targets for reviewing the needs of older patients on their case management register.

Updated 30 January 2017

The practice is rated as good for the care of working-age people (including those recently retired and students).

• The practice was proactive in offering online services, as well as a full range of health promotion and screening that reflected the needs of this group of patients.

• The QOF data showed the practice had performed above most of the local CCG and England averages, in providing recommended care and treatment to this group of patients. (Just before we published the report, the QOF data for 2015/16 was released. This showed that the practice had further improved their QOF performance).

• The practice was open each week day from 8am to 6.30pm. Patients who were unable to attend the surgery during normal opening hours were able to access pre-bookable appointments with a nurse practitioner, at an extended hours service located in the WPCC on a Saturday from 11am to 12.45pm, and on a Sunday from 1pm to 3.30pm. In addition to this, weekend appointments with a named GP were provided intermittently. Patients were also able to access a walk-in service for minor injuries, illnesses and ailments, at the WPCC from 8am to 8pm, seven days per week (excluding public holidays). Clinical staff from the practice covered regular sessions each week at this service, as did staff from the other Workington GP practices.

• Information on the practice’s website, and on display in their patient waiting areas, directed patients to the out-of-hours service. 

Updated 30 January 2017

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

• There were suitable arrangements for meeting the needs of patients experiencing poor mental health. The QOF data, for 2014/15, showed the practice had performed above local CCG and national averages, in relation to providing care and treatment to this group of patients. (Just before we published the report, the QOF data for 2015/16 was released. This showed that the practice had further improved their QOF performance).

• Patients experiencing poor mental health had access to information about how to access various support groups and voluntary organisations. Staff from a local alcohol and drug recovery service regularly attended the practice, to provide patients who had a range of substance misuse problems with appropriate advice and support.

• Patients with mental health needs were referred to the local Community Mental Health Care Team, if staff thought they would benefit from the services it provided.

• The practice’s clinical IT system clearly identified patients with dementia and other mental health needs, to ensure staff were aware of their specific needs.

Updated 30 January 2017

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

• There were suitable arrangements for meeting the needs of vulnerable patients. For example, the practice maintained a register of patients with learning disabilities which they used to ensure they received an annual healthcare review. Extended appointments were offered to enable this to happen.

• Systems were in place to protect vulnerable children from harm. Staff understood their responsibilities regarding information sharing and the documentation of safeguarding concerns, and they regularly worked with multi-disciplinary teams to help protect vulnerable patients.

• Appropriate arrangements had been made to meet the needs of patients who were also carers.