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Inspection Summary


Overall summary & rating

Good

Updated 25 August 2017

Letter from the Chief Inspector of General Practice

We carried out an announced comprehensive inspection at Oaklands on 4 August 2015. The overall rating for the practice was requires improvement as the practice required improvement for providing safe and well led services. The full comprehensive report on the August 2015 inspection can be found by selecting the ‘all reports’ link for Oaklands on our website at www.cqc.org.uk.

This inspection was undertaken on 11 July 2017 and was an announced comprehensive inspection 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 4 August 2015. This report includes our findings in relation to those requirements.

Overall the practice is rated as good.

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

  • There were systems in place to reduce risks to patient safety, for example, equipment checks were carried out, there were systems to protect patients from the risks associated with insufficient staffing levels and to prevent the spread of infection.
  • Staff understood and fulfilled their responsibilities to raise concerns and report incidents and near misses. Staff were aware of procedures for safeguarding patients from the risk of abuse.
  • Patients’ needs were assessed and care was planned and delivered following best practice guidance.
  • Staff felt supported. They had access to training and development opportunities appropriate to their roles.
  • Patients said they were treated with compassion, dignity and respect. We saw staff treated patients with kindness and respect.
  • Services were planned and delivered to take into account the needs of different patient groups.
  • Access to the service was monitored to ensure it met the needs of patients.
  • There was a system in place to manage complaints.
  • There were systems in place to monitor and improve quality and identify risk.

The practice had made some improvements to meet legal requirements but there were still areas where the provider should make improvements including:

  • Introduce a system to allow the findings and actions arising from investigations into significant events to be consistently shared with staff. Record the action taken and date of review of all significant events in the significant event log to allow a comprehensive overview of issues arising and actions implemented.

  • Introduce a formal process to monitor cleaning standards.

  • Ensure in-house checks of the fire alarm and emergency lighting take place at the recommended frequencies.

  • An up to date risk assessment to identify and manage risks presented by Legionella should be put in place.

  • The procedure to follow when a patient presents as needing urgent medical attention should be reiterated to all staff.
  • Ensure staff recruitment records contain evidence of information having been gathered about any health conditions which are relevant (after reasonable adjustments) to the role the person was being employed to undertake.
  • Review the system to identify the training needs of staff.

  • Review system used to identify carers registered with the practice.

Professor Steve Field (CBE FRCP FFPH FRCGP) 

Chief Inspector of General Practice

Inspection areas

Safe

Good

Updated 25 August 2017

At our previous inspection on 4 August 2015, we rated the practice as requires improvement for providing safe services.

Improvements were needed to ensure the premises were safe as there were some areas of the premises that fell below acceptable standards of cleanliness. Improvements were needed to the management of significant events to ensure the policy was updated to reflect the procedures in place and to expand the range of reportable incidents. At this inspection we found that improvements had been made and the practice is now rated as good for providing safe services.

We found that

the system in place for reporting, recording and investigating significant events had been reviewed and the written procedures to support the process had been updated. The records of significant events showed that the range of reportable incidents had been expanded.

Meetings between all staff teams were regularly occurring

. However, we found that further work was needed to the system for sharing findings from significant events to provide a consistent approach and to records that provided an overview of these events so that it could be clearly identified what action had been taken and when. The systems in place for ensuring appropriate standards of cleanliness and hygiene had been improved. The premises were clean, policies and procedures had been updated and clinical waste was being suitably managed. We found that the monitoring of cleaning standards was not being recorded.

There were appropriate systems in place to ensure that equipment was safe to use. There were systems to protect patients from the risks associated with insufficient staffing levels and medicines management. Staff were aware of procedures for safeguarding patients from the risk of abuse.

Effective

Good

Updated 25 August 2017

The practice is rated as good for providing effective services. Patients’ needs were assessed and care was planned and delivered in line with current legislation. Staff referred to guidance from the National Institute for Health and Care Excellence (NICE) and used it routinely. Staff worked with other health care teams and there were systems in place to ensure appropriate information was shared. Staff felt supported and they told us they had

access to training and development opportunities appropriate to their roles.

Caring

Good

Updated 25 August 2017

The practice is rated as good for providing caring services. Patients spoken with and who returned comment cards were positive about the care they received from the practice. They commented that they were treated with respect and dignity and that staff were caring, supportive and helpful. Responses to the National GP Patient Survey (July 2016) relating to the caring approach of the practice were in-line with local and national averages.

Responsive

Good

Updated 25 August 2017

The practice is rated as good for providing responsive services. Services were planned and delivered to take into account the needs of different patient groups. A range of access to the service was provided and this was monitored to ensure it met the needs of patients.

The practice had a complaints policy which provided staff with guidance about how to handle a complaint.

Well-led

Good

Updated 25 August 2017

At our previous inspection on 4 August 2015, we rated the practice as requires improvement for providing well-led services as the provider had not ensured their audit and governance systems were effective. The significant event policy did not reflect the process in place and the range of significant events identified needed to be expanded. Regular appraisals of staff were not carried out, staff were unclear about the roles of others within the practice and there was limited evidence of audit or of other methods of quality improvement. Risk management systems in relation to cleanliness and infection control needed to be improved.

At this inspection we found that improvements had been made and the practice is now rated as good for providing well-led services.

The practice had a vision and strategy to deliver high quality care and promote good outcomes for patients. 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 and staff meetings. The practice reviewed patient and staff feedback and acted on this.

Checks on specific services

People with long term conditions

Good

Updated 25 August 2017

The practice is rated as good for the care of people with long-term conditions. The practice held information about the prevalence of specific long term conditions within its patient population such as diabetes, chronic obstructive pulmonary disease (COPD), cardio vascular disease and hypertension. This information was reflected in the services provided, for example, reviews of conditions and treatment, screening programmes and vaccination programmes. The practice had a system in place to ensure regular reviews of patients with long term conditions. Quality and Outcome Framework (QOF) data showed the practice was performing in-line with other practices locally and nationally in monitoring patients with long term conditions. The practice encouraged patients to monitor their long term conditions where possible. For example, through the use of blood pressure monitoring machines at home or by using a monitor at the practice. The

practice worked with other agencies and health providers to provide support and access to specialist help when needed.

Families, children and young people

Good

Updated 25 August 2017

The practice is rated as good for the care of families, children and young people. Child health surveillance and immunisation clinics were provided. Immunisation rates were in line with local and national averages for all standard childhood immunisations. There was a system to ensure that any missed immunisations were followed up with parents or a health visitor.  Priority was given to children and young people who needed to see a GP. Child health promotion information was available on the practice website and in leaflets displayed in the waiting area. Flexible appointment times were provided around school times. Family planning and sexual health services were provided.

Older people

Good

Updated 25 August 2017

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

The practice kept registers of patients’ health conditions and used this information to plan reviews of health care and to offer services such as vaccinations for flu and shingles. GPs visited local care homes weekly. V

isits were carried out by the same clinicians to provide continuity and these clinicians were available for senior care home staff for advice and guidance outside of these visits. A dedicated telephone line was in place to prioritise calls from nursing and residential homes and the community team. Care plans were in place for care home residents to support their health and well-being. The

practice worked with other agencies and health providers to provide support and access specialist help when needed. Multi-disciplinary meetings were held to discuss and plan for the care of frail and elderly patients.

Working age people (including those recently retired and students)

Good

Updated 25 August 2017

The practice is rated as good for the care of working-age people (including those recently retired and students). The practice appointment system and opening times provided flexibility to working patients and those in full time education. The practice was open from 8am to 6.30pm Monday to Friday. Extended hours were provided Monday evening until 8pm, Tuesday morning 7am to 8am and alternate Saturday mornings 8.30am to 11.15am. Patients could book appointments in person, via the telephone and on-line. The appointment system provided pre-bookable and on the day appointments. Routine appointments could be booked up to two weeks in advance for GPs and four weeks in advance for nurses. Repeat prescriptions could be ordered on-line or by attending the practice. Telephone consultations and home visits were also offered. The practice offered health promotion and screening that reflected the needs of this population group such as cervical screening, NHS health checks, contraceptive services, smoking cessation advice and family planning services.

People experiencing poor mental health (including people with dementia)

Good

Updated 25 August 2017

The practice is rated as good for the care of people experiencing poor mental health (including people with dementia). GPs worked with specialist services to review care and to ensure patients received the support they needed. The practice maintained a register of patients who experienced poor mental health. The register supported clinical staff to offer patients experiencing poor mental health, including dementia, an annual health check and a medication review. The practice worked with multi-disciplinary teams in the case management of people experiencing poor mental health, including those with dementia. The practice referred patients to appropriate services such as memory clinics, psychiatry and counselling services. Patients were also signposted to relevant services such as Age UK, and the Alzheimer’s Society and were offered resources such as talking therapies and on-line self-help resources. The staff team had received training in dementia awareness to assist them in identifying patients who may need extra support.

People whose circumstances may make them vulnerable

Good

Updated 25 August 2017

The practice is rated as good for the care of people whose circumstances may make them vulnerable. A register was kept of patients with a learning disability and there was a system

to ensure these patients were offered an annual health check. Se

rvices for carers were publicised and a record was kept of carers to ensure they had access to appropriate services. A member of staff acted as a carer’s link and they were working to identify carers and promote the support available to them. Appointments for travellers were prioritised and opportunistic screening and provision of immunisations and vaccinations were offered to promote the health care needs of this vulnerable patient group. The practice referred patients to local health and social care services for support, such as drug and alcohol services and to Alternative Solutions for support with social issues that were having a detrimental impact upon their lives.