Bartlemas Surgery

Updated 9 May 2017

We undertook an inspection of this practice on 12 April 2017. The practice provides services from East Oxford Health Centre, Oxford, Oxfordshire, OX4 1XD

Bartlemas Surgery has a purpose built location with good accessibility to all its consultation rooms. The practice serves 9,100 patients from the surrounding area. The practice demographics show that the population has a lower proportion of patients over 65 compared to the national average and much higher prevalence of younger patients. The practice had a higher proportion of patients from ethnic minority backgrounds, a transient population (there was a turnover of patients of approximately 10% every year) and the highest rate of diabetes in Oxford with over 500 patients on their diabetes register. The local population also has a significant prevalence of patients with mental health problems, substance misuse and homelessness.

• There are six GP partners working at the practice, and three salaried GPs, including six female and three male. There are three practice nurses, and two healthcare assistants. A number of administrative staff and a practice manager support the clinical team.
• There are five whole time equivalent (WTE) GPs, 1.5 WTE nurses 1 WTE healthcare assistant.
• This is a training practice and three GPs in training work at the practice.
• Bartlemas Surgery is open between 8.30am and 6.30pm Monday to Friday. There are extended hours nursing appointments available on Saturday mornings.
• Out of hours GP services were available when the practice was closed by phoning 111 and this was advertised on the practice website.

Updated 9 May 2017

Letter from the Chief Inspector of General Practice

Our previous comprehensive inspection at Bartlemas Surgery on 26 September 2016 found breaches of regulations relating to the governance of the practice. The overall rating for the practice was good, but they were rated requires improvement in the effective domain. The full comprehensive report from the September 2016 inspection can be found by selecting the ‘all reports’ link for Bartlemas Surgery on our website at www.cqc.org.uk.

This inspection was an announced focused inspection visit carried out on 12 April 2017. It was conducted 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. 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 evidence we reviewed and collected 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:

• Improvements to diabetes care were in progress and reflected in data since our previous inspection.
• There had been a significant reduction in exception reporting in national clinical data submissions since our previous inspection.
• The process for medicine reviews had been improved and data indicated monitoring was taking place.
• Health checks for patients with learning disabilities had increased significantly.
• Guidance on obtaining consent from patients under 16 had been implemented.
• Survey data indicated the majority of patients were satisfied with access to preferred GPs.
• In the July 2016 GP national survey results the practice had a lower than average rating for seeing a GP of choice. In our last inspection report we suggested the provider should consider this. The practice undertook its own survey published in March 2017 and this showed a significant difference to the national GP survey and significantly better results in terms of access to a named GP. This indicated that of those patients to whom the question was relevant, 67% stated they found access to a GP of choice acceptable or easy. There were 326 responses to the survey.

Areas the provider should make improvements:

• Continue to improve the care for patients and performance in diabetes.

Professor Steve Field (CBE FRCP FFPH FRCGP) 

Chief Inspector of General Practice

Updated 27 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 had appropriate training.
• Patients at risk of hospital admission were identified as a priority.
• The most recent published results showed the practice was performing well compared to national averages. However, there was poor performance in diabetes and many exemptions in national data where patients were not accessing the care reviews related to their conditions or having their conditions managed in line with national data.
• All these patients were offered structured annual review to check their health and medicines needs were being met. Exceptions were only made after being offered a review three times and the decision was made by a clinician.
• 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 27 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 similar to average for all standard childhood immunisations.
• Staff explained how they treated children and young people in an age-appropriate way including recognition of their rights to access treatment.
• We saw positive examples of joint working with midwives and health visitors.
• Joint working with external organisations took place in the management of children at risk of abuse.
• The practice was aware of this risks regarding female genital mutilation among its populations and provided training to staff.

Updated 27 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 high proportion of older people in its population.
• GPs offered personalised care to patients in care and nursing homes.
• The premises were accessible for patients with limited mobility. However, there was no hearing loop available for patients with hearing difficulties.
• Patients over 75 had a named GP in order to maintain their continuity of care.
• Care planning was provided for patients with dementia.
• There was support provided for carers where necessary through referrals to external services and charities.

Updated 27 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 considered and the practice had adjusted the services it offered enable continuity of care.
• Patients’ feedback on the appointment system had been responded to by introducing a new appointment system.
• The appointment system was monitored to identify improvements where possible.
• 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.
• Travel vaccinations were available.
• There were extended hours appointments available on Saturday mornings to provide long term condition reviews and other nursing appointments.

Updated 27 October 2016

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

• Performance for mental health related indicators was 74% compared to the national average 92% and regional average of 95%. Unvalidated data from 2016 showed an improvement to 94% in mental health performance.
• Exception reporting for mental health indicators was below the local and national average of 11% at 8% in 2015.
• The proportion of patients on mental health register with an up to date care plan and physical assessment was 68%.
• 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 advanced 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.

Updated 27 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.
• The practice offered longer appointments for vulnerable patients.
• A temporary registration process was available to patients who may be in the area for a short period of time and who needed to see a GP.
• There was a higher than Oxford average of deprivation among the practice’s patient population. Citizen Advice Bureau workers held surgeries at the practice to support any patients who may need advice on benefits or other concerns.
• The practice had a visiting nurse employed via the local GP federation, who had been working with housebound patients, particularly those with chronic disease and frail patients. This has reduced the risk of hospital admissions and enabled regular assessment and follow up of acute illness as well as routine chronic disease management.
• 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.
• Joint working with external organisations took place in the management of patients at risk of abuse or harm.