Updated 9 June 2016
Letter from the Chief Inspector of General Practice
Luther Street provides primary health care services for homeless people over the age of 16 and people vulnerably housed in Oxford. It is based in a purpose built medical centre and provides services to five hostels in the City of Oxford. The service is actively involved with a range of voluntary and statutory organisations in the area to provide co-ordinated care to this vulnerable patient group. The service is available to patients who find it difficult to register with general practice and as a consequence would not access care and treatment they require.
The service is part of Oxford NHS Foundation Trust and works closely with Oxford Homeless Pathways (an organisation providing hostels and other services for the homeless). The practice provides training opportunities for both GPs and nurses from local universities. The four GPs working at the practice are supported by a practice manager and a team of specialist staff including a specialist addiction practitioner and mental health practitioners. Additional services including podiatry and dentistry are available at the practice.
We carried out a comprehensive inspection on 30 September 2015. We spoke with patients, a member of the patient participation group and staff including the management team. The inspection focussed on whether the care and treatment of patients was safe, effective, caring, responsive and well led. We undertook a focussed inspection in April 2016 to follow up on the concerns relating to not all staff receiving basic life support training and nursing staff requiring updated training in administration of some vaccines. The provider submitted an action plan and evidence to demonstrate that all practice staff had received basic life support training after the inspection in September 2015. They also submitted evidence of nursing staff receiving updated training in administering immunisations and promotion of the availability of chaperone services. We have been able to re-rate the safe domain based on these positive changes.
Overall the practice is now rated as outstanding. It was outstanding for provision of caring and responsive services. Good for safe, effective and well led services. The practice was rated outstanding for provision of services to three of the six population groups. We did not apply ratings to the population group of older people. This was due to the practice only having 2 patients registered over the age of 75.
Our key findings from this follow up inspection were as follows:
- All staff had received training in basic life support.
- Nursing staff were up to date in the administration of immunisations
At our first inspection in September 2015 we found:
• Patients were kept safe because there were arrangements in place for staff to report and learn from significant events and incidents by attendance at the daily team meetings.
• There were systems in place to keep patients safe from the risk and spread of infection.
• The practice was responsive to the differing needs of its patient population.
• We saw that staff were able to identify and respond to the changing risks of patients, this included deteriorating health and well-being or the need to refer to other services.
• Patients were treated with compassion, dignity and respect.
• The practice has a clear ethos to improve the health of vulnerable and excluded groups.
• There was a culture of learning and development.
• Innovative approaches were used to improve patient health.
We saw several areas of outstanding practice during our first inspection including:
• Provision of volunteer support to patients attending hospital appointments and appointments with other services. This meant patients who might not attend appointments were assisted to do so.
• All patients receive a comprehensive health check when they first register with the practice. Patients health and social care needs were therefore identified at an early stage and services established to meet these needs.
• Visiting homeless patients in remote locations, which other services would find difficult to do, to deliver care and treatment. Patients in these circumstances would otherwise have gone without care and support they needed.
• The practice involves homeless patients in the delivery of services via an award winning patient participation group and undertakes patient surveys. Action is then undertaken to adjust service delivery in response to patient feedback.
• Innovative treatment regimes are employed. For example alcohol reduction programmes that do not involve medicines. Research shows this treatment programme to be both effective and reduces risks associated with medicines.
• Daily team meetings took place where all staff were involved in planning care and treatment ensuring a co-ordinated approach to meeting patients care and treatment needs.
Professor Steve Field (CBE FRCP FFPH FRCGP)
Chief Inspector of General Practice