Bloxham Surgery

Updated 15 June 2016

We undertook an inspection of this practice on 10 May 2016. The practice provides services from two sites:

• The Surgery, Banbury, Oxfordshire OX15 4ES.
• Hook Norton Surgery, The Bourne, Hook Norton, Oxfordshire OX15 5PB

Bloxham Surgery is a converted building with all patient services provided on the ground floor. Hook Norton Surgery is purpose built and there is onsite disabled parking at both sites. Both premises are accessible for patients on the ground floor. The practice serves patients from local villages and surrounding rural area. This includes dispensing medicines to patients eligible to receive their prescriptions directly from the practice’s dispensary.

• There are four GP partners at the practice, two female and two male. There are three practice nurses and two phlebotomists. A number of administrative staff and a practice manager support the clinical team.
• There were are 31 GP sessions per week and two whole time equivalent nurses.

• The practice is open between 8am and 6.30pm Monday to Friday. There are extended hours appointments on Mondays until 8pm and either Tuesday or Thursday mornings from 7am every week.
• Out of hours GP services were available when the practice was closed by phoning 111 and this was advertised on the practice website.

The practice serves 7100 patients. There is minimum deprivation among the local population. There are a lower number of patients between 20 and 40 years old compared to the national average but a higher number of patients over 40 years old. The patient list was predominately white British in origin with very minimal representation from ethnic minority backgrounds.

The practice had not been inspected by CQC previously.

Updated 15 June 2016

Letter from the Chief Inspector of General Practice

We carried out an announced comprehensive inspection at The Bloxham Surgery on 10 May 2016. Overall the practice is rated as good.

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

• There was a system in place for reporting and recording significant events.
• Risks to patients were usually assessed and well managed.
• Staff assessed patients’ needs and delivered care in line with current evidence based guidance.
• Staff were trained in order to provide them with the skills, knowledge and experience to deliver effective care and treatment.
• Patients said they were treated with compassion, dignity and respect and they 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.
• Patients said they found it easy to make an appointment with a named GP and there was continuity of care, with urgent appointments available the same day.
• 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.
• The provider was aware of and complied with the requirements of the duty of candour.

Areas the provide should make improvements are:

• Review the monitoring and checking of the dispensary and medicines management to ensure it reflects all national guidance.
• Formalise and document the completion of clinical audit to ensure improvements in care resulting from audit are embedded.
• Improve the coding on the patient record system to ensure that monitoring of repeat medicine reviews is undertaken

Professor Steve Field (CBE FRCP FFPH FRCGP) 

Chief Inspector of General Practice

Updated 15 June 2016

The practice is rated as good for the care of 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.
• The most recent published results were 100% of the total number of points available compared to the clinical commissioning group (CCG) average of 97% and national average of 95%.
• The practice has a rate of 7% exception reporting compared to the national average of 9% and regional average of 8%.
• 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.
• Patients had access to their medicines for any health conditions via the dispensary.

Updated 15 June 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, for example, children and young people who had a high number of A&E attendances.
• Immunisation rates were similar to average 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.
• We saw positive examples of joint working with midwives, health visitors and school nurses.
• Joint working with external organisations took place in the management of children at risk of abuse.

Updated 15 June 2016

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

• The practice offered proactive, personalised care to meet the needs of the older people in its population.
• There was a 45 bed nursing home next door to Bloxham Surgery and a GP with a special interest in care of the elderly visited the nursing home weekly or when required.
• The practice employed a community Phlebotomist to visit patients who are unable to come to surgery for blood tests.
• The practice was responsive to the needs of older people, and offered home visits and urgent appointments for those with enhanced needs.
• The premises were accessible for patients with limited mobility and there was a hearing aid loop available for patients with poor hearing.
• All appointments were available on the ground floor.
• Patients over 75 had a named GP.
• Eligible patients had access to their medicines for any health conditions via the dispensary.

Updated 15 June 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.
• Patients’ feedback on the appointment system was very positive overall.
• 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.
• Travel vaccinations were available.
• There were extended hours appointments on Mondays until 8pm and either Tuesday or Thursday mornings from 7am every week.

Updated 15 June 2016

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

• Performance for mental health related indicators was 100% compared to the national average 92% and regional average of 95%.
• There were 31 patients on the mental health conditions register and 24 had a care plan in place. Eight patients had not attended for health checks or care plan discussions.
• 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 advanced 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.

Updated 15 June 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 homeless people, travellers and those with a learning disability.
• 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.
• Joint working with external organisations took place in the management of patients at risk of abuse or harm.