Letter from the Chief Inspector of General Practice

This practice is rated as good overall. (Previous inspection February 2017 – Good)

The key questions are rated as:

Are services effective? – Good

We carried out an announced comprehensive inspection at Dr Burke and Partners on 17 May 2016. The practice was rated as requires improvement for providing effective services. The overall rating for the practice was good. The full comprehensive report on the May 2016 inspection can be found by selecting the ‘all reports’ link for Dr Burke and Partners on our website at www.cqc.org.uk.

We carried out a desk-based review on 20 February 2017 to confirm that the practice had carried out their plan to meet the legal requirements in relation to the breaches in regulations that we identified in our previous inspection on 17 May 2016. The practice remained as requires improvement for effective services.

This inspection was a further desk-based review carried out on 8 November 2017 to confirm that the practice had carried out their plan to meet the legal requirements in relation to the breaches in regulations that we identified in our previous comprehensive inspection on 17 May 2016 and the desk-based review on 20 February 2017. This report covers our findings in relation to those requirements and also additional improvements made since our last inspection.

Overall the practice is now rated as good.

Our key findings were as follows;

• Patients that do not attend their bowel or breast screening were followed up by the practice. Recall letters were being sent to patients highlighting the importance of attending these clinics and also providing patients with links to further information. The practice told us GPs and nurses were also actively advising patients during consultations.
• The practice had reviewed their diabetes care for patients. The GP and nurse leads have undertaken further enhanced skills in a Year of Care plan for diabetic patients. Data for 2016/17 showed that the practice has made progress and had improved all diabetes indicators, although they were still achieving below local and national averages.

• The practice had reviewed care planning systems for patients with a diagnosed mental health condition. Practice nurses had completed further training to carry out health checks for patients with mental health conditions to support the GPs. They had improved on completed care plans from 84.7% in 2015/16 to 98.7% in 2016/17.
• The practice had appointed a Clinical Pharmacist. This had enabled the repeat prescription process to be streamlined and the practice provided us with their latest figures for medicine reviews which show improvements in the number of reviews being completed within 12 months.
• The practice had introduced a comprehensive risk assessment form and system at the university practice site which enabled them to carry out an initial assessment of the patient and prioritise the urgency of the patient’s health needs accordingly. Patients were also informed of waiting times and given a choice to come back for their appointment depending on the urgency.

At our previous inspection on 20 February 2017, we rated the practice as requires improvement for providing effective services as patient uptake of the national screening programme, mental health care plans and diabetes care were all below local and national averages. At this inspection we found that the data showed improvements in many areas and that improved systems and processes were in place. Consequently, the practice has been rated as good for providing effective services.

However, the areas where the provider should continue making improvements are;

• Continue to actively encourage patients to attend for health screening through the national screening programs and improve uptake rates.
• Continue to review and improve on diabetes care indicators for patients.

Professor Steve Field (CBE FRCP FFPH FRCGP) 

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Chief Inspector of General Practice

Letter from the Chief Inspector of General Practice

We carried out an announced comprehensive inspection at Dr Burke and Partners (Also known as St Bartholomews Medical Centre) on 17 May 2016. Overall the practice is rated as good. However, there were requirements required in providing effective services.

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 mostly assessed and well managed.
• Staff assessed patients’ ongoing needs and delivered care in line with current evidence based guidance. There was a nurse walk-in service available to students from the nearby Oxford Brookes University. This provided flexibility for this section of the patient population. However, there was no clear assessment tool which non-clinical staff could assess the urgency of patients’ needs.
• National data suggested patients mostly received appropriate care for long term conditions. However, diabetes performance was poor. Action had been taken to identify what could be done to improve performance.
• 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 must make improvements are:

• Improve the monitoring of the nurse walk-in service at the branch site available to students to ensure it is accessed appropriately and safely by students.
• Continue to Identify what improvements to diabetes performance can be achieved as a result of poor national data indicators.

Areas the provide should make improvements are:

• Improve the coding on the patient record system to ensure a more effective monitoring of repeat medicine reviews is undertaken.
• Review the results from the GP national survey on satisfaction scores regarding GP and nurse consultations and involvement in decisions, in order to identify improvement.
• Review and identify what improvements to bowel and breast cancer screening rates can be achieved.
• Review the uptake of mental health care plans to identify how more can be put in place for eligible patients

Professor Steve Field (CBE FRCP FFPH FRCGP) 

Chief Inspector of General Practice

On the day of our visit to Dr Burke and partners we met with the practice manager and with one of the GP partners. We spoke with five patients,five members of practice staff and also met with the chair of the patient participation group (PPG).

Patients received sufficient information about their treatment. One of the patients we spoke with said "I've had a good explanation of the diagnosis and treatment. I was told what's going to happen and how it's [a wound] going to heal".

Patients were happy with their care and treatment and were referred for specialist advice and treatment when needed. A patient we spoke with told us "I have been very well looked after" and "the doctor rang the hospital while I was with them and spoke to the consultant to get advice and organise the referral”.

Patients were cared for in a clean and hygienic environment. A patient said "it [the practice] always looks very clean and tidy to me". The risk of infection was minimised because current guidance was followed.

Staff felt well supported to carry out their role and we saw that staff received training relevant to their job. A member of staff we spoke with said "I love my job, everybody is nice and my manager is very supportive".

Patients were asked for their views and they were acted upon. We saw that two patient satisfaction surveys had identified getting through on the telephone as an issue. The telephone system had been upgraded to enable quicker answering of patient calls.

Letter from the Chief Inspector of General Practice

We carried out an announced comprehensive inspection at Dr Burke and Partners on 17 May 2016. The practice was rated as requires improvement for providing effective services. The overall rating for the practice was good. The full comprehensive report on the May 2016 inspection can be found by selecting the ‘all reports’ link for Dr Burke and Partners on our website at www.cqc.org.uk.

This inspection was a desk-based review carried out on 20 February 2017 to confirm that the practice had carried out their plan to meet the legal requirements in relation to the breaches in regulations that we identified in our previous inspection on 17 May 2016. This report covers our findings in relation to those requirements and also additional improvements made since our last inspection.

The practice remains rated as requires improvement for effective services.

Our key findings were as follows:

• The practice had a limited risk assessment for patients attending the walk in service at the university practice site. However, they had improved the systems and processes to ensure patients who attended with an urgent medical condition were identified and prioritised.

• The practice had reviewed their diabetes care for patients. They had trained nurses and the new lead GP in enhanced skills in diabetes care. Data from the practice for 2016/17 showed an improvement in diabetes indicators, although they were still achieving below local and national averages.

• The practice had reviewed care planning systems for patients with a diagnosed mental health condition. They had improved on completed care plans from 54% to 72%.

• Health screening of patients through the national screening programme remained below local and national averages and the practice was not actively following up on patients who did not attend.

During our last inspection in May 2016 we found concerns relating to poor patient satisfaction scores for some aspects of GP and nurse care and treatment. The national GP patient survey mori poll was conducted between July and September 2015 and January to March 2016. The results were published in July 2016. There was a marked improvement in patient satisfaction scores;

• 86% of patients said the GP gave them enough time compared to the clinical commissioning group (CCG) average of 89% and the national average of 87%. This had increased from 80% in the previous survey.

• 96% of patients said the last nurse they spoke to was good at treating them with care and concern compared to the CCG average of 91% and national average of 92%. This had increased from 82% in the previous survey.

• 95% of patients said the last nurse they saw was good at listening to them compared to the CCG average of 92% and the national average of 91%. This had increased from 74% in the previous survey.

• 87% of patients said the last GP they saw was good at involving them in decisions about their care compared to the CCG average of 84% and national average of 82%. This had increased from 75% in the previous survey.

However, there were areas of practice where the provider must make improvements;

• Ensure patients are actively encouraged to attend for health screening through the national screening program and improve uptake rates.

• Continue to review and improve on mental health care planning and diabetes care indicators for patients.

• Ensure all patients on repeat medicines are reviewed for suitability of their current medicine regime.

In addition, there were areas of practice where the provider should make improvements;

• Ensure the risk assessment for the walk in service captures all areas of risk and is effective.

At our previous inspection on 17 May 2016, we rated the practice as requires improvement for providing effective services as patient uptake of the national screening programme, mental health care plans and diabetes care were all below local and national averages. At this inspection we found that although the data showed improvements in many areas the practice was still over 10% below local and national averages for many aspects of care. Consequently, the practice remains rated as requires improvement for providing effective services.

Professor Steve Field (CBE FRCP FFPH FRCGP) 

Chief Inspector of General Practice