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Oak Street Medical Practice Good

Reports


Inspection carried out on 29 January 2020

During an inspection looking at part of the service

We carried out an inspection of Oak Street Medical Practice on 29 January 2019 due to the length of time since the last inspection. Following our review of the information available to us, including information provided by the practice, we focused our inspection on the following key questions:

  • Are services at this location effective?
  • Are services at this location responsive?
  • Are services at this location well-led?

Because of the assurance received from our review of information we carried forward the ‘good’ ratings for the following key questions:

  • Are services at this location safe?
  • Are services at this location caring?

At the last inspection in December 2015 we rated the practice overall as providing an outstanding service. Specifically, we found the practice to be good for providing a safe, caring and effective service and outstanding for providing a responsive and well led service. It was also found to be providing good services across the patient population groups with responsive services for people whose circumstances may make them vulnerable and patients experiencing poor mental health (including people with dementia) were rated as outstanding.

At this inspection, we have rated the practice as good. We saw the practice was providing a responsive and well-led service and still demonstrated effective leadership, a clear vision and a patient focussed approach to care and treatment. However, we noted some improvement were required to ensure services were wholly effective for all population groups.

We based our judgement of the quality of care at this service is 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.

We rated the population groups of people with long term conditions, working age people (including those recently retired and students), and peoples whose circumstances may make them vulnerable as requires improvement for providing effective services because:

  • Prescribing rates for hypnotic medicines were significantly higher than local and national averages.
  • The uptake rate for the national cervical cancer screening programme was below the 80% target rate.
  • The practice had only undertaken 28% of annual reviews for those patients with a learning disability.

We rated the other population groups as good.

We rated the practice as outstanding for providing responsive services for people whose circumstances may make them vulnerable because:

  • Services were tailored to meet the needs of individual patients. They were delivered in a flexible way that ensured choice and continuity of care.
  • There were innovative approaches to providing integrated person-centred care.
  • The practice had identified areas where there were gaps in provision locally and had taken steps to address them.

We rated the other population groups as good.

We rated the practice as good for providing well-led services because:

At this inspection, we saw the practice was providing a well-led service and still demonstrated effective leadership, a clear vision and a patient focussed approach to care and treatment. However, we noted some systems and processes in place had led to high levels of exception reporting, higher than average prescribing for hypnotics and low numbers of reviews completed for patients with a learning disability. The practice had some plans in place to address these areas. Therefore, we have rated the practice as good for providing well-led services.

Whilst we found no breaches of regulations, the provider should:

  • Continue to monitor and improve prescribing rates for the prescribing of hypnotic medicines.
  • Review the provision of the national cervical screening programme and improve uptake in line with the national target of 80%.
  • Review the provision of immunisations for children and improve uptake in line with the world health organisation target of 95%.
  • Review the provision of health checks for patients with learning disabilities with the aim of increasing uptake above the CCG target of 50%.
  • Continue to monitor the systems and processes to ensure patients are reviewed and followed up appropriately.

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

Inspection carried out on 9 December 2015

During a routine inspection

Letter from the Chief Inspector of General Practice

We carried out an announced comprehensive inspection at Oak Street Medical Practice on 9 December 2015.

We have rated the practice overall as providing an outstanding service. Specifically we found the practice to be good for providing a safe, caring and effective service and outstanding for providing a responsive and well led service. It was also found to be providing good services across the patient population groups and vulnerable patients and mental health and people with dementia were rated as outstanding.

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

  • Staff understood and fulfilled their responsibilities to raise concerns, and to report incidents and near misses. Information about safety was recorded, monitored, appropriately reviewed and addressed.
  • Risks to patients were assessed and well managed.
  • Patients’ needs were assessed and care was planned and delivered following best practice guidance. Staff had received training appropriate to their roles and any further training needs had been identified and planned.
  • Patients said they were treated with compassion, dignity and respect and they were involved in their care and decisions about their treatment.
  • Information about services and how to complain was available and easy to understand.
  • Patients said they found it easy to make an appointment with a named GP and that there was continuity of care, with urgent appointments available the same day.
  • 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.

There were some areas of outstanding practice:

  • The practice looked at all admissions, and over time was able to evidence that their admissions rates were lower than local averages. We saw evidence from the previous and current year that emergency admissions, falls admissions and A&E attendance rates were significantly lower than the local CCG average via a chart supplied by Norwich CCG called Dashboards. The practice’s two week wait Cancer referrals conversion rate was within the accepted range of 9-14%.

  • They worked closely with the City Reach programme (the service is provided for people who are homeless, or those at risk of being homeless, sex workers, prisoners and ex-offenders, people who substance misuse, travellers and asylum seekers). A Partner at the practice was the lead GP at City Reach and approximately 30 patients had successfully moved from the City Reach programme to the practice for their ongoing care. We spoke with two patients of Oak Street Medical Practice who were formerly from the City Reach Programme. The Patients now speak at conferences on their experiences and praised both City Reach and Oak Street Medical Practice for their assistance in their care.

  • The practice supported Highwater House which is a 22 bed registered care home for people who have experienced homelessness and who have both mental health and substance abuse (alcohol and drugs) issues. The practice supported the Highwater House team to deliver care by providing routine GP primary care services and by a rapid medical response of advice and input, either in the surgery or the care home, within the hour, whenever a medical, mental health or behavioural crisis occurred. In the last two years three patients have moved on to independent living.

Professor Steve Field (CBE FRCP FFPH FRCGP) 

Chief Inspector of General Practice