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Inspection Summary


Overall summary & rating

Good

Updated 10 March 2016

Letter from the Chief Inspector of General Practice

We carried out an announced comprehensive inspection at Oakwood Surgery on 19 January 2016. Overall the practice is rated as good.

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

  • The practice ensured that when things went wrong that these were investigated and learning was shared with staff. Risks to patients were assessed and well managed. There were systems for assessing risks including those associated with medicines, premises, equipment and infection control.
  • There was a detailed business continuity plan to deal with untoward incidents that may affect the day to day running of the practice.
  • Staff were recruited robustly with all of the appropriate checks carried out to determine each person’s suitability and fitness to work at the practice.
  • Patients’ needs were assessed and care was planned and delivered following published local and national best practice guidance. Clinical audits and reviews were carried out to make improvements to patient care and treatment.

  • Staff were supported and received role specific training to meet the needs of patients and there was a system for staff appraisal.
  • Patients said they were treated with compassion, dignity and respect.
  • Information about services and how to complain was available and easy to understand. Complaints were investigated and responded to appropriately and apologies given to patients when things went wrong or their experienced poor care or services. Complaints were reviewed and any trend identified and monitored to improve patient satisfaction.
  • Some patients said they found it difficult to access appointments and to contact the practice by telephone. The practice had reviewed its appointments system and upgraded the telephone systems to address patients comments about the lack of accessible appointments and difficulties
  • 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 to make improvements to the services provided.

Professor Steve Field (CBE FRCP FFPH FRCGP) 

Chief Inspector of General Practice

Inspection areas

Safe

Good

Updated 10 March 2016

The practice is rated as good for providing safe services. There were systems in place to monitor safety and to act when things went wrong. Lessons were learned and communicated with staff to support improvement. Information about safety was recorded, monitored, appropriately reviewed and addressed.

There were policies, procedures and risks assessments to identify risks to patients and staff. These included safeguarding adults and children, infection prevention and control and health and safety.

Staff were recruited with all of the appropriate checks carried out including proof of identify, employment references and Disclosure and Barring Services (DBS) checks. Staff were trained and had access to appropriate policies and guidance for their roles

Medicines were managed safely. These stored appropriately and checks were carried out to ensure that medicines were in date and available as required.

The practice had appropriate premises and equipment and these were well maintained to help keep patients and staff safe.

Effective

Good

Updated 10 March 2016

The practice is rated as good for providing effective services.

Data showed patient outcomes were at or above average for the locality for the management of the majority of long term conditions and disease management such as heart disease dementia and diabetes. Where areas for improvements were identified the practice acted promptly to address these. Staff referred to guidance from the National Institute for Health and Care Excellence (NICE) local and national initiatives and used it routinely.

  • Patients’ needs were assessed and care was planned and delivered in line with current legislation and guidance.

  • Reviews were carried out to monitor and review treatment for patients with long term conditions.

  • The practice worked proactively with other health and social care professionals to ensure that patients received coordinated care and treatment.

  • A system of audits and reviews were in place to monitor and improve outcomes for patients.

  • Staff were supported and received training relevant to their roles and the needs of patients.

Caring

Good

Updated 10 March 2016

The practice is rated as good for providing caring services. The results from the national GP patient survey published on 7 January 2016 showed that patients generally satisfied with how staff at the practice treated them and the practice performance was similar to other GP practices both locally and nationally for several aspects of care. Where areas for improvement were identified the practice had acted on these to improve patients’ experience.

Patients who completed comment cards and those we spoke with during the inspection also told us that staff at the practice were respectful and caring. Patients said they were treated kindly with dignity and respect. Patients’ privacy was maintained during consultations and treatment and information in respect of patients was treated confidentially. The practice had a dedicated room where patients could speak in private should they wish to.

Patients told us that they received information about their treatment in a way which they could understand and they were involved in decisions about their care and treatment. Information for patients about the services available was easy to understand and accessible. The practice recognised the needs of patients who were carers and provided support and information about the range of agencies and organisations available.

Responsive

Good

Updated 10 March 2016

The practice is rated as good for providing responsive services. It reviewed the needs of its local population and engaged with the NHS England Area Team and Clinical Commissioning Group (CCG) to secure improvements to services where these were identified.

Appointment times and availability were flexible to meet the needs of patients. Same and next day appointments were available. Home visits and telephone consultations were provided as needed. The practice had responded to patients comments about access to appointments and getting through to the surgery on the telephone. They had upgraded the telephone system and amended the appointments system to offer more same day appointments.

The practice had good facilities and was well equipped to treat patients and meet their needs. Accessible toilets and baby changing facilities were available.

Information about how to complain was available and easy to understand and evidence showed that the practice responded quickly to issues raised. The practice offered apologies to patients when things went wrong or the service they received failed to meet their expectations. Learning from complaints was shared with staff and other stakeholders.

Well-led

Good

Updated 10 March 2016

The practice is rated as good for being well-led. It had a clear vision and strategy to provide personalised high quality care for all its patients. Patients had access to GPs throughout the day via face to face appointments or for advice and telephone consultations. The strategy included planning for the future. Staff were clear about the vision and their responsibilities in relation to this. Information about the practice was available to staff and patients.

There was a clear leadership structure within the practice and staff felt supported by management. The practice had a number of policies and procedures to govern activity and these were regularly reviewed and updated so that they reflected current legislation and guidance. There were systems in place to monitor and improve quality and identify risk.

The practice proactively sought feedback from staff and patients, which it acted on. The patient participation group (PPG) was active and met with practice staff six times each year to discuss any issues and how these could be improved upon. The patient participation group was working proactively to attract new members. Staff told us that they felt supported and that they could raise comments and suggestions, which were acted upon.

Checks on specific services

People with long term conditions

Good

Updated 10 March 2016

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

The practice offered proactive, personalised care to meet the needs of people with long term conditions, including:

  • Extended opening and evening appointments were available three evenings each week.

  • Patients with long term conditions had specific care plans to coordinate their care and treatment.

  • Appointments and reviews were carried out for patients who lived in local care homes and these were co-ordinated to include carers where possible.

  • Proactive health promotion and health screening including smoking cessation, information and advice around alcohol consumption, diet and lifestyle.

  • Collaborative working with other health care professionals to coordinate care and treatment.

  • GPs and nursing staff had lead roles in chronic disease management and provided a range of clinics including asthma, diabetes and chronic obstructive pulmonary disease (COPD). The practice performance for the management of these long term conditions was similar to or higher than other GP practices nationally.

  • The practice had a dedicated member of staff to coordinate reviews for the management of long term conditions and work was being done to streamline reviews so as to minimise the number of visits for patients with one or more long term condition.

Families, children and young people

Good

Updated 10 March 2016

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

The practice offered proactive, personalised care to meet the needs of people with long term conditions, including:

  • Collaborative working with health visitors and the local safeguarding team to monitor the care and welfare for children.

  • There were twice weekly ante-natal clinics available led by a community midwife.

  • Staff undertook appropriate training including safeguarding and domestic abuse awareness.

  • Urgent same day appointments were available for children.

  • A full range of infant and childhood immunisations were available.

  • Appropriate referrals were made to Children and Adolescent Mental Health Services (CAMHS).

  • On site clinics for teenagers run by an external organisation and supported by the practice nurse to offer advice on sexual health and contraception.

Older people

Good

Updated 10 March 2016

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

Nationally reported data showed that outcomes for patients were good for conditions commonly found in older people.

The practice offered proactive, personalised care to meet the needs of older people, including:

  • Monthly meetings with other health care professionals to reduce unplanned hospital admissions.

  • A range of appointments were available including telephone consultations and home visits.

  • Home visits for phlebotomy was provided as needed.

  • Patients who were over 75 years had a named GP who was responsible for coordinating their care.

  • A range of health promotion and screening services were available including flu and shingles vaccinations and cancer screening.

  • Patients were referred as needed to a local befriending service

  • Dementia screening and referral to specialist services were available where appropriate.

  • The practice offered an ‘open door’ service to carers, friends and relatives for advice and support.

The patient participation group contributed information to a local community newsletter to provide information to the local community about the practice and local support groups.

Working age people (including those recently retired and students)

Good

Updated 10 March 2016

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

The practice offered proactive, personalised care to meet the needs of working-age people (including those recently retired and students), including:

  • Access to extended evenings appointments three days per week.

  • Flexible appointments and telephone consultations that could be booked in person, by telephone and online.

  • Same day appointments for urgent requirements.

  • Longer appointments provided as needed.

  • A range of in-house services including counselling, phlebotomy and ECG.

  • Proactive promotion for NHS Health Check Screening and cancer screening including breast and bowel screening.

People experiencing poor mental health (including people with dementia)

Good

Updated 10 March 2016

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

The practice offered proactive, personalised care to meet the needs of people experiencing poor mental health (including people with dementia), including:

  • Structured appointments for mental health checks and learning disability health checks.

  • Depression screening and referral for specialist treatment where required.

  • A walk-in minor injuries clinic.

  • The practice had told patients experiencing poor mental health about how to access various support groups and voluntary organisations.

  • It had a system in place to follow up patients who had attended accident and emergency (A&E) where they may have been experiencing poor mental health.

People whose circumstances may make them vulnerable

Good

Updated 10 March 2016

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

The practice offered proactive, personalised care to meet the needs of people whose circumstances may make them vulnerable, including:

  • Staff undertook training in safeguarding vulnerable people and equality and diversity.

  • The practice worked with the local social services, probation services and drug & alcohol services to help support patients according to their individual circumstances.

  • Patients with no permanent address and homeless people were able to register at the practice.

  • The practice organised a food bank voucher scheme for vulnerable patients.

  • Patients were signposted to a local befriending service as needed.