Cogges Surgery

Updated 15 June 2017

Dr Green and Partners is more commonly known as Cogges Surgery and is located in Witney, Oxfordshire. The practice was founded in 1991 as part of new housing development in Cogges neighbourhood. Dr Green and Partners is within Oxfordshire Clinical Commissioning Group (CCG) and provides personal medical services to approximately 7570 registered patients. A CCG is a group 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.

All services are provided from:

• Cogges Surgery, 12 Cogges Hill Road, Witney, Oxfordshire, OX28 3FS.

According to data from the Office for National Statistics, this area of Oxfordshire has a high level of affluence and minimal economic deprivation. The age distribution of the registered patients is largely similar to the national averages. Although there is a slightly higher than average number of patients aged between 35 and 54 years of age and under 14 years of age.

Ethnicity based on demographics collected in the 2011 census shows the population of Witney and the surrounding area is predominantly White British with less than 3% of the population from an ethnic minority background. The practice provides GP services to six local care homes.

Dr Green and Partners comprises of three GP Partners (two female and one male) and one salaried GP (female). The GPs cover a whole time equivalent (WTE) of 2.5 full time hours. The practice is currently recruiting for another GP and regular locum GPs cover an additional 1 WTE. The all-female nursing team consists of one nurse practitioner, one practice nurse, a health care assistant and a phlebotomist. The nursing team offers a WTE of 2.2 full time hours with the nurses covering 1.5 WTE. The practice manager is supported by a team of reception, administrative and secretarial staff who undertake the day to day management and running of Dr Green and Partners.

The practice has core opening hours between 8am and 6.30pm Monday to Friday. Extended hours are available for routine pre-bookable appointments every Monday between 6.30pm and 7.30pm.

The practice has opted out of providing the out-of-hours service. This service is provided by the out-of-hours service accessed via the NHS 111 service. Advice on how to access the out-of-hours service is clearly displayed on the practice website, on the practice door and over the telephone when the surgery is closed.

Updated 15 June 2017

Letter from the Chief Inspector of General Practice

We carried out an announced comprehensive inspection at Dr Green and Partners on 3 October 2016. The practice was rated requires improvement for effective services. The overall rating for the practice was good. The full comprehensive report on the October 2016 inspection can be found by selecting the ‘all reports’ link for Dr Green and Partners on our website at www.cqc.org.uk.

This inspection was a desk-based review carried out on 15 May 2017 to confirm that the practice had carried out their plan to meet the legal requirements in relation to the breaches in regulations that we identified in our previous inspection on 3 October 2016. This report covers our findings in relation to those requirements and also additional improvements made since our last inspection.

The practice is now rated as good for providing effective services.

Our key findings were as follows:

• Staff had received training pertinent to their role and responsibilities and the training policy had been updated to reflect suitable intervals for updates and further training. All GPs had received fire safety, equality and diversity and Mental Capacity Act (2005) training.

• All patients on the learning disability register had been offered an annual review.

• The practice had identified a programme of continuous clinical audit to improve services to patients.

In addition to the above we saw evidence of the practice taking action to reduce waiting times for patient appointments. The practice had added administration time to patient appointments so patients received a full 10 minutes and the GP had time to write up the patient record. This had been discussed and reviewed with the patient participation group and had commenced in May 2017. Patients who had multiple concerns or complex medical histories were automatically offered a double appointment to accommodate their enhanced needs. In addition, when a clinic was running over, the GPs would announce the delay to the waiting room over the tannoy. These initiatives had been implemented recently and were too early to measure the impact this was having on patient waiting times.

The practice had also reviewed the doorway access from the lobby and waiting room to the reception area. They had applied for funding to reconfigure the ground floor of the building to improve access for patients. The funding was secured in March 2017 and the practice was consulting with an architect, practice staff and the patient participation group to gain views on how this can be improved.

Professor Steve Field (CBE FRCP FFPH FRCGP) 

Chief Inspector of General Practice

Updated 8 November 2016

The practice was rated as good for providing services to people with long-term conditions.

• Nursing staff had lead roles in chronic disease management and patients at risk of hospital admission were identified as a priority.

• Performance for diabetes related indicators was similar to the national average.

• The percentage of patients with diabetes, on the register, whose last measured total cholesterol being within a satisfactory range was 83%, which was statistically similar than the CCG (84%) and national (81%) averages.

• The percentage of patients with diabetes, on the register, in whom the last IFCC-HbA1c being within a satisfactory range was 81%, which was statistically similar than the CCG (79%) and national (78%) averages.

• Longer appointments and home visits were available when needed.

• All these patients had a named GP and 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 8 November 2016

The practice was rated as good for providing services to 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.

• Immunisation rates were relatively high for all standard childhood immunisations.

• Patients told us that children and young people were treated in an age-appropriate way and were recognised as individuals, and we saw evidence to confirm this.

• The practice’s uptake for the cervical screening programme was 86%, which was higher than the CCG average of 83% and the national average of 82%.

• Appointments were available outside of school hours and the premises were suitable for children and babies.

• We saw positive examples of joint working with midwives, health visitors and school nurses.

• The practice had encouraged and been successful in ensuring younger people were members of the practice patient participation group.

Updated 8 November 2016

The practice was rated as good for providing services to older people.

• The practice offered proactive, personalised care to meet the needs of the older people in its population.

• The practice was responsive to the needs of older people, and offered home visits and urgent appointments for those with enhanced needs.

• The practice identified if patients were also carers; information about support groups was available in the waiting areas.

• The practice worked with the multi-disciplinary teams in the care of older vulnerable patients.
• Some areas of accessibility within the practice required improvement. The practice did not have an induction hearing loop and access to the reception area may be difficult for some patients.

Updated 8 November 2016

The practice was rated as good for providing services to working age people.

• The needs of the working age population, those recently retired and students had been identified and the practice had adjusted the services it offered to ensure these were accessible, flexible and offered continuity of care.

• The practice was proactive in offering online services as well as a full range of health promotion and screening that reflects the needs for this age group. There was an increasing contact from patients by email and text. The practice used social media to promote the services of the practice.

• Daily phlebotomy services were available at the practice which meant patients did not have to attend the hospital for blood tests.

Updated 8 November 2016

The practice was rated as good for providing services to people experiencing poor mental health and those with dementia.

• 84% of patients diagnosed with dementia whose care has been reviewed in a face-to-face review in the preceding 12 months (01/04/2014 to 31/03/2015), was the same as the national average.

  Performance for mental health related indicators was similar to the national average.

• The percentage of patients experiencing poor mental health have had a comprehensive, agreed care plan documented in the record, in the preceding 12 months (01/04/2014 to 31/03/2015) was 83%, which was statistically similar than the CCG (89%) and national (88%) averages.

• The percentage of patients experiencing poor mental health whose alcohol consumption has been recorded in the preceding 12 months (01/04/2014 to 31/03/2015) was 92%, which was statistically similar than the CCG (89%) and national (90%) averages.

• The practice regularly worked with multi-disciplinary 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 in place to follow up patients who had attended accident and emergency where they may have been experiencing poor mental health.

• Staff had a good understanding of how to support patients with mental health needs and dementia.

Updated 8 November 2016

The practice was rated as good for providing services to people whose circumstances may make them vulnerable.

• The practice registered patients living in vulnerable circumstances including homeless people, travellers and those with a learning disability.

• All patients with a learning disability were invited to attend the practice for an annual health check. Thirty one patients with a learning disability were registered as a patient at the practice. Data for 2015/16 showed 19 of the 31 patient’s (61%) had received an annual health check.

• 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 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.