Archived: Oakengates Medical Practice

Updated 28 July 2016

Oakengates Medical Practice is registered with the Care Quality Commission (CQC) as a GP partnership provider in Telford. The practice holds a General Medical Services (GMS) contract with NHS England. A GMS contract is a contract between NHS England and general practices for delivering general medical services and is the commonest form of GP contract. The practice area is one of increased deprivation when compared with the national and local Clinical Commissioning Group (CCG) area. At the time of our inspection the practice had 14,180 patients.

The main site is Oakengates Medical Practice, with branch site in Hadley, Telford. The sites are as follows:

• Oakengates Medical Practice, 27 Limes Walk, Oakengates, Telford, TF2 6JJ
• Hadley Surgery, Highfield Clinic, Waterloo Road, Hadley, Telford,

We visited Oakengates Medical Practice as part of this inspection. The Hadley Surgery is one and half miles away from the main practice.

We found there had been changes to the practice registration. One partner had left the practice some time ago and the practice had not notified the Care Quality Commission of this change or amended their registration to reflect these changes. Another partner had also left unexpectedly just before the inspection.

The practice staffing comprises of:

• Five GP partners (three male and two female), two female salaried GPs and one long term male locum GP.
• Three female advanced nurse practices, five female practice nurses and three female health care assistants.
• A practice director and operational practice manager.
• An informatics manager.
• Two secretaries, a prescription clerk, a coding clerk and reception staff.

The main practice was open between 8.30am and 6pm Monday to Friday. GP appointments were available between 8.30am and 11.20am and 3pm and 5.20pm. The branch practice at Highfield Clinic, Hadley was open Monday, Wednesday and Thursday with GP appointments only available between 8.30am and 11.30am and 2pm ad 5pm. Nurse practitioner appointments were available between 9.45am and 12.45pm, and 3pm and 5.40pm, with telephone triage between 2pm and 3pm. Nurse lead appointments were available between 8.30am and 6pm, and health care assistant clinics between 9am and 4.40pm.

The practice has opted out of providing cover to patients in the out-of-hours period. During this time services are provided by Shropdoc.

Updated 28 July 2016

Letter from the Chief Inspector of General Practice

We carried out an announced comprehensive inspection at Oakengates Medical Practice on 14 June 2016. Overall the practice is rated as requires improvement.

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 not always assessed and well managed. For example the practice had not assured that their staff were immune to health associated infections.
• 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.
• Patient satisfaction with their experience of contacting the practice and making appointments was below local and national averages.
• 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.
• 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.

The areas where the provider must make improvement are:

• Improve the quality of services provided for patients contacting the practice by telephone and their overall experience of making appointments.
• Review the systems for assessing and monitoring the quality of service provision and take steps to ensure risks are managed appropriately.

The areas where the provider must should make improvement are:

• Ensure that all required recruitment checks are obtained for staff.
• Record the immunisation status of staff to establish if staff and patients were protected from the risk of health care acquired infections.
• Review the fire risk assessment to ensure that it is robust.
• Improve the information available for staff on the Control of Substances Hazardous to Health.
• Evaluate the reasons for poor performance in the national GP patient survey regarding patient satisfaction with their interactions with GPs and nurses and take action to improve performance in this area.
• Adopt a more proactive approach to identifying and meeting the needs of carers.

Professor Steve Field (CBE FRCP FFPH FRCGP) 

Chief Inspector of General Practice

Updated 28 July 2016

The practice was rated as requires improvement in responsive and well led, and good in the domains of safe, effective and caring. The concerns which led to these ratings apply to everyone using the practice, including this population group.

• The practice nurses had lead roles in chronic disease management and patients at risk of hospital admission were identified as a priority.
• The practice maintained registers of patients with long term conditions. Patients were offered a structured annual review to check their health and medicines needs were being met.
• Performance in the five diabetes related indicators were comparable to the national average. For example: The percentage of patients with diabetes, on the register, in whom a specific blood test was recorded was 79% compared with the national average of 77%.
• The practice hosted diabetic and foot screening services.
• Longer appointments and home visits were available when needed.
• 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.

Updated 28 July 2016

The practice was rated as requires improvement in responsive and well led, and good in the domains of safe, effective and caring. The concerns which led to these ratings apply to everyone using the practice, including this population group.

• There were systems in place to identify and follow up children who were at risk, for example families with children in need or on children protection plans. The safeguarding lead held quarterly meetings with the health visitors to discuss at risk children and families.
• Appointments were available outside of school hours and the premises were suitable for children and babies. Same day emergency appointments were available for children.
• Two members of clinical staff had the lead role as teenager/young person champions. Dedicated afternoon appointments for teenagers were available.
• There were screening and vaccination programmes in place and the practice’s immunisation rates
• Data from the Quality and Outcomes Framework (QOF) for 2014/15 showed that 79% of women aged 25-64 had received a cervical screening test in the preceding five years, compared to the national average of 82%.
• The practice provided sexual health services, which enabled patients to be screened for sexually transmitted infections that the practice, instead of having to travel to a specialist clinic.
• The practice offered family planning and routine contraception services.

Updated 28 July 2016

The practice was rated as requires improvement in responsive and well led, and good in the domains of safe, effective and caring. The concerns which led to these ratings apply to everyone using the practice, including this population group.

• 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.
• Patients who lived in care homes with long term conditions and / or dementia were offered regular reviews.
• The practice discussed the needs of patients who had recently been discharged from hospital with the community matron.
• The practice worked closely with the Age Concern Care Navigator for guidance on benefits and support available in the community, particularly for older isolated patients. Care Navigators assist patients who may feel lonely or isolated, have little local support, have been recently bereaved or who wish to find out about services which may be available to them. They can help put in place support or find activities provided by voluntary and statutory services.

Updated 28 July 2016

The practice was rated as requires improvement in responsive and well led, and good in the domains of safe, effective and caring. The concerns which led to these ratings apply to everyone using the practice, including this population group.

• The practice offered book on the day appointments each day with the GPs, pre-bookable appointments and triage / telephone consultation appointments. Urgent appointments were also available for people that needed them
• The practice was part of a local initiative to offer extended hours appointments to patients registered at six local GP practices. Extended hours appointments were available between 6pm and 8pm each weekday evening and between 9am and 1pm on Saturdays at one of the six participating practices.
• The practice was proactive in offering online services as well as a full range of health promotion and screening that reflects the needs for this age group.

Updated 28 July 2016

The practice was rated as requires improvement in responsive and well led, and good in the domains of safe, effective and caring. The concerns which led to these ratings apply to everyone using the practice, including this population group.

• Eighty percent of patients diagnosed with dementia had had their care reviewed in a face to face meeting in the last 12 months, which was lower than the national average of 84%.
• Performance for the mental health related indicators was comparable to the CCG and national average.
• The practice had told patients experiencing poor mental health about how to access various support groups and voluntary organisations.

Updated 28 July 2016

The practice was rated as requires improvement in responsive and well led, and good in the domains of safe, effective and caring. The concerns which led to these ratings apply to everyone using the practice, including this population group.

• The practice held a register of patients living in vulnerable circumstances including those with a learning disability or identified as vulnerable.
• The practice offered longer appointments for patients with a learning disability.
• An alcohol support worker attended the practice for clinics, and was able to refer patients for additional support and treatment.
• The staff knew how to recognise signs of abuse in vulnerable adults and children. The 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.