Donnington Medical Partnership

Updated 5 September 2017

There has been a GP practice at Donnington Health Centre for approximately 50 years, which has been enlarged and developed over the years to cater for the changing needs of the local population. Donnington Medical Partnership is based at the centre and offer a wide range of primary care services including appointments with GPs and practice nurses, care from a range of allied professionals, and close links with district nurse and health visiting service. It is also a training practice for GP trainees and medical students.

The practice has over 14,000 patients and the practice area covers the east side of Oxford. The practice’s population is ethnically diverse and its score of deprivation is six on a scale of one to ten where ten is the least deprived rating. There is a high proportion of patients with English as a second language and the practice covers areas with high rates of deprivation. The practice is able to accommodate the needs of people with disabilities and there is a disabled parking space available. The practice provides its services under a General Medical Services (GMS) contract, where the contract is directly negotiated with NHS England.

At the time of our inspection the practice’s staff included seven GP partners (three males and four females), six employed GPs, four practice nurses, two health care assistants and 24 non-clinical, administration and reception staff.

The practice is open from 8am to 6pm on Monday to Friday and urgent care is available between 8am to 8.30am and 6pm to 6.30pm. Extended hours service are offered on Saturday mornings. Out of hours services are accessible via NHS 111. Information about how patients can access these services is available on the practice’s website and at the practice’s entrance. In addition to pre-bookable appointments, urgent appointments are also available for people that needed them.

Updated 5 September 2017

Letter from the Chief Inspector of General Practice

At our previous comprehensive inspection at Donnington Medical Partnership on 23 November 2016 we found breaches of regulation relating to the safe care and treatment. The overall rating for the practice was good but we found the practice to require improvement for the provision of safe services. It was good for providing, effective, caring, responsive and well-led services. Consequently we rated all population groups as good. The previous inspection reports can be found by selecting the ‘all reports’ link for Donnington Medical Partnership on our website at www.cqc.org.uk.

This inspection was an announced desktop inspection carried out on 31 July 2017 to confirm that the practice had carried out their plan to meet the legal requirements in relation to the breaches in regulations that we identified in our previous inspection on 23 November 2016. This report covers our findings in relation to those requirements and improvements made since our last inspection.

We found the practice had made the required improvements since our last inspection and was meeting the regulations that had previously been breached. We have amended the rating for this practice to reflect these changes. The practice is now rated good for the provision of safe, effective, caring, responsive and well led services. Overall the practice is rated as good.

Our key findings were as follows:

• Improvements had been made to medicines management processes and the administration of medicines which required authorisation from prescribers.
• The system of monitoring training had been improved to ensure when staff needed safeguarding training it was delivered.
• Calibration checks on emergency equipment was undertaken when required.

In addition to the areas we told the provider to make improvements we also asked the provider to consider making improvements in other areas. The practice had taken action as a result:

• The practice had identified 20 patients who required home visits for reviews of their long term conditions and the practice was in the process of enabling nurses to provide these.

• A new recall letter had been created and was being sent to encourage women eligible for cervical smears to undertake these. The uptake of smears had increased from 70% in 2016 to 77% in 2017.
• The practice had identified 58 patients with learning disabilities and was in the process of contacting these patients to request them to undertake health checks and reviews. At the time of inspection only five of these patients had received health checks. In July 2017 the practice had extended the role of their practice care navigator to include patients with learning disabilities to enable visits and additional prompting for health checks.

Areas the provider should make improvements

• Increase the uptake of learning disability reviews to ensure that this group of patients receive the assessments that reduce the risk unidentified or exacerbations related to existing health problems.

Professor Steve Field (CBE FRCP FFPH FRCGP) 

Chief Inspector of General Practice

Updated 3 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. There were designated practice nurse clinics for asthma, diabetes, cardiovascular disease with support from GPs.
• Performance for diabetes related indicators was similar to the local and national averages.
• 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. There was a call and recall system in place for chronic disease management which was supported by a designated practice administrator.
• GPs and practice nurses liaised regularly with other services such as the Community Specialist Diabetic nurses for patients needing more specialist input, without the need to go regularly to hospital outpatient appointments. There was also a daily liaison with the district nurses at meetings and via email.
• There was a lead GP for each clinical area for example diabetes, chronic pulmonary obstructive disease and established protocols for management.
• The practice provided access to daily phlebotomy clinics at the practice, including for patients wanting to have blood checks done on behalf of secondary care.

Updated 3 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. Monthly multi-disciplinary meetings took place with the health visitor team. Midwifes and school nurses were also invited and attended when they could.
• Immunisation rates were relatively high for all standard childhood immunisations. Designated baby immunisation clinics were provided which were staffed by two nurses to improve the patient experience.
• The practice’s uptake for the cervical screening programme was 71%, which was lower than the CCG average of 83% and the national average of 82%.
• Appointments were available outside of school hours and the premises were suitable for children and babies. The practice had baby changing facility and was breastfeeding friendly.
• Triple appointments were provided for mother and baby 6 to 8 week check to give enough time for questions and support. The practice provided new baby checks for those not done in hospital and there was an on-site midwife.

Updated 3 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. There was a named GP and usual doctor system in place to provide continuity of care, including for most patients needing home visits.
• The practice was responsive to the needs of older people, and offered home visits and urgent appointments for those with enhanced needs.
• GPs proactively visited a care home with twice weekly ward rounds. CCG data showed this had reduced inappropriate hospital admissions and was valued by the home.
• The practice’s Care Navigator worked from the practice, attended the practice’s multi-disciplinary meetings (MDT) and visited and supported elderly patients with care needs.
• Dementia Screening was offered to those in “at risks” groups and to any patient with concerns about their memory.
• The practice used digital Advanced Care Plans for all care home residents, and those in the community at risk of unplanned admission. Admission avoidance register were held of patients with care plans who were at risk of hospital admission. These plans were regularly reviewed and patients were contacted following their hospital discharge.
• The practice provided influenza vaccines to patients in nursing homes not covered by the District Nurse service.
• GPs liaised with the district nurses and specialist palliative care team when end of life care was provided. Patient receiving end of life care were discussed at the monthly MDT meeting. Regular palliative care meeting also took place with specialist nurses from the local hospice.

Updated 3 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 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. Appointments were pre-bookable on-line as well as ordering of medication and access to patient record for those who want it. The practice had a text message appointment reminder system and facility to cancel appointments.
• The practice provided Saturday morning extended hours surgeries for GP and practice nurse for those working during the week.
• The practice had a virtual Patient Participation Group to allow engagement with those who can’t attend the face to face meetings.

Updated 3 January 2017

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

• 80% of patients with schizophrenia, bipolar affective disorder and other psychoses who have a comprehensive, agreed care plan documented in the record, in the preceding 12 months, which was comparable to the clinical commissioning group (CCG) average of 89% and the national average of 88%.
• 76% of patients diagnosed with dementia had their care reviewed in a face to face meeting in the last 12 months, which was comparable to the CCG average of 85% and to the national average of 84%.
• The practice regularly worked with multi-disciplinary teams in the case management of patients experiencing poor mental health, including those with dementia. Care plans for patients with mental health problems were either developed with their GP or via the adult mental health team.
• 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.
• Staff had a good understanding of how to support patients with mental health needs and dementia.
• The practice provided physical health checks and blood monitoring for those on the mental health register via a call and recall system.
• There was an on-site practice counsellor available to patients via the Talking Space Improving Access to Psychological Therapies (IAPT) service.

Updated 3 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. Monthly multi-disciplinary meetings took place where families with safeguarding concerns, patients needing palliative care and clinical incidents were discussed.
• Continuity of care was provided by usual doctor system which aided those with complex needs or communication issues. Double appointments were offered where it was needed. Physical health checks were offered to those with learning disabilities.
• Health checks for learning disabled patients were offered however, not all of these patients had an annual review and three patients had none.
• 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. Staff training had focussed on relevant areas such as Adult and Child Safeguarding, Domestic Violence, Mental Capacity Act, Female Genital Mutilation.
• One GP had worked with the council to provide extra-long initial appointments with an interpreter to help settle refugees into the practice.
• There was an on-site benefits advisor to help patients with financial and benefit related issues.
• There was also an on-site drugs and alcohol worker, supported by a lead GP for drugs and alcohol.