Archived: Your Health Partnership - Oakham Surgery Also known as Oakham Surgery

Updated 3 October 2017

Your Health Partnership – Oakham Surgery is a partnership of five GP practices including Oakham Surgery and one branch surgery. Oakham Surgery provides NHS services to the local community in Oldbury, West Midlands. The practice has an approximate patient population of 11.600 and is part of the NHS Sandwell and West Birmingham Clinical Commissioning Group (CCG). CCGs are groups of general practices that work together to plan and design local health services in England. They do this by 'commissioning' or buying health and care services.

The service is registered with the Care Quality Commission to provide primary medical services. Services to patients are provided under a General Medical Services (GMS) contract used when services are agreed locally with a practice which may include additional services beyond the standard contract. The practice has expanded its contracted obligations to provide enhanced services to patients. An enhanced service is above the contractual requirement of the practice and is commissioned to improve the range of services available to patients.

Based on data available from Public Health England, the levels of deprivation (deprivation covers a broad range of issues and refers to unmet needs caused by a lack of resources of all kinds, not just financial) in the area served by Oakham Surgery are greater than the national average, ranked at four out of 10, with 10 being the least deprived.

The clinical team includes five GPs (two female and three male), two practice nurses and one advanced nurse practitioner (ANP). There were also two healthcare assistants (HCAs). The practice was part of a partnership of six sites and many of the functions were centralised. For example, there was a centralised governance team which was based at the surgery.

The practice had achieved training practice status helpingqualified doctors, complete the final stages of their GP Training. The practice also engaged in the training of medical undergraduate students.

The practice is open from 8am to 6.30pm Monday to Friday. Extended hours appointments are offered on a Thursday from 6.30pm to 8pm. The practice was part of a partnership with six local sites and patients were given option to attend for appointments during extended hours at those sites. Saturday opening was offered between 8.30am to 10.30am at another site that was part of the partnership and two appointments for patients from Oakham Surgery are allocated. There is also an option for telephone consultation on Sunday Mornings.

The practice has opted out of providing out-of-hours services to their own patients. This service is provided by the external out of hours service provider.

Updated 3 October 2017

Letter from the Chief Inspector of General Practice

We carried out an announced comprehensive inspection at Your Health Partnership – Oakham Surgery on 20 July and 23 August 2017. The practice is part of partnership called Your Health Partnership (YHP), a five practice group (and one branch site) operating with centralised management and governance. Overall the practice is rated as good.

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

• There was an open and transparent approach to safety and a system in place for reporting and recording significant events.
• The practice had clearly defined and embedded systems to minimise risks to patient safety.

• Staff were aware of current evidence based guidance. Staff had been trained to provide them with the skills and knowledge to deliver effective care and treatment.
• Results from the national GP patient survey showed patients were treated with compassion, dignity and respect and were involved in their care and decisions about their treatment.
• Information about services and how to complain was available. Improvements were made to the quality of care as a result of complaints and concerns.
• The service operated ‘Doctor First’ appointment system and most patients said they found it easy to make an appointment. However, some working patients also stated that the appointment system did not work as well for them. The practice was in the process making changes to improve the appointment system following feedback from patients and staff.
• The practice had good facilities and was well equipped to treat patients and meet their needs.
• The practice was a partnership of five locations (and one branch site) and the management and leadership structure was clear and available to staff. Staff felt supported by management.
• We saw evidence that the practice proactively sought feedback from staff and patients, which it acted on. For example, patients with multiple long term conditions were managed in a single appointment and this was developed though feedback from nursing staff.
• The provider was aware of the requirements of the duty of candour. Examples we reviewed showed the practice complied with these requirements.

The areas where the provider should make improvement are:

• Continue to monitor the new appointment system to ensure it meets the needs of all patients.

Professor Steve Field (CBE FRCP FFPH FRCGP) 

Chief Inspector of General Practice

Updated 3 October 2017

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

• Nursing staff had lead roles in long-term disease management and patients at risk of hospital admission were identified as a priority.
• The practice was part of a corporate partnership and delivered specialised clinics in diabetes, heart disease, chronic obstructive pulmonary disease, asthma, anticoagulation as well as other specialist community services ophthalmology, gynaecology and dermatology.
• Patients had access to a physiotherapist and an in-house pharmacist was available to call patients to answer medication queries or provide advice.
• The practice achievement for diabetes related indicators was 92%. This was above the CCG average of 88% and the national average of 90%. A diabetes specialist consultant held clinics for more complex cases. This was as part of the Diabetes Inpatient Care and Education (DICE) programme, a CCG funded area of enhanced care.
• The nursing team were involved in the development of a clinic called ‘year of care’ which incorporated review of patients with multiple long term conditions within one appointment. The nursing team were recognised for their work in the CCGs inaugural primary care awards.
• There was on-going development and support for nursing staff, for example, for diabetes.
• The practice followed up on patients with long-term conditions discharged from hospital and ensured that their care plans were updated to reflect any additional needs.
• The provider had a centralised home visiting team that reviewed housebound patients with long term conditions.
• All these patients had a named GP and there was a system to recall patients for a structured annual review to check their health and medicines needs were being met. 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 3 October 2017

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

• From the sample of documented examples we reviewed, we found there were systems 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 accident and emergency (A&E) attendances.
• The practice operated a ‘Doctor First’ appointment system where all patients speak on the phone with a GP. The GP may ask the patient to come into the surgery if they felt it necessary. Same day appointments were available for families following a telephone call by the GP and appointments were available so that school children could be seen outside of school hours. The premises were suitable for children and babies.
• Public Health England data we looked at showed that immunisation rates were slightly below the target of 90% for three of the four sub-indicators for standard childhood immunisations. However, the practice was able to demonstrate from their own records that they were meeting the 90% target for relevant childhood immunisations.
• The practice enrolled all babies into the child health surveillance programme so that they could be reviewed by the health visiting team. The practice invited all new mothers and babies for postnatal checks.
• The practice’s uptake for the cervical screening programme was 85%, which was above the CCG average of 80% and the national average of 81%.

Updated 3 October 2017

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

• Staff were able to recognise the signs of abuse in older patients and knew how to escalate any concerns.
• The practice offered proactive, personalised care to meet the needs of the older patients in its population.
• The practice offered influenza, pneumococcal and shingles vaccinations to patients.
• The practice was responsive to the needs of older patients, and offered home visits and urgent appointments for those with enhanced needs.
• The practice identified at an early stage older patients who may need palliative care as they were approaching the end of life. It involved older patients in planning and making decisions about their care, including their end of life care.
• The practice followed up on older patients discharged from hospital and ensured that their care plans were updated to reflect any extra needs.
• Multidisciplinary team meetings were held on a monthly basis, where patients were selected and reviewed along with palliative care patients.
• Older patients were provided with health promotional advice and support to help them to maintain their health and independence.

Updated 3 October 2017

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

• The needs of these populations had been identified and the practice had adjusted the services it offered to ensure these were accessible, flexible and offered continuity of care. This included extended hours service on Thursday evenings until 8pm for working patients who could not attend during normal opening hours. The practice was part of a partnership six sites and patients were able to access extended hours service provided by other sites. On Saturdays another site that was part of the partnership, offered appointments between 8.30am and 11.15pm and two pre-bookable appointments were available for patients registered at this practice. A Sunday morning GP call back service was also available (remote access by GP).
• The practice had reviewed its appointment system and had made changes to ensure it met the needs of all patients, including working age people.
• The practice offered online services such as making appointments and ordering repeat prescriptions, as well as a full range of health promotion and screening that reflected the needs for this age group.

Updated 3 October 2017

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

• The practice carried out advance care planning for patients living with dementia.
• 87% of patients diagnosed with dementia had their care reviewed in a face to face meeting in the last 12 months. This was above the local CCG average of 84% and the national average of 84%.
• 95% of those patients with mental health conditions had their alcohol consumption recorded in the previous 12 months. This was above the CCG average of 93% and the national average of 89%.
• The practice regularly worked with multidisciplinary teams in the case management of patients experiencing poor mental health, including those with dementia.
• The practice carried out advance care planning for patients with dementia.
• The practice had told patients experiencing poor mental health about how to access various support groups and voluntary organisations.
• The practice had a system to follow up patients who had attended accident and emergency where they may have been experiencing poor mental health.
• Staff we spoke with had a good understanding of how to support patients with mental health needs and dementia.

Updated 3 October 2017

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

• The practice operated an effective recall system and individual care plans were developed to help ensure a tailored approach to care. For example, data provided by the practice showed 35 patients registered at the practice with a learning disability, 73 with mental health as well as 89 patients living with dementia. Data we looked at showed that patients received timely reviews.
• End of life care was delivered in a coordinated way which took into account the needs of those whose circumstances may make them vulnerable.
• The practice offered longer appointments for patients with a learning disability.
• The practice regularly worked with other health care professionals in the case management of vulnerable patients.
• The practice had information available for vulnerable patients about how to access various support groups and voluntary organisations.
• Staff we spoke with knew how to recognise signs of abuse in children, young people and adults whose circumstances may make them vulnerable. They 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.
• The practice’s computer system alerted GPs if a patient was a carer. The practice had identified 132 patients as carers (1% of the practice list). The practice had a designated carers champion who had attended training organised by the CCG. The role of the carers champion was to inform, co-ordinate and signpost carers as well as to keep the practice team updated on any new guidance. The practice had a notice board dedicated to carers where written information was displayed informing carers of support services available.