Letter from the Chief Inspector of General Practice

We carried out a focussed, desk based review inspection at Oakwood Medical Centre on 15 June 2017. We rated the practice as good for providing safe services and it is rated as good overall.

We previously conducted an announced comprehensive inspection of the practice on 4 August 2016. As a result of our findings, the practice was rated as requires improvement for providing safe services and rated as good for providing effective, responsive, caring and well led services, which resulted in an overall rating of good. At that time, we found that the provider had breached Regulation 18 (Staffing) of the Health and Social Care Act 2008, due to some staff members having not received mandatory information governance; and infection prevention and control training.

The practice wrote to us to tell us what they would do to make improvements and meet the legal requirements. We undertook this focussed desk based inspection to check that the practice had followed their plan, and to confirm that they had met the legal requirements.

This report only covers our findings in relation to those areas where requirements had not been met. You can read the report from our last comprehensive inspection by selecting the ‘all reports’ link for Oakwood Medical Centre on our website at www.cqc.org.uk/location/ 1-552812563.

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

• The practice had taken action to ensure that staff had received mandatory information governance and infection prevention and control training.

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 Oakwood Medical Centre on 4 August 2016. Overall the practice is rated as good.

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

• The practice was unable to provide evidence that all staff had undergone all mandatory training, this included information governance training for all staff, and infection prevention and control.

• Most patients said they found it easy to make an appointment with a GP and there was continuity of care, with urgent appointments available the same day.
• There was an open and transparent approach to safety and an effective system in place for reporting and recording significant events.
• 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.
• 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.

The areas where the provider must make improvement are:

• Ensure all staff are kept up to date with mandatory training in line with national guidance and guidelines.

The areas where the provider should make improvement are:

• To consider how to improve the appointments system for the benefit of patient access.

• To review its GP patient survey results and consider ways to improve patient satisfaction.

Professor Steve Field CBE FRCP FFPH FRCGP

Chief Inspector of General Practice

Oakwood Medical Centre is a GP surgery which provides primary medical care and a range of services including maternity care, sexual health and minor surgery clinics to over 7000 people in the Enfield area of north London. It is open Monday- Friday 8am to 6.30 pm and on Saturday mornings. Outside of these times an out of hours service is available.

Before our inspection we talked to a range of health and social care professionals in the community who engaged with patients from Oakwood Medical Centre. These included pharmacists, community matron and care home managers. We talked to three members of the Patient Participation Group (PPG). On the day of the inspection we observed staff talking to patients and spoke to three non-clinical staff including the practice manager, two nurses and three doctors including the clinical lead. We reviewed practice management and staff files, and 17 comment cards which patients had posted on the reception desk.

The regulated activities we inspected were diagnostic and screening procedures, family planning, surgical procedures, treatment of disease and disorder or injury and maternity and midwifery services.

The practice had systems in place to protect patients from avoidable harm and abuse. Significant adverse events (SAEs) were reviewed and key learning points shared with staff. Care and treatment was delivered in line with recognised best practice standards such as NICE guidelines. The practice worked effectively with other healthcare providers in the community such as care homes. Staff approached people in a person centred way and they tried to accommodate people’s different needs. One patient with learning disabilities found it difficult to remember their medical appointments so staff telephoned them on the day to remind them to attend.

There were systems in place to monitor and improve quality. The practice had received adverse comments in patient surveys about telephone access to the surgery and the appointments system. In response to this staff had introduced a number of changes such as extending surgery hours, online booking and more staff at peak times to answer phones. The practice actively involved patients by responding to their comments on the NHS Choices website and responding to suggestions made by the PPG and in patient surveys.

There was a clear leadership and governance structure and staff aimed to provide a person-centred service.

Older people were offered annual health checks and worked with multidisciplinary teams to improve and coordinate their care.

People with long term conditions such as diabetes and learning disabilities received regular reviews of their health and medication at the practice.

The practice provided regular family planning and sexual health clinics as well as appointments for teenagers who requested confidential advice on contraception and sexual health.

The practice responded to the needs of working age people and those recently retired by changing and reviewing the appointments system to improve access.

Staff accommodated and changed their procedures to serve the needs of vulnerable people who had poor access to primary care.

A nurse-led service was provided for people with poor mental health and clinical staff worked closely with the local community mental health teams and psychiatrists.