Cowley Road Medical Practice

Updated 5 July 2016

Cowley Road Medical Practice provides GP services on a General Medical Services Contract to about 8,000 patients in the city of Oxford, with the list size having increased significantly in the past nine years. The area has some socio-economic deprivation and a higher than average level of unemployment. The population is mobile and culturally diverse, including a large number of asylum seekers, refugees and people with English as a second language. The practice has significantly more patients aged 20 to 39 than the national average, and fewer aged above 40.

The practice has three GP partners, two female and one male, one salaried female GP and one male locum GP, equivalent to three whole time GPs, covering 30 weekly morning and afternoon consultation sessions. There are three practice nurses, equivalent to 1.7 whole time nurses, and a healthcare assistant, along with a practice manager, assistant practice manager, a medical secretary, and five administration and reception staff. The practice is a teaching practice for trainee GPs and medical students.

The practice is based at East Oxford Health Centre, an NHS-owned building which also houses another GP practice, an independent pharmacy and a number of health services. Cowley Medical Practice is based on the ground floor of the building, which has designated disabled parking spaces and ramp access. There are seven consulting rooms and one nurse treatment rooms. The practice has a dedicated waiting area for children, baby changing facilities, a toilet for people with disabilities, and a lower reception desk area for wheelchair users.

The practice is open from 8.30am to 6pm Monday to Friday, with telephone lines open from 8am to 6.30pm. Appointments are available between 8.30am and 11.30am, and between 2pm and 5.30pm. The practice has not opted to be funded by NHS England to provide an extended hours enhanced service. An out of hours GP service is provided by Primary Medical Limited, and is accessed by calling the NHS 111 telephone number.

Updated 5 July 2016

Letter from the Chief Inspector of General Practice

We carried out an announced comprehensive inspection at Cowley Road Medical Practice on 11 April, 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.
• 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 one area of outstanding practice:

The practice had a proactive policy of registering patients who may have had difficulty registering elsewhere, including failed asylum seekers, those with addictions and patients who demonstrate challenging behaviour. It also considered on a case-by-case basis keeping patients registered after they had moved out of area, if they would benefit from continuity of care. The practice was currently presenting a case to the CCG for additional funding for the care of asylum seekers and refugees, and was involved in a project to use medical students as mentors for those who had newly arrived in the city. It had also recently welcomed a university anthropology student to spend time in the practice researching the use of interpreters in GP practices and was inviting them back to a team meeting for feedback.

The practice provided specific examples of responsive care for patients in vulnerable population groups which demonstrated positive liaison with other agencies to ensure all information was available for decision making, and advocacy regarding issues such as female genital mutilation.

The areas where the provider should make improvement are:

• Maintain the governance of newly implemented procedures, for example regarding prescription form security in consulting rooms.

• The practice needs to find reconsidered ways of improving patients’ attendance for health reviews, particularly those from diverse cultural backgrounds and with English as a second language.For example, by ensuring that patients who are not attending appointments to manage long term conditions are given wider opportunities to engage with local health care provision.
• Risk assess medical equipment including dressings to ensure they are appropriately stored.
• Undertake work to identify more patients as carers, and review its carers’ list regularly.

Professor Steve Field (CBE FRCP FFPH FRCGP) 

Chief Inspector of General Practice

Updated 5 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.

• In addition to established clinics for those with asthma, diabetes and raised blood pressure, nurses were planning to start running clinics to help those with coeliac disease manage their condition.

• However not all patients are attending appointments to manage long term conditions and may need more support to do so.

• Diabetes management indicators were comparable to national averages, with 92% of patients with diabetes receiving a foot examination and risk classification within the last 12 months, compared to a national average of 88%.

• 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 5 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.

• The waiting room had a separate waiting area for families with young children.

• 74% of female patients aged 25 to 64 had attended for cervical screening within the target period, compared to a national average of 82%.

• Appointments were available outside of school hours and the premises were suitable for children and babies.

• We saw positive examples of joint working with district nurses.

• There was a proactive approach to safeguarding children to support their welfare. This included links with a local expert in female genital mutilation to improve staff awareness of the issue, such as how to identify concerns and make appropriate referrals.

Updated 5 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 and urgent appointments for those with enhanced needs.

• The practice had good links with a local care home, with a named GP who visited it for a ward round of registered patients on a weekly basis.

Updated 5 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 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.

• All clinical staff had undergone training to improve the diagnosis and management of chlamydia, a common sexual transmitted disease.

• Although the practice had chosen not to offer extended opening hours as a funded enhanced service, it reviewed this regularly to ensure that this reflected the needs of its population.

Updated 5 July 2016

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

• 87% of patients diagnosed with dementia who had had their care reviewed in a face to face meeting in the last 12 months, which is better than the national average of 84%.

• 95% of patients with schizophrenia, bipolar affective disorder and other psychoses had a comprehensive, agreed care plan documented in the preceding 12 months, compared to the national average of 88%.

• The practice offered longer appointments to patients with complex needs including mental health issues, and patients in crisis were often seen on a weekly basis.

• 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.

Updated 5 July 2016

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

• The practice had undertaken an audit of 108 newly registered patients in a four-week period in 2016, and found that 33 nationalities were represented, with 50 per cent being new to the UK on registration.

• The practice had an “open door” policy of registering patients who may have had difficulty registering elsewhere, including failed asylum seekers, those with addictions and patients who demonstrate challenging behaviour.

• The practice provided specific examples of responsive care for patients in vulnerable population groups which demonstrated positive liaison with other agencies to ensure all information was available for decision making, and advocacy regarding issues such as female genital mutilation.