Evergreen Oak Surgery

Updated 12 January 2017

The Evergreen Oak Surgery was inspected on Wednesday 26 October 2016. This was a comprehensive inspection.

The practice is situated in Parkstone and area of Poole in Dorset. The practice provides a personal medical service to 5.300 patients living in the area of Poole. There is also a branch practice 2.5 miles away from the main site in Creekmoor.

The practices population area is in the eighth decile for deprivation, which is on a scale of one to ten. The lower the decile the more deprived an area is compared to the national average. The practice population ethnic profile is predominantly White British with a higher number of patients aged between 41years and 60 years. The practice also provides care to a number of patients living in 13 local care and nursing homes. The average male life expectancy for the practice area is 80 years which is slightly higher than the national average of 79 years; female life expectancy is 84 years which is also higher than the national average of 83 years.

The practice team consists of four GP partners, two male and two female providing 21 GP sessions each week. The GPs held managerial and financial responsibility for running the business. The team are supported by a practice manager, a patient services manager, two practice nurses, two healthcare assistants and 10 additional administration and reception staff. The practice ss a training practice for doctors training to become GPs.

The practice is open between 8am and 6.30pm Monday to Friday. Booked appointments are offered between 8.30am and 10.30am and 4pm until 5.30pm. The practice offers a range of appointment types including book on the day, telephone consultations morning, lunchtime and during the afternoon and advance appointments bookable online. Extended hours are offered on a Monday evening between 6.30pm and 8.30pm.

Outside of these times patients are directed to contact the 111 NHS telephone number. Details are also given on the practice website of other useful telephone numbers and addresses where patients can seek assistance when the practice is closed.

The Evergreen Oak Surgery provides regulated activities from Evergreen Oak Surgery, 43 Commercial Road, Parkstone, Poole, Dorset BH14 0HU and their branch practice at The Creekmoor Surgery,1 Borley Road, Creekmoor, Poole BH17 7DT. We did not visit this branch surgery at this inspection.

Updated 12 January 2017

Letter from the Chief Inspector of General Practice

We carried out an announced comprehensive inspection at The Evergreen Oak Surgery on 26 October 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. The practice was clean, tidy and hygienic. We found suitable arrangements were in place that ensured the cleanliness of the practice was maintained to a high standard.
• The practice was run efficiently and was well organised. 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 named GP that cared for patients aged over 75 years. All of these 480 patients registered at the practice had received a health review that included clinical need, social need and screening for dementia either at home or in the practice. These patients had also been assessed for their needs should hospitalisation be required and for end of life care. Patients that lived home alone were visited monthly.

The areas where the provider should make improvement are:

• Review audit processes to ensure multiple cycle audits are undertaken to measure service improvement.

Professor Steve Field (CBE FRCP FFPH FRCGP) 

Chief Inspector of General Practice

Updated 12 January 2017

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.

• 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.

• The practice nurse held six weekly clinics with the diabetes specialist nurse for those patients with more complex needs.

Updated 12 January 2017

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 practice’s uptake for the cervical screening programme was 89%, which was higher than the national average of 82%. There was a policy to offer telephone reminders for patients who did not attend for their cervical screening test.

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

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

• The practice also provided medical care to a local Women’s Refuge which housed vulnerable mothers and children who have suffered domestic abuse.

Updated 12 January 2017

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 had a named GP that cared for patients aged over 75 years. All of these 480 patients registered at the practice had received a health review that included clinical need, social need and screening for dementia either at home or in the practice. These patients had also been assessed for their needs should hospitalisation be required and for end of life care. Patients that lived home alone were visited monthly.

• Older patients with complex care needs or those at risk of hospital admissions had personalised care plans which were shared with local organisations to facilitate continuity of care.

• The practice was responsive to the needs of older people, and offered home visits and urgent appointments for those with enhanced needs.

• Regular ward rounds were undertaken in local care and nursing homes. The practice provided care to a number of patients living in 13 local care and nursing homes.

Updated 12 January 2017

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 held daily telephone consultation sessions which benefitted patients at work or in education.

• 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.

Updated 12 January 2017

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

• 79% of patients diagnosed with dementia had had their care reviewed in a face to face meeting in the last 12 months, which was slightly lower than both the clinical commissioning group (CCG) average of 85% and national average of 84%.

• The percentage of patients with schizophrenia, bipolar affective disorder and other psychoses who had a comprehensive, agreed care plan documented in their records in the preceding 12 months was 91%, which was better than the national average of 88%.

• 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 12 January 2017

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 also had a Health and Social Care Co-ordinator assigned to them to follow up any actions from the multi disciplinary meeting and ensure the right people attend and appropriate patents were discussed.

• 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.