Letter from the Chief Inspector of General Practice

We carried out an announced comprehensive inspection at Oakhill Medical Practice on 2 August 2016. The overall rating for the practice was requires improvement. The full comprehensive report dated 2 August 2016 can be found by selecting the ‘all reports’ link for Oakhill Medical Practice on our website at www.cqc.org.uk.

We carried out an announced focused inspection on 15 August 2017 to confirm that Oakhill Medical Practice had carried out their action plan, to meet the legal requirement relating to the breach in regulation that we identified at our previous inspection. This report covers our findings in relation to the requirement and also additional improvements made since our last inspection.

Overall the practice is now rated as good. Our key findings were as follows:

• The practice had completed their action plan to meet the legal requirement in respect of managing risks to patients to ensure good governance.

• Effective systems were in place for receiving and acting on patient safety information in a timely and consistent way. Risks to patients were assessed and appropriately managed to protect them from avoidable harm.

• The procedure for managing patient test results had been reviewed to ensure this was effective and safe.

• Recruitment procedures had been strengthened to ensure that all appropriate pre-employment checks and information was obtained when appointing new staff.

• Senior staff were clear as to the plans for the service, and were able to demonstrate a commitment to on-going improvements. A business development plan outlined plans for the service.

• Aspects of the governance arrangements had been strengthened to ensure the delivery of high quality care, and that risks to patients were assessed and appropriately managed.

• Regular formal partnership meetings were in place as planned to discuss the business and clinical issues and to review on-going improvements.

• The practice undertook quality improvement activity including clinical and non-clinical audits. However, clinical audits completed in the last two years did not include any completed, full cycle audits where required to monitor improvements made in patients care.

In addition the provider should:

• Strengthen the monitoring of completed clinical audits, including the completion of full cycle audits where required to monitor improvements made in patients care.

Professor Steve Field (CBE FRCP FFPH FRCGP) 

Chief Inspector of General Practice

Letter from the Chief Inspector of General Practice

We carried out an announced comprehensive inspection at Oakhill Medical Practice on 2 August 2016. Overall the practice is rated as requires improvement.

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

• The practice had a vision to deliver high quality care and promote positive outcomes for patients. However, we found there were limited records to support that the practice vision and strategy was regularly reviewed.

• Formal governance meetings were not always undertaken as planned although the leadership team told us informal discussions took place regularly.

• Some risks to patients were assessed and managed but in other cases the actions needed to mitigate risk were not effective. For example, those relating to disclosure and barring checks, patient group directions, the processing of patient information including letters and test results.

• There was an open and transparent approach to safety and an effective system in place for reporting and recording significant events.

• Clinical audits were carried out and used to drive improvements to patient outcomes.

• The practice planned and co-ordinated patient care with the wider multi-disciplinary team to deliver effective and responsive care for patients with complex health needs and / or living in vulnerable circumstances.

• Patients said they were treated with compassion, dignity and respect and they were involved in their care and decisions about their treatment.

• Although most patients we spoke with said they found it easy to make an appointment with a GP others told us that access to appointments could sometimes be difficult and this was reflected in the national GP patient survey results and complaints received by the practice.

• We found the practice was in liaison with the telephone system provider to secure improvements and following our inspection a new telephone system was installed.

• The practice had good facilities and was well equipped to treat patients and meet their needs.

• 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 and this included installation of a new telephone system.

• There was a clear leadership structure and staff felt supported by management. The practice proactively sought feedback from staff, patients and the virtual patient participation group which it acted on.

The areas where the provider must make improvements are:

Ensure effective systems are established and operate effectively in respect of:

• Maintaining up to date records relating to staff and the management of the regulated activities to ensure good governance and to protect patients against identifiable risks.
• Processing patient information (test results) timely and ensuring any identified risks are mitigated where practicable.

The areas where the provider should make improvements are:

• Ensure monitoring of prescription stationery; maintaining the serial numbers of pre-printed prescription form stock stored and prescription pads distributed within the practice.

Professor Steve Field CBE FRCP FFPH FRCGP

Chief Inspector of General Practice

We carried out this inspection to see if the provider had made improvements following our last inspection in September 2013. At the time of our inspection we found that the provider did not have arrangements in place to protect people’s privacy and dignity as staff were unaware of the chaperone role and had not received appropriate training.

At the last inspection we found that staff were not aware of correct procedures to minimise the risk and spread of infection as they had not received appropriate training. Additionally we identified concerns with recruitment procedures which we told the provider we would review in greater detail.

During this inspection we found the provider had addressed these concerns. Staff had received training on how to provide chaperone cover and the correct procedures relating to infection prevention and control. People we spoke with told us they felt they were treated with dignity and respect and that the practice was clean.

We found that the provider had effective recruitment processes in place and appropriate checks were carried out before a person was employed.

We spoke with seven patients of Oakhill Medical Practice during our inspection. All of the patients told us they were happy with the care and treatment they received at the practice. Five of the patients said that it was often difficult to get through to the practice on the telephone to make an appointment, however all of the patients we spoke with said they had been able to see a doctor if they requested an emergency appointment.

We found that patients were involved in their care and treatment which was provided in a way intended to ensure their safety and welfare. However we found that patients’ privacy and dignity was not always protected.

Patients were being cared for in a clean, hygienic environment. However we found that patients and staff were not always protected from the risk of infection because appropriate guidance had not been followed.

Staff received appropriate professional development including appraisals and training. Staff we spoke with told us that they felt well supported by the management team at the practice. We found that the provider did not have proper systems in place to ensure that staff were registered with the relevant professional body.

We found that the practice carried out a range of audits on a regular basis to monitor the quality of the service and to learn from any mistakes made. There was a Patient Participation Group at the practice and they were involved in assessing the quality of care patients received.