Archived: Oakfield Surgery

Updated 3 February 2017

Oakfield Surgery is a small practice based in Penge in the London Borough of Bromley. The practice list size is approximately 3504. Life expectancy for males in the practice is 77 years and for females 82 years. Both of these are in line with Bromley CCG and national averages for life expectancy. The practice has a higher than average number of patients with in the working population age ranges 25-49 years both males and females. The practice has a higher than average number of male and female patients aged 55-84 years. The practice was based in the fourth most deprived decile.

The practice is set out over the ground floor. Facilities include two consultation rooms, a patient waiting area. The premises provided a wooden ramp for wheelchair access and there was a disabled toilet. There was no hearing loop for patients with hearing impairments.

The staff team compromises of two GP partners one male and one female. Both partners worked eight sessions a week. Other staff included one part time female nurse, a female health care assistant, the administrative team includes a part time practice manager, five receptionists, two administration staff, and two summarisers.

The practice operates under a Personal Medical Services (PMS) contract, and is signed up to a number of local and national enhanced services (enhanced services require an enhanced level of service provision above what is normally required under the core GP contract).

The practice reception and telephone lines are open from 8am to 6.30pm Monday to Friday. Appointments are available to patients from 8.30am to 6.30pm Monday to Fridays. They offer extended hours on Saturday from 9.00am to 10.30am with appointments available during these hours. The nurse provided appointments from 1pm to 7pm on a Tuesday and Thursday. When the practice is closed patients are directed (through a recorded message on the practice answer machine) to contact the local out of hours service. Information relating to out of hours services is also available on the practice website. The practice was also responsible for looking after patients in a nearby care home. We spoke with the home and they confirmed they have worked with the practice for many years and that the GPs were very responsive, and provided a very good service, the home could contact them via emails, phone calls, and the practice was always efficient at responding to them.

The practice has secured the development of a purpose built GP premises, and will be moving in June 2017.

The practice is registered as a partnership with the Care Quality Commission (CQC) to provide the regulated activities of treatment of disease, disorder or injury; diagnostic and screening; family planning; maternity and midwifery services and surgical procedures at one location.

Updated 3 February 2017

Letter from the Chief Inspector of General Practice

We carried out an announced comprehensive inspection at Oakfield Surgery on 13 July 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 adequate facilities and was well equipped to treat patients and meet their needs. However, the practice did not have baby change facilities.
• 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.

• The practice worked with young females, as the area had a high pregnancy rate. The practice encouraged teenagers to come in for sexual health services, consequently this helped to reduce the under 16 conception rate and the practice was awarded a star certificate for its efforts in outstanding delivery within Bromley.

The areas where the provider should make improvement are:

• Review provision to allow those with hearing impairment to access practice services.

• Consider providing baby changing facilities.

• Review the Carers’ policy content to provide relevant and up to date contacts and services.

• Keep appropriate records of fire drills.

• Review ways to increase take up of screening, to improve patient outcomes.

• Review involvement of patients in decision making about care and treatment, to improve patient satisfaction.

Professor Steve Field CBE FRCP FFPH FRCGP 

Chief Inspector of General Practice

Updated 3 February 2017

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

• GPs had lead roles in chronic disease management and patients at risk of hospital admission were identified as a priority.

• Performance for diabetes related indicators was comparable. For example, 67% of patients had well-controlled diabetes, indicated by specific blood test results, comparable to the Clinical Commissioning Group (CCG) average of 75% and the national average of 78%.

• 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 3 February 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 Accident and Emergency (A&E). 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 82%, which was comparable to the Clinical Commissioning Group (CCG) average of 84% and the national average of 82%.

• Appointments were available outside of school hours; however, the practice did not have baby changing facilities.

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

• The practice worked with young females and teenagers as the area had a high pregnancy rate, the practice encouraged teenagers to come in via posters and leaflets, and opportunistically for sexual health services, consequently this helped to reduce the under 16 conception rate. For example the London Borough of Bromley as a whole reduced the under 16 conception rate (figures are per 1000), over the period 2012-2014 the rates were 2012 -6.5, 2013 -5.5 and in 2014 this was reduced to 2.4 which was against the trend in surrounding comparable boroughs where the rates have increased year on year

• The practice was awarded a star achievement for achieving an above average score in promoting National chlamydia screening programme (NCSP).

Updated 3 February 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 was responsive to the needs of older people, and offered home visits and urgent appointments for those with enhanced needs.

Updated 3 February 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 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 3 February 2017

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

• 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.

• The practice provided access to in-house counselling, this service was offered by referral and took place in the practice every Friday afternoon.

Updated 3 February 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.

• For 2015/16, the practice had identified 11 patients on the learning disabilities register and seven had received an annual review, which was 64%.

• 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 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.