Oakley Medical Practice

Updated 22 April 2016

Oakley Medical Practice has been situated in purpose built premises since 1994, located in one of the more deprived areas of Leeds and is part of the Leeds South and East Clinical Commissioning Group (CCG). The building has recently been modernised and redesigned to include additional consulting rooms, storage space and double automatic doors at the entrance of the building; to facilitate easier access for wheelchair users. There is a small car park on site and additional parking on nearby streets.

The practice patient list size is 4,992 with a higher than national average of patients who are aged between 0 to 35 years. There is a higher than average unemployment rate of 13%, compared to 8% locally and 5% nationally. Fifty percent of patients are white British. The rest of the practice population consists of patients who are of Asian, African or Eastern European origin.

The practice has good working relationships with local health, social and third sector services to support provision of care for its patients. (The third sector includes a very diverse range of organisations including voluntary, community, tenants’ and residents’ groups.)

The practice is open Monday to Friday 8am to 6pm, with the exception of Wednesday when it is closed from 1pm. Saturday morning appointments are available from November 2015 to March 2016 under the Winter Pressure Scheme. When the practice is closed out-of-hours services are provided by Local Care Direct, which can be accessed via the surgery telephone number or by calling the NHS 111 service.

There are three GP partners, two female and a male, who are supported by a female sessional GP and a female locum GP. The practice is also staffed by three female practice nurses, a practice manager, an administrator, a secretary and a team of three administration and reception staff.

Personal Medical Services (PMS) are provided under a contract with NHS England. The practice is registered to provide the following regulated activities; maternity and midwifery services, family planning, diagnostic and screening procedures and treatment of disease, disorder or injury. They also offer a range of enhanced services such as influenza, pneumococcal and childhood immunisations.

Updated 22 April 2016

Letter from the Chief Inspector of General Practice

We carried out an announced comprehensive inspection at Oakley Medical Practice on 23 February 2016. Overall the practice is rated as good for providing safe, effective, caring, responsive and well-led care for all of the population groups it serves.

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

• The practice was aware of and complied with the requirements of the duty of candour (being open and transparent with people who use the service, in relation to care and treatment provided). The partners encouraged a culture of openness and honesty, which was reflected in their approach to safety. All staff were encouraged and supported to record any incidents using the electronic reporting system. There was evidence of good investigation, learning and sharing mechanisms in place.
• There was a clear leadership structure and a stable workforce in place. Staff were aware of their roles and responsibilities and told us the GPs and manager were accessible and supportive. The practice promoted an all inclusive approach amongst staff.
• Risks to patients were assessed and well managed. There were good governance arrangements and appropriate policies in place.
• Patients’ needs were assessed and care was planned and delivered following best practice guidance. Staff had the skills, knowledge and experience to deliver effective care and treatment.
• The practice had good facilities and was well equipped to treat and meet the needs of patients. Information regarding the services provided by the practice was available for patients.
• There was a complaints policy and clear information available for patients who wished to make a complaint.
• Patients said they were treated with compassion, dignity and respect and were involved in care and decisions about their treatment.
• Patients were positive about access to the service. They said they found it easy to make an appointment, there was continuity of care and urgent appointments were available on the same day as requested.
• Longer appointments were given to those patients requiring interpreter services.
• A small number of identified patients with complex needs were fast tracked for access to a clinician.
• The practice sought patient views how improvements could be made to the service, through the use of patient surveys, the NHS Friends and Family Test and the patient participation group.
• The ethos of the practice was to deliver good patient centred care.

We saw two areas of outstanding practice:

• The practice worked closely with a local nursing home, a named GP attended on a weekly basis providing support to patients and staff as needed. The nursing home manager verbally confirmed there had been a reduction in unplanned hospital admissions as a result of the interventions by the practice. Unfortunately, due to a recent change in home ownership they could not provide the written statistics to evidence the reductions.
• The national GP patient survey results showed satisfaction rates were significantly higher than the local and national averages.

However, there were two areas where the practice should make improvements:

• Ensure oxygen is available on the premises, in case of urgent need by a patient.
• Ensure all staff receive an agreed formalised annual appraisal and personal development plan.

Professor Steve Field CBE FRCP FFPH FRCGP

Chief Inspector of General Practice

Updated 22 April 2016

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

• All these patients had a named GP and a structured annual review to check that their health and medicines needs were being met. The practice nurses had lead roles in the management of long term conditions.
• Patients who were identified most at risk of hospital admission were identified as a priority.
• The practice delivered care for patients using an approach called The House of Care model. This approach enabled patients to have a more active part in determining their own care and support needs in partnership with clinicians. It was used with all patients who had diabetes, chronic obstructive pulmonary disease (COPD) or coronary heart disease.

• 100% of newly diagnosed diabetic patients had been referred to a structured education programme in the last 12 months, compared to 87% locally and 90% nationally.
• 86% of patients diagnosed with asthma had received an asthma review in the last 12 months, compared to 75% locally and nationally.
• 95% of patients diagnosed with COPD had received a review in the last 12 months, compared to 88% locally and 90% nationally.
• Longer appointments and home visits were available when needed.

Updated 22 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 accident and emergency (A&E) attendances.
• Patients and staff told us children and young people were treated in an age-appropriate way and were recognised as individuals.
• Appointments were available outside of school hours and the premises were suitable for children and babies. All children who required an urgent appointment were seen on the same day as requested.
• The practice worked with midwives, health visitors and school nurses to support the needs of this population group. For example, the provision of ante-natal, post-natal and child health surveillance clinics.
• Uptake rates were high for all standard childhood immunisations, achieving 100% for many vaccinations.
• Sexual health, contraceptive and cervical screening services were provided at the practice.
• 79% of eligible patients had received cervical screening, compared to 82% both locally and nationally.

Updated 22 April 2016

The practice is rated as good for the care of older people.

• The practice provided proactive, responsive and person centred care to meet the needs of the older people in its population. Home visits and urgent appointments were available for those patients in need.
• The practice worked closely with other health and social care professionals, such as the district nursing and local neighbourhood teams, to ensure housebound patients received the care and support they needed.
• Care plans were in place for those patients who were considered to have a high risk of an unplanned hospital admission.
• Health checks were offered for all patients over the age of 75 who had not seen a clinician in the previous 12 months.
• The practice worked closely with a local nursing home, providing weekly ‘ward rounds’ and support as needed. The nursing home manager confirmed there had been a reduction in unplanned hospital admissions as a result of interventions by the practice.
• Weekly meetings were undertaken with a community Consultant for older people to case review any patients of concern.
• Those patients who were at an increased risk of isolation and unplanned hospital admission were referred to Age UK for additional support.

Updated 22 April 2016

The practice is rated as good for the care of working age people (including those recently retired and students).

• The needs of these patients had been identified and the practice had adjusted the services it offered to ensure these were accessible, flexible and offered continuity of care.
• Saturday morning clinics were offered during the Winter Pressure Scheme from November 2015 until the end of March 2016.
• The practice was proactive in offering online services as well as a full range of health promotion and screening that reflected the needs for this age group. For example, cervical screening and the early detection of COPD for patients aged 40 and above who were known to be smokers or ex-smokers.
• Health checks were offered to patients aged between 40 and 75 who had not seen a GP in the last three years.

Updated 22 April 2016

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

• The practice regularly worked with multidisciplinary teams in the case management of people in this population group, for example the local mental health team. Patients and/or their carer were given information on how to access various support groups and voluntary organisations, such as Carers Leeds.
• One of the GP partners up until recently had been the mental health clinical lead for the CCG, providing education and support to other local practices.
• 94% of patients diagnosed with dementia had received a face to face review of their care in the last 12 months, which was comparable to the local and national averages.
• 94% of patients who had a severe mental health problem had received an annual review in the past 12 months and had a comprehensive, agreed care plan documented in their record. This was higher than both the local and national average of 88%.
• Staff had a good understanding of how to support patients with mental health needs or dementia.

Updated 22 April 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 and regularly worked with multidisciplinary teams in the case management of this population group.
• Double length appointments were given to those patients who required interpreter services.
• The practice had identified a small number of vulnerable patients with complex needs, who were to be fast tracked for appointments and access to a clinician. All staff were aware of these patients.
• Staff knew how to recognise signs of abuse in children, young people and adults whose circumstances may make them vulnerable. They 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 could evidence the number of children who were on a child protection plan (this is a plan which identifies how health and social care professionals will help to keep a child safe).
• Those patients who were on the autistic spectrum disorder were coded on the computer system. This alerted clinicians to provide additional support as needed.
• Information was provided on how to access various local support groups and voluntary organisations.
• As part of the blood borne virus screening programme, HIV, Hepatitis B and C testing were offered to all new patients aged between 16 and 65. Testing was also offered to those patients who were thought to be ‘at risk’.