The Charlbury Medical Centre

Updated 30 May 2017

The Charlbury Medical Centre provides GP services to 5,300 patients in a rural area of the Cotswolds, centred on the small market town of Charlbury. The practice serves an

area with an overall low level of deprivation, although there are pockets of rural poverty, with related issues of geographical isolation, including ease of access to medical care. Ethnicity based on demographics collected in the 2011 census shows the population of the surrounding area

is predominantly white British.

The practice has three GP partners, two female and one male, and one female salaried GP, equivalent to 3.5 whole time GPs. There are three practice nurses, and two healthcare assistants. The practice works closely with the local district nursing team, which is based on site, to provide shared patient care and avoid hospital visits for services such as phlebotomy, dressing changes and minor urgent care. The surgery building was built in the late 1990s.

There is an onsite dispensary which can provide pharmaceutical services to patients who live more than one mile (1.6km) from their nearest pharmacy premises.

Two dispensers currently provide the services to approximately one third of the practice’s patients. The practice provides a delivery service for dispensed medicines to be collected by patients from shops in the outlying villages when appropriate.

The practice is fully open from 8am to 6.30pm Monday to Friday, with the nursing team offering appointments from 7.30am four mornings a week. The out of hours service is provided by Oxford Health and is accessed by calling NHS 111. Advice on how to access the out of hours service is contained in the practice leaflet, on the patient website and on a recorded message when the practice is closed. Services are delivered from:

The Charlbury Medical Centre

Enstone Road

Charlbury

OX7 3PQ

Updated 30 May 2017

Letter from the Chief Inspector of General Practice

Our previous comprehensive inspection at The Charlbury Medical Centre on 24 August 2016 found breaches of regulations relating to staffing. The overall rating for the practice was good, but the practice was rated requires improvement in the effective domain. The full comprehensive report from the August 2016 inspection can be found by selecting the ‘all reports’ link for The Charlbury Medical Centre on our website at www.cqc.org.uk.

This inspection was an announced focused desktop inspection (we have not visited the practice but requested information to be sent to us) carried out on12 April 2017. The inspection was conducted to confirm that the practice had carried out their plan to meet the legal requirements in relation to the breach in regulations that we identified in our previous inspection. This report covers our findings in relation to those requirements and improvements made since our last inspection.

We found the practice had made improvements since our last inspection. The information requested in April 2017 identified that the practice was meeting the regulation that had previously been breached. We have amended the rating for this practice to reflect these changes. The practice is now rated good for the provision of safe, effective, caring, responsive and well led services. In addition the practice made improvements to its services where we suggested this could improve services for patients.

Our key findings were as follows:

• A programme of appraisal had been followed and staff received appraisals to ensure their development and learning needs were met. This provided staff with the opportunity to enhance their learning and development.
• In addition to the regulatory breach, actions were taken where we suggested the provider should consider our findings. For example:
• Hearing loops have been installed in the reception area and the dispensary to aid patients with impaired hearing.
• Printers that contain prescriptions now have tray locks to prevent unauthorised access
• In response to patient feedback, evening appointments on a rota basis with the other practices were made available to patients.
• New temperature recording equipment for fridges were purchased to ensure they were effectively monitored. This ensured the storage of medicines in the fridges was safe.
• A process for disseminating medicine safety alerts to staff was introduced, with records available in a folder should staff need to access them for information.

Professor Steve Field (CBE FRCP FFPH FRCGP) 

Chief Inspector of General Practice

Updated 12 October 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 practice offered nurse-led clinics for asthma, diabetes and chronic obstructive pulmonary disease, and practice nurses evaluated and dressed leg ulcers to avoid the need for hospital attendance.

• Performance for diabetes related indicators was above the clinical commissioning group (CCG) and national average with 100% of patients with diabetes receiving a foot examination and risk classification in the preceding 12 months, compared to the CCG average of 90% and the national average of 88%, and 88% of patients with diabetes achieving their blood glucose target level compared to the CCG average of 79% and national average of 78%.

• Longer appointments and home visits were available when needed.

• 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 12 October 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 relatively high for all standard childhood immunisations.

• Immunisation rates were in line with the national average for 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.

• 85% of female patients aged 25 to 64 had received a cervical screening test in the preceding five years, compared to a CCG average of 83% and a 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 health visitors, who were based on site, the midwife, who held a weekly on-site clinic, and school nurses.

The practice offered chlamydia screening and family planning, and provided emergency contraception when appropriate.

Updated 12 October 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.

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

The practice worked closely with other medical services, including the local district nursing team based at the surgery, to provide multi-agency planned and responsive care to patients with palliative, complex or urgent medical needs.

There was proactive end of life care, working with patients, their families, the local palliative care service and district nursing team, and a local charity providing end of life nursing. This included attending regular multi-disciplinary meetings to discuss patients with palliative and complex needs.

Updated 12 October 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.

• 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.

• Nurse team appointments were available from 7.30am four days a week for patients who wished to attend before work, or for fasting blood tests.

• Telephone consultations were available for patients who could not easily attend the surgery owing to other commitments.

• Travel advice, vaccinations and smoking cessation appoints were available on site.

• There was a high uptake of health checks offered to new patients and those aged over 40, and offered a range of health promotion support, including exercise referrals.

Updated 12 October 2016

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

• 95% of patients diagnosed with a serious mental health problem had their care reviewed in a face to face meeting in the last 12 months, which is above the CCG average of 89% and the 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. It had access to a local dementia advisor when additional support was required.

• Advance care planning was undertaken for patients with dementia.

• Patients experiencing poor mental health were signposted to various support groups and voluntary organisations.

• There was 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.

• The practice had worked to improve its coding system for patient records to ensure that it identified all patients with dementia appropriately.

• Patients requiring additional support were referred to local talking therapies and addictions services, and a counsellor was based at the practice once a week. It also had information available for patients to self-refer.

The practice worked closely with the community mental health team, and received regular visits from a community mental health team consultant to discuss patient cases.

Updated 12 October 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.

• Longer appointments were offered to patients with a learning disability.

• The practice regularly worked with other health care professionals in the case management of vulnerable patients.

• Information was given to 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.

• Team members discussed child safeguarding issues regularly with the health visitor based at the surgery, and adult safeguarding matters with multi-disciplinary teams whenever appropriate.

• The practice held a register of carers to identify their needs and offer support and signposting.

• Patients reliant on limited public transport services were offered flexible appointments to fit with the times they could visit the practice.

• Patients with a hearing difficulty were identified, and a sign language interpreter offered. They received communications by email or fax if required.

• The practice could access interpretation services for patients whose English was limited.