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28 Beaumont Street Good Also known as Dr Stephenson and partners

Inspection Summary


Overall summary & rating

Good

Updated 28 February 2017

Letter from the Chief Inspector of General Practice

In April 2016 we carried out a comprehensive inspection of 28 Beaumont Street. Shortfalls were identified relating to the effective delivery of healthcare services at this practice. As a result of this inspection, we asked the practice to make improvements to ensure that staff were aware of the principles and requirements of the Mental Capacity Act (2005) and the Gillick competencies.

We also found that the practice did not have an effective system for the recording and coding of patient care on the patient record system. The record system did not alert staff to vulnerable patients. This meant that information was not always readily available to all staff and delivery of care could be compromised. The practice had not undertaken a comprehensive fire risk assessment, and improvements were needed to monitor and record staff training provision.

The practice was rated as requiring improvement for effective services, and good for safe, caring, responsive and well led services. The practice had an overall rating of good.

We carried out a desk based inspection in November 2016 to ensure the practice had made improvements since our last inspection. The practice sent us evidence in the form of training certificates for three members of staff, details of their fire risk assessment, and an updated staff training record document. In addition the practice also supplied a comprehensive assessment of the steps they had taken, to demonstrate that changes had been made.

We found the practice had made improvements since our last inspection in April 2016.

At this inspection we found that:

  • The practice had provided training for members of the nursing and senior management team. This was to ensure that staff were able to understand and determine the principles of the Mental Capacity Act 2005, and Gillick competency.

  • The practice had reviewed the recording and coding of patient care on the patient record system. As a result the practice had advised us that they were now auditing and monitoring this issue.

  • The practice had instructed an independent company to assess the risk of fire in the practice and produce a comprehensive fire risk assessment.

  • Actions from this risk assessment included regular fire drills and monthly audits of fire safety risks.

  • Systems were now in place to reduce and minimise the risk of fire to both staff and patients.

  • The practice had supplied a copy of their training records, to demonstrate the steps taken to improve the previous training recording issues found.

  • Systems were now in place to monitor training and ensure that effective care is made available to patients.

Following this desk based inspection we rated the practice as good for providing effective services. The overall rating for the practice remains good. This report should be read in conjunction with the full inspection report of 5 April 2016. A copy of the full inspection report can be found at www.cqc.org.uk.

Professor Steve Field (CBE FRCP FFPH FRCGP) 

Chief Inspector of General Practice

Inspection areas

Safe

Good

Updated 23 June 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.
  • When safety incidents occurred, investigations took place and any action to improve processes was undertaken 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.
  • Medicines were managed in a way that kept patients safe.
  • Risks to patients were assessed and well managed.

Effective

Good

Updated 28 February 2017

Since our last inspection in April 2016, the practice was found to have undertaken work to address the previous issues found by:

  • Providing training for members of the nursing and senior management team, to ensure they were able to understand and determine the principles of the Mental Capacity Act, and Gillick competencies.

  • Reviewing the recording and coding of patient care on the patient record system.

  • Auditing and monitoring the recording and coding of patient care on the patient record system.

  • Instructing an independent company to assess the risk of fire in the practice.

  • Producing a fire risk assessment, and providing examples that all staff members were now following this.

  • Ensuring systems were now in place to reduce and minimise the risk of fire to both staff and patients.

  • Supplying a copy of training records to show the improvements made to the monitoring and record keeping of staff training.

  • Ensuring systems were now in place to monitor training and ensure that effective care is made available to patients

Caring

Good

Updated 23 June 2016

The practice is rated as good for providing caring services.

  • Data from the National GP Patient Survey showed patients rated the practice similarly or higher than average in several aspects of care.
  • From patient records we saw that care was tailored to patients’ individual needs.
  • 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 confidentiality.

Responsive

Good

Updated 23 June 2016

The practice is rated as good for providing responsive services.

  • The national GP survey showed very positive feedback regarding patient access to appointments. This was reflected in feedback we received from patients during the inspection.
  • Practice staff reviewed the needs of its local population which had a high number of young adults from the local University colleges.
  • 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.

Well-led

Good

Updated 23 June 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 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 open culture and all staff were involved in the running of the practice.
  • 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 acting on notifiable safety incidents and ensured this information was shared with staff to ensure appropriate action was taken.
  • The practice had not sought all the feedback from patients it could have in regards the appointment system.

Checks on specific services

People with long term conditions

Good

Updated 23 June 2016

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

  • The practice followed guidance in the management of chronic diseases.
  • Patients at risk of hospital admission were identified and had care plans written where appropriate.
  • There were GPs with expertise in various clinical areas, such as respiratory diseases.
  • The practice achieved 97% on its quality outcomes framework scores (QOF) in 2015. QOF is a quality system to measure the performance and quality of patient care and treatment.
  • The care of long term conditions was audited to identify where improvements in the management of a specific condition could be made.
  • Longer appointments and home visits were available when needed.
  • There was a process to offer a periodic structured review to check patients’ health.
  • There was monitoring of patients on long term medicines, although due to recording issues on the record system the extent to which these were up to date was not clear.
  • 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.

Families, children and young people

Good

Updated 23 June 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.
  • Any children at risk would be flagged on the records system to ensure reception staff would be alerted to their vulnerability.  
  • Childhood immunisation rates for the vaccinations given were slightly lower than CCG averages. However, 60% of families with young children were from other countries and many had accessed care for their children outside the UK.

  • There were very high numbers of students registered at the practice and its services were tailored to their needs. For example, Visits to local University colleges took place to enable new students to register at the practice and also provide them with information about NHS services. Students were also offered face to face registration, checking and updating any immunisations required and reviewing of medical histories during their first week at university. Lunch time appointments were also available for students as they may be more convenient for them.

  • Staff were aware not always provided with appropriate awareness of the circumstances and rights when gaining consent from patients under 16.
  • Baby changing facilities were available.
  • GPs worked with midwives and health visitors in the provision of care.

Older people

Good

Updated 23 June 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 patients in its population.
  • Care plans were available for patients deemed at high risk of unplanned admissions.
  • Access for patients with limited mobility was good including for those with mobility scooters.
  • There were named GPs for this group of patients.
  • A named GP provided care to patients in a local care home and visited frequently to provide any care or reviewed patients’ needs.
  • Screening for conditions which patients in this population group may be at risk of was provided, such as dementia.

Working age people (including those recently retired and students)

Good

Updated 23 June 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.
  • Commuters who found it easier to see a GP near to their place of work in Oxford were registered with the practice if they requested.
  • Extended hours appointments were available.
  • The practice was proactive in offering online services as well as a full range of health promotion and screening that reflected the needs for this age group.

  • Patient feedback on the availability of appointments from the national survey and on the day of inspection was positive.
  • Phone consultations were offered to patients.
  • Online appointment booking was available.

People experiencing poor mental health (including people with dementia)

Good

Updated 23 June 2016

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

  • Performance for mental health related indicators was 98% compared to the CCG average of 95% and national average of 93%.

  • 90% of the 68 patients eligible for a care plan had one in place and reviewed in in 2015/16.

  • The practice informed us that all patients on lithium (a medicine which requires close monitoring) were appropriately monitored.
  • The practice regularly worked with multi-disciplinary teams in the case management of patients experiencing poor mental health, including those with dementia.
  • There was screening available for patients deemed at risk of dementia and a referral pathway to a memory clinic if required.
  • The practice carried out advance care planning for patients with dementia.

People whose circumstances may make them vulnerable

Good

Updated 23 June 2016

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

  • Learning disability health checks were offered to patients.
  • The practice held a register of patients living in vulnerable circumstances.
  • Patients with care plans were alerted to reception staff.
  • The practice offered longer appointments for vulnerable patients.
  • GPs regularly worked with multi-disciplinary teams in the case management of vulnerable patients.
  • A mentoring scheme offered young people with social, emotional or potential mental health problems with support.
  • 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.