Observatory Medical Practice

Updated 18 April 2017

Letter from the Chief Inspector of General Practice

We carried out an announced comprehensive inspection at Jericho Health Centre - Kearley on 16 August 2016. Overall the practice is rated as good. Improvements are required to ensure the service is providing safe services.

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

• There was a system in place for reporting and recording significant events. Reviews of complaints, incidents and other learning events were thorough.
• Risks to patients were mostly assessed and well managed. However, some risks were not fully managed specifically in relation to monitoring of fridge temperatures and storage of liquid nitrogen.
• Staff assessed patients’ ongoing needs and delivered care in line with current evidence based guidance.
• National data suggested patients received appropriate care for long term conditions.
• The system for reviewing patients on repeat medicines identified patients who required a review, but the practice was in the process of ensuring higher achievement of up to date medicine reviews was achieved.
• Staff were trained in order 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. 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 and routine 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.
• There was a strong ethos of continuous learning.

Areas the provide must make improvements are:

• Ensure risks related to cold chain storage of medicines, emergency medicines and liquid nitrogen are managed appropriately.

Areas the provide should make improvements are:

• Continue to improve the monitoring of patients on repeat prescriptions and ensure that patient reviews of their long term conditions are maximised via minimising exceptions.
• Review lower than average uptake of specific child vaccines.
• Consider feedback regarding consultations with GPs where feedback from the national survey is consistently below local averages.

Professor Steve Field (CBE FRCP FFPH FRCGP) 

Chief Inspector of General Practice

Updated 14 September 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.
• The most recent published results showed 99% of the total number of points available compared to the clinical commissioning group (CCG) average of 97% and national average of 95%. The extent of patients excepted from long term condition reviews was reduced in 2016 compared to 2015.
• There were nurse home visits offered for patients with long term conditions who found it difficult to make it to the practice.
• All these patients were offered 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 14 September 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.
• 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.
• We saw positive examples of joint working with midwives, health visitors and school nurses.
• Joint working with external organisations took place in the management of children at risk of abuse.

Updated 14 September 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.
• GPs offered home visits and urgent appointments for those with enhanced needs.
• The premises were accessible for patients with limited mobility and there was a hearing aid loop available for patients with poor hearing.
• Patients over 75 had a named GP.
• There were nurse home visits offered for patients with long term conditions who found it difficult to make it to the practice.

Updated 14 September 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.
• Patients’ feedback on the appointment system was very positive overall.
• 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.
• The practice registered patients from two Oxford University colleges and a designated GP was assigned to ensure there was monitoring of this group of patients.

Updated 14 September 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 91% compared to the national average 92% and regional average of 95%.Exception reporting for mental health indicators was slightly below the national average (11%) and regional average (11%) at 9%.
• The proportion of patients on the mental health conditions register with a care plan was 84% compared to the local average of 89%.
• 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 14 September 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 including those with a learning disability.
• 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.
• The staff worked closely with substance and alcohol misuse service providers in supporting these patients.