Chipping Norton Health Centre

Updated 6 July 2016

Chipping Norton Health Centre provides GP services to nearly 15,000 patients in the Cotswolds market town of Chipping Norton. It was opened in April 2015 when the town’s previous two GP practices merged to form the current practice. The practice has nine GP partners, six female and three male, along with three female salaried GPs and two locum GPs, equivalent to 7.3 whole time GPs. There are six practice nurses, equivalent to 4.5 whole time equivalent nurses, five healthcare assistants and six dispensary staff. There is also a business manager, medical secretaries, and administration, reception, finance and quality monitoring staff. The practice is a training and teaching practice for trainee GPs and medical students. There is a pharmacy attached to the surgery, and practice staff work within it to provide a dispensing service to patients.

The practice serves the town of Chipping Norton and surrounding villages in an area with a low level of deprivation and a mainly white British population, with life expectancy and prevalence of long-term health conditions in line with national averages. It also provides Local Enhanced Services to a number of care and nursing homes, including those supporting people with dementia, and to three schools, including one for children with social, emotional or behavioural difficulties.

The practice is based at Chipping Norton Health Centre, which is located on the outskirts of the town. The three story building, which is owned by the practice, provides rented space to a number of other health services. It has two lifts, designated disabled parking spaces and ramp access. There are 33 consulting rooms, some of which are rented to other health services, four treatment rooms and a minor operations room. There is also a large meeting room which is used for group sessions such as addiction support. The surgery has baby changing facilities, a confidential room which can be used for breastfeeding, a toilet for people with disabilities, and a lower reception desk area for wheelchair users. There is a 100 hour community pharmacy owned by the practice on site, which provides dispensing services to patients who live more than one mile from a pharmacy.

The practice is open from 8.30am to 6.30pm Monday to Friday, with GP appointments available between 8.30am and 11.10am, and between 2.30pm and 6pm. A total of seven hours’ evening appointments are offered midweek, with the hours varying on a rotating basis to widen patient choice. An out of hours GP service is provided by Oxford Health, and is accessed by calling the NHS 111 telephone number. From 8am, when the out of hours service ends, until the surgery opens at 8.30am, urgent telephone calls received by the practice are directed to the emergency duty GP from the practice.

Updated 6 July 2016

Letter from the Chief Inspector of General Practice

We carried out an announced comprehensive inspection at Chipping Norton Health Centre on 4 May 2016. Overall the practice is rated as good.

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

• There was an open and transparent approach to safety and an effective system in place for reporting and recording significant events.
• Risks to patients were assessed and well managed.
• 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.

We saw several areas of outstanding practice, including:

• The practice ran clinics and group sessions for patients with addictions which was open to patients from a number of local practices. The sessions were run by the practice alongside support workers from a local drug and alcohol agency, and the GPs had access to an expert substance misuse clinician who could be contacted when required. The practice was in discussion with the CCG to expand this service and allow patients from practices in the wider area to attend.
• Patients in the Chipping Norton area received enhanced support for their end of life care needs. This was provided by a charity which the partners of the practice had created and continued to support. Since April 2015, 30 patients had been supported by the charity, for a total of 1,425 nursing hours.

The areas where the provider should improve are:

• Review the long term conditions recall systems and procedures to ensure that patients who are not attending health review appointments to manage their long term conditions are given wider opportunities to engage with health care provision.

• Ensure all staff appraisals are completed by October 2016 and annual appraisals take place thereafter.

• Ensure that employee records are updated to reflect training and DBS checks undertaken at the two previous practices prior to the merger in April 2015.

• Ensure repeat prescription reviews are undertaken within the defined timescales to ensure medicines for patients are still appropriate for their care and treatment.

Professor Steve Field (CBE FRCP FFPH FRCGP) 

Chief Inspector of General Practice

Updated 6 July 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.

• Diabetes management indicators were comparable to national averages, with 96% of patients newly diagnosed with diabetes in the last 12 months being referred to a structured education programme within nine months of diagnosis, compared to a CCG average of 95% and a national average of 90%.

• The practice had launched a diabetes community outreach programme, and recently held its first education event, with a view to getting more patients with diabetes involved in clinical research and improving their management of the condition.

• The practice offered protected GP consultation slots for patients with long-term conditions so that they could see their usual GP about acute issues within 24 or 48 hours rather than the duty GP in the walk-in clinic.

• The practice was piloting a CCG project to integrate community nursing care for patients with long-term conditions by co-ordinating the work of the practice team with district nurses.

• Longer appointments and home visits were available when needed.

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 6 July 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.

• 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.

• Eighty five per cent of female patients aged between 25 and 65 had a cervical screening test in the past 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. Children attending the walk-in clinic for urgent appointments were prioritised.

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

Updated 6 July 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.

• The practice was responsive to the needs of older people, and offered home visits, including blood tests and reviews of long-term conditions, and urgent appointments for those with enhanced needs.

• The practice provided support to a number of local care and nursing homes, with an allocated GP who visited for weekly ward rounds.

• Patients in the Chipping Norton area received enhanced support for their end of life care needs. This was provided by a charity which the partners of the practice had help to create and continued to support. Since April 2015, 30 patients had been supported by the charity, for a total of 1,425 nursing hours. The practice had 50% funded a community volunteer bus service to help less mobile patients access the health centre and adjacent community hospital.

The practice had identified 4% of its patients as carers for other family members, and had links with the local carers’ association, as well as with the Citizens’ Advice Bureau which held sessions on site.

Updated 6 July 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 offered a total of seven hours of evening consultations midweek, with the hours varying on a rotating basis to offer more patient choice. Telephone consultations were available for those who could not easily attend in person.

• The practice was proactive in offering online services including appointment booking and repeat prescription ordering, as well as a full range of health promotion and screening that reflects the needs for this age group.

• It ran a number of clinics including for smoking cessation, counselling, addictions and well person health.

Updated 6 July 2016

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

• Ninety one per cent of patients diagnosed with dementia had their care reviewed in a face to face meeting in the last 12 months, which was better than the national average of 84%.

• 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.

The practice was in the process of working with a local green gym conservation group to support the physical and mental health of participants.

Updated 6 July 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.

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

• 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.

• The practice ran addictions clinics and group sessions which were attended by patients from a number of local practices. The practice was in discussion with the CCG to expand this service.