Burford Surgery

Updated 31 August 2016

Burford Surgery and Carterton Health Centre (the branch practice) offers primary medical services to over 6400 patients in a rural area of Oxfordshire. There is a wide practice boundary covering a 50 square mile area, with some remote areas not serviced by local transport links. The practice provides GP services for two nursing homes within the community.

The practice has four GP partners (two male, two female) and three salaried GPs (two female, one male). The GPs cover a total of 36 sessions per week which is a whole time equivalent (WTE) of 4.5 full time GPs. The nursing team consists of three practice nurses (all female) and four healthcare assistants (all female). The practice dispensary has a dispensary manager and two dispensers. The practice is supported by an organisational and administration team, consisting of a practice manager, two secretaries, a finance assistant, a coding administrator, a reception manager and five receptionists.

Burford Surgery is a training practice and have two trainee GPs currently in their last year of training. (A training practice provides support and mentorship to qualified doctors who are undergoing further training to become GPs). They also support medical students who are on placements of up to six weeks.

Burford Surgery (the main practice) is located in a purpose built building in a semi-rural area. There is ample parking available and designated disabled parking spaces. The wide entranceway doors lead directly into the waiting room area and a reception desk with lowered counter. There are seven GP consultation rooms, one nurse treatment room and a phlebotomy room which are accessible from the waiting area. There are two patient toilet facilities including a disabled toilet with emergency pull cord. Baby change facilities are also available.

The main practice at Burford is open between 8am and 6.30pm Monday to Friday. Routine appointments are from 8am to 11.30am every morning and 2pm to 6.20pm daily. Extended hours appointments are offered on four mornings per week from 7.30am to 8am and from 6.30pm until 7pm on two evenings per week. In addition to pre-bookable appointments that can be booked up to six weeks in advance, urgent appointments are also available for patients that need them.

Carterton Surgery (the branch practice) is located approximately five miles from the main practice. Opening times are from 8am to 12.30pm Monday to Friday with appointments from 8.30am to 11am. The branch site shares the property with another GP practice in a purpose built single storey accommodation. The reception desk is clearly labelled and the consultation and treatment rooms are located to one side of the building. There is a treatment room along the corridor of the other practice which is mostly used by the midwives and health visitors when they run clinics from the branch.

Services are provided from:

Burford Surgery, 59 Sheep Street, Burford, Oxfordshire, OX18 4LS

and

Carterton Surgery,6 Alvescot Rd, Carterton, Oxfordshire, OX18 3JH

We visited both practice sites as part of the inspection. The practice has not been inspected by CQC prior to this inspection.

Updated 31 August 2016

Letter from the Chief Inspector of General Practice

We carried out an announced comprehensive inspection at Burford Surgery on 28 June 2016. Overall the practice is rated as good.

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

• Staff understood and fulfilled their responsibilities to raise concerns and report incidents and near misses, All opportunities for learning from internal and external incidents were maximised.
• Staff assessed patients’ needs and delivered care in line with current evidence based guidance. Staff had been trained 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 and easy to understand. 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.
• However, the practice dispensary was not secure which put staff and patients at risk. The entry way was easily accessible to members of the public or any other unauthorised person. There was inconsistent recording of near miss incidents for dispensary staff to reflect on learning outcomes.

The area where the provider should make improvements are:

• Ensure that all medicines are stored securely and only accessed by authorised staff.

• All dispensary staff should record and investigate all near misses in the dispensary (to include dispensing and prescribing near misses).

Professor Steve Field (CBE FRCP FFPH FRCGP) 

Chief Inspector of General Practice

Updated 31 August 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.

• 76% of diabetic patients had achieved a target blood level of below 64mmol compared to the CCG average of 79% and national average of 78%.

• Longer appointments and home visits were available when needed.

• The practice offered home visits from the nursing team for elderly, housebound patients who required a review of their long term conditions or flu vaccines.

• 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 31 August 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 patients 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 cervical screening programme had achieved 82% which was comparable to 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.

• Following feedback from staff, the practice had introduced a system of open access to children aged 12 years and under. This resulted in patients aged under 12 offered a same day appointment without prior GP triage.

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

Updated 31 August 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 patients in its population.

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

• The practice paid for a delivery driver to take medicines, patient information leaflets and other correspondence (such as x-ray forms) to patients with restricted mobility.

• The practice provided GP services for two nursing homes. The GPs offered twice weekly visits to assess and monitor the residents. One of the GPs had also offered training to the nursing homes on the recognition of sepsis (a life threatening infection that affects the whole body) and developed a template document for them to follow if one of the residents became unwell. The document advised when emergency assistance should be sought which avoided any unnecessary delays in getting medical assistance to the patient.

Updated 31 August 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. For example, the practice offered telephone and email consultations and email correspondence for test results.

• 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.

• The practice had an online blood pressure recording form for patients to access from home. This allowed patients to enter their recording without the need to visit the practice.

Updated 31 August 2016

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

• 81% of patients diagnosed with dementia had their care reviewed in a face to face meeting in the last 12 months, which was comparable to the CCG average of 85% and the national average 84%.

• 94% of patients experiencing poor mental health had received an annual physical health check which was better than the CCG average of 89% and national average of 88%.

• 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. There was an annual educational afternoon dedicated to mental health within the practice. In 2016,  a consultant from the local community mental health team was asked to attend for an educational session with staff.

Updated 31 August 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 and had offered 100% of patients with a learning disability a review of their health care needs.

• The practice regularly worked with other health care professionals in the case management of vulnerable patients. For example, the practice worked closely with the pharmacists in two local towns to identify patients who were not collecting, or forgetting to collect their medicines. This collaborative working ensured vulnerable patients were quickly followed up and assessed for any signs of deteriorating health.

• 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.