Wychwood Surgery

Updated 26 August 2016

Letter from the Chief Inspector of General Practice

We carried out an announced comprehensive inspection at Wychwood Surgery on 8 December 2015. Overall the practice is rated as good. We have rated the practice as requires improvement for providing effective services.

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

• There was an open and transparent approach to safety and an effective system in place for reporting and recording significant events.
• Risks to patients were assessed and well managed.
• Staff assessed patients’ needs and delivered care in line with current evidence based guidance. Staff had the skills, knowledge and experience to deliver effective care and treatment.
• Staff demonstrated a good awareness of their roles and responsibilities and received training. However, monitoring of training was not monitored or recorded appropriately.
• Patient care was effectively monitored in order to drive improvement.
• Patients said they were treated with compassion, dignity and respect and they were involved in their care and decisions about their treatment.
• The diverse needs of the patient population were considered in the planning and delivery of the service, specifically the older population.
• Information about services and how to complain was available and easy to understand.
• Patients’ satisfaction in the accessing appointments was very positive and ranked very highly when compared to the local and national averages from the national GP surgery.
• 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.

We saw areas of outstanding practice:

• During Saturday morning extended hours the practice took back any calls usually made to the out of hours service, so that any home visits for local complex patients could be made. This provided a more personalised and responsive service to local care homes on a Saturday.
• Data showed that patients rated the practice very highly in several aspects of care. This was reflected in the national GP survey results. For example:
  • 98% said the last GP they spoke to was good at treating them with care and concern compared to the CCG average of 88% and national average of 85%.
  • 100% said the nurse gave them enough time compared to the local average and national average of 92%.

However there were areas of practice where the provider must make improvements:

• Improve monitoring of staff training to ensure the practice delivers and refreshes staff training required for staff awareness and skills.

Professor Steve Field (CBE FRCP FFPH FRCGP) 

Chief Inspector of General Practice

Updated 21 January 2016

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

• Patients at risk of hospital admission were identified as a priority and offered care plans aimed at reducing the risk of a hospital admission.
• Longer appointments and home visits were available when needed.
• All patients with long term conditions were offered a structured annual review to check that their health and medicines needs were being met.
• In 2014-15, 96.1% of the total number of points available were achieved on the quality outcomes framework (QOF – a tool used to monitor patient care and treatment), compared to a national average of 94% and local average of 97%. In 2014-15, exception reporting was lower than the national and regional average. Overall the practice exception reporting for 2014-15 was lower than the national. This indicated that the practice was making efforts to meet the needs of as many patients as possible in line with national guidance.
• Health screening and promotion was undertaken.

Updated 21 January 2016

The practice is rated as good for the care of 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 of harm.
• Child immunisation rates were high.
• Baby changing facilities were available.
• Appointments were available outside of school hours and the premises were suitable for children and babies.
• The practice offered chlamydia and out of 470 eligible patients 124 were screened in the preceding 12 months.

Updated 21 January 2016

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

• GPs provided home visits to older patients during the week and Saturday mornings.
• The practice offered proactive, personalised care to meet the needs of the older patients in its population. For example, working with local volunteers to provide patient transport.
• It was responsive to the needs of older patients.
• The appointment system suited patients who were able to attend and wait for an appointment when they needed one.
• Staff had a good understanding of the Mental Capacity Act 2005.
• The premises were accessible to patients with limited mobility.

Updated 21 January 2016

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

• 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.
• There was a walk-in appointment service and pre-booked appointments available. There was low use of out of hours GP services by this practice's patients.
• The practice was proactive in offering online services as well as a full range of health promotion and screening that reflected the needs for this age group.
• Extended hours were provided for patients who found it difficult to attend outside of normal working hours.
• The appointment system may have been restrictive to patients who could not attend in the morning due to the walk-in system in operation.

Updated 21 January 2016

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

• The practice regularly worked with multi-disciplinary teams in the case management of patients experiencing poor mental health, including those with dementia.
• Counselling was provided onsite.
• Exception reporting for dementia diagnosis was high. This was explained by two care homes where new residents arrived with a dementia diagnosis and the original dementia screening test results were not available to the monitoring system used to establish QOF scores.
• 90% of patients with a mental health condition had care plans in place.
• GPs had a good understanding of the Mental Capacity Act 2005.

Updated 21 January 2016

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

• The practice held a register of patients living in vulnerable circumstances including those reaching the end of their life and those with a learning disability.
• Patients with no permanent address including travellers were registered at the practice if they needed to see a GP.
• Longer appointments were offered for patients in vulnerable circumstances.
• There were flags on the patient record system to identify vulnerable patients.
• The practice regularly worked with multi-disciplinary teams in the case management of vulnerable patients.
• The practice provided comprehensive care for patients with drug and alcohol addictions.
• A local volunteer scheme was used to bring patients to the practice or deliver medicines where patients found it difficult to do so themselves.