White Horse Medical Practice

Updated 1 April 2016

White Horse Medical Practice is located within a purpose built health centre in Faringdon, south west Oxfordshire. In April 2015, a smaller practice which shared the health centre (Fernhill Practice) merged with White Horse Medical Practice.

White Horse Medical Practice is a large rural dispensing practice covering 130 square kilometres and is one of the practices within Oxfordshire Clinical Commissioning Group (CCG). The practice provides general medical services to approximately 15,000 registered patients in Faringdon and the surrounding villages.

All services are provided from:

• White Horse Medical Practice, Faringdon Health Centre, Faringdon, Oxfordshire SN7 7YU.

There are 12 GPs at the practice (five male and seven female), of which three are GP Partners who are occasionally supported by locum GPs.

The all-female nursing team consists of a nurse prescriber, five practice nurses and six health care assistants, four of whom are also administration staff. All of the nursing team contribute with a mix of skills and experience including insulin initiation.

A practice manager, deputy practice manager, business manager, data manager and a team of reception and administrative staff undertake the day to day management and running of the practice.

White Horse Medical Practice is a dispensing practice, the dispensary is managed by a dispensary manager and the dispensary team consists of six dispensers and two counter assistants. There is a daily delivery of medicines to three village post offices and any house bound patient who requires this service.

The practice population has a higher proportion of patients aged over 65 compared to local and national averages. For example, 21% of practice patients are aged over 65 compared to the local CCG average (16%) and national average (17%). The practice also provides GP services to three local care homes (approximately 133 patients).

According to national data there is minimal deprivation in south west Oxfordshire; however the practice is located within a pocket of deprivation. The prevalence of patients with a long standing health condition is 55% compared to the local CCG average (50%) and national average (54%). People living in more deprived areas and with long-standing health conditions tend to have greater need for health services.

The practice has core opening hours between 8am and 6.30pm every weekday (appointments start from 8am and the last appointment is 6pm) with the exception of Monday when the practice remains open until 8pm (last appointment 7.20pm).

The dispensary opening times mirrors the practices core opening hours including the late surgery on Monday evening.

The practice opted out of providing the out-of-hours service. This service is provided by the out-of-hours service accessed via the NHS 111 service. Advice on how to access the out-of-hours service is clearly displayed on the practice website and over the telephone when the surgery is closed.

Updated 1 April 2016

Letter from the Chief Inspector of General Practice

We carried out an announced comprehensive inspection at White Horse Medical Practice on 24 February 2016. Overall the practice is rated as good.

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

• The practice had a vision which had quality and safety as its top priority. A business plan was in place, was monitored and regularly reviewed and discussed with all staff. High standards were promoted and owned by all practice staff with evidence of team working across all roles.

• The practice had an effective governance system in place, was well organised and actively sought to learn from performance data, incidents and feedback.

• Staff understood and fulfilled their responsibilities to raise concerns, and to report incidents and near misses. Information about safety was recorded, monitored, appropriately reviewed and addressed.

• Risks to patients were assessed and well managed, this included premises maintenance, equipment checks and emergency procedures. All staff checks required were undertaken however not all recruitment and background check correspondence were accessible on the day of inspection.

• Feedback from patients and stakeholders about their care was consistently and strongly positive.

• Historically outcomes for patients who use services were consistently very good. Nationally reported Quality and Outcomes Framework (QOF) data, for 2012/13 and 2013/14, showed the practice had performed excellently in obtaining almost all of the total points available to them for providing recommended care and treatment to patients. We saw evidence of data irregularities for the 2014/15 period and saw the practice was proactive in seeking a resolution to these irregularities.

• The practice implemented suggestions for improvements and made changes to the way it delivered services as a consequence of feedback from patients and from the patient participation group.
• We found there was good staff morale in the practice, with high levels of team spirit and motivation. There was a strong learning culture evident in the practice. This came across clearly through discussions with staff members and in the approach to adopting and championing new initiatives.
• It was evident the practice had gone through a period of transition including a merge of practices. There was a clear leadership structure and staff felt supported by management.

We saw several areas of outstanding practice including:

• The practice was consistent in supporting patients to live healthier lives through a targeted and proactive approach to health promotion. For example, the practice invited all non-UK born patients to be screened and tested for hepatitis B and C (a virus that can cause inflammation of the liver). Of the patients screened so far, we saw evidence of patients who have now had a positive diagnosis for hepatitis and have since received care and treatment to manage this condition which was previously undiagnosed.

• White Horse Medical Practice actively supported breast feeding mothers. For example, there was a weekly breast feeding clinic at the practice every Monday called ‘The Baby Bar’, clear signage welcoming breast feeding mothers and a private space was available for breast feeding mothers.

• White Horse Medical Practice is research active, supporting a number (approximately 25 clinical trials) of National Institute of Clinical Research (NIHR) portfolio studies. The practice working with their patient participation group (PPG), community groups and other local organisations, ran a comprehensive survey on maternity service needs across Oxfordshire. In February 2016, the practice was awarded first place in the Research Engagement Award (NIHR Clinical Research Network award in partnership with the National Association for Patient Participation (N.A.P.P.) which celebrated the outstanding leadership and dedication by the PPG in health research in primary care.

Professor Steve Field CBE FRCP FFPH FRCGP

Chief Inspector of General Practice

Updated 1 April 2016

The practice is rated as good for the care of people with long-term conditions.

• The GPs and nursing team had the knowledge, skills and competency to respond to the needs of patients with long term conditions such as diabetes and COPD (Chronic obstructive pulmonary disease is the name for a collection of lung diseases including chronic bronchitis, emphysema and chronic obstructive airways disease).

• Longer appointments and home visits were available when needed.

• Patients at risk of hospital admission were identified as a priority.
• There had been data irregularities following the merge of practices and change of computer systems however outcomes for patients who use services were consistently good. For example, real time (February 2016) Quality and Outcomes Framework performance for diabetes related indicators was in line with the national average. The practice achieved 90% of targets compared to the national average (89%).

Updated 1 April 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 for standard childhood immunisations (12 months, 24 months and five years) given in 2014/15 were higher when compared with the CCG average.

• 75% of patients diagnosed with asthma, on the register, had an asthma review in the last 12 months. This was comparable to the national average which was also 75%.

• 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.

• The practice’s uptake for the cervical screening programme was 81%, which was comparable to the national average (82%).

• Appointments were available outside of school hours and the premises were suitable for children and babies. White Horse Medical Practice actively supported breast feeding mothers. For example, there was a weekly breast feeding clinic at the practice every Monday called “The Baby Bar”, clear signage welcoming breast feeding mothers and a private space was available for breast feeding mothers.
• We saw positive examples of joint working with midwives and health visitors who were based on site.

Updated 1 April 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 patients in its population.

• The practice was responsive to the needs of older patients. Longer appointments, home visits and urgent appointments were available for those with enhanced needs.

• The practice systematically identified older patients and coordinated the multi-disciplinary team (MDT) for the planning and delivery of palliative care for people approaching the end of life.

• We saw unplanned hospital admissions and re-admissions for the over 75’s were regularly reviewed and improvements made.

• The practice provided medical care to three local care homes with a lead GP designated to each of the three homes. The designated GPs held regular sessions at the homes to review patients with non-urgent health problems; this time was also used to proactively identify and manage any emerging health issues and undertake medication reviews.
• Nationally reported data showed that outcomes for patients for conditions commonly found in older people were higher than national averages. For example, 100% of patients aged 75 or over with a record of a fragility fracture on or after 1 April 2014 and a diagnosis of osteoporosis, who were currently treated with an appropriate bone-sparing agent. This is higher when compared to the CCG average (92%) and national average (93%).

Updated 1 April 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.

• Appointments were available between 8am and 6pm Tuesday to Friday. The practice and dispensary was open every Monday evening until 8pm specifically for patients not able to attend outside normal working hours but there were no restrictions to other patients accessing these appointments.

• 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.

• Patients who wished to check their own blood pressure and their weight and height were encouraged to do so and the results were reviewed by the health care assistant.

Updated 1 April 2016

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

• 93% of people experiencing poor mental health had a comprehensive, agreed care plan documented in their medical record, which was higher when compared to the national average (88%).

• 84% of patients diagnosed with dementia who had had their care reviewed in a face to face meeting in the last 12 months, which is comparable to the national average also 84%.

• The practice regularly worked with multi-disciplinary teams in the case management of people experiencing poor mental health, including those with dementia. This included a regular dementia and memory support group held at the practice each month and one of the members of the patient participation group who is also a ‘Dementia Friend’ held a dementia information session at the practice. This session focused on dementia and the small things that you can do that make a difference in helping those living 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.

Updated 1 April 2016

The practice is rated as good for the care of people whose circumstances may make them vulnerable.

• There were policies and arrangements to allow people with no fixed address to register and be seen at the practice.

• The practice offered longer appointments for patients with a learning disability. It had carried out annual health checks for 54% of people (21 out of 39 patients) with a learning disability and there was evidence that these had been followed up. The remaining 46% had all been offered an annual health check, 11 had declined, five are exempt from a health check and we saw two patients had scheduled health checks in the forthcoming weeks.

• The practice regularly worked with multi-disciplinary teams in the case management of vulnerable people.
• 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.