The Rycote Practice

Updated 12 September 2016

The Rycote Practice is located in a purpose built health centre that is shared with another GP practice. All consulting and treatment rooms are situated on the ground floor and these have been refurbished and redesigned within the last five years. There are bus routes close by and disabled parking bays are provided close to the practice main entrance. The community hospital is next door to the practice and a range of services such as, podiatry and dietician clinics are available to practice patients at the hospital.

There are eight GPs working at the practice. Six are partners and two are salaried they make up 5.64 whole time GPs. Four are male and four female. The practice nursing team consists of two nurse practitioners, four practice nurses and three health care assistants. All are female and are equivalent to 5.6 whole time nurses. The practice has appointed a third nurse practitioner who is due to start later in 2016. The practice manager is supported in the day-to-day delivery of general management functions by a team of six administration and 10 reception staff. All are part time. There are four contracted locum administration staff who cover staff absences when required. The practice is accredited to deliver training for qualified doctors who are seeking to become GPs and placements are offered to medical students.

Approximately 11,600 patients are registered at the practice. Over 20% of the patients are aged over 65 years. The practice provided services via General Medical Services (GMS) contract. (A GMS contract is a contract between NHS England and general practices for delivering general medical services and is the commonest form of GP contract. National data shows that there is minimal income deprivation amongst the registered population. A significant majority of patients have English as their first language. Most are white British. Translation services are available for those patients whose first language is not English but these services are rarely required.

The practice is open between 8am and 6.30pm Monday to Friday. The duty GP covered 6pm to 6.30pm when the out of hours service took over responsibility. Appointments are offered from 8.20am to 11.30am every morning and 2.20pm to 5.50pm daily. The practice is open from 7.15am on both Tuesday and Thursday morning for extended hours clinics with appointments commencing at 7.30am. Both GP and health care assistant (HCA) appointments are available at these early morning clinics. Extended hours appointments are also offered, by GPs and the nurse practitioner, on a Monday evening between 6.30pm and 7.15pm. The practice offers Saturday morning extended hours between 8.30am and 10.30am when a mixture of on the day and pre-bookable appointments are available.

The practice has opted out of providing out of hours services to their patients. The out of hours service is provided by Buckinghamshire Urgent Care and is accessed by calling NHS 111. Advice on how to access the out of hours service is contained in the practice leaflet, on the patient website and on a recorded message when the practice was closed.

All services are provided from:

The Rycote Practice, Thame Health Centre, East Street, Thame, Oxfordshire, OX9 3JZ

Updated 12 September 2016

Letter from the Chief Inspector of General Practice

We carried out an announced comprehensive inspection at The Rycote Practice on 20 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 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 were nine patients registered with the practice who were diagnosed with a learning disability. All these patients had an annual health check in 2014/15 but only three had the same check in 2015/16.

• Two vials of medicine held for emergency use were found to be past their expiry date. These medicines were removed and replaced during the inspection and the practice reinforced their checking procedure.

We saw areas of outstanding practice including:

• The practice had enlisted the support of patients with long term conditions to act as patient teachers for medical students and GPs in training. These patients related their experiences of living with long term conditions to the trainees and students to give them a better understanding of how to treat and care for patients with similar conditions. Other patients with these conditions were able to benefit from the knowledge gained by the students and trainees.

• The practice took a proactive approach to encouraging patients to attend for cancer screening. For example, 97% of eligible patients attended for cervical cytology screening compared to the national average of 82%.

• A visiting counsellor led regular sessions to support the senior leadership team work through the challenges of general practice.

The areas where the provider should make improvements are:

• Ensure patients with a learning disability are supported to access the practice or other services for health checks.

• Ensure reception staff are trained to operate the hearing loop to assist patients who wear a hearing aid.

• Ensure that the practice policy for checking emergency medicines is operated consistently to make sure checks of these medicines are carried out thoroughly

Professor Steve Field (CBE FRCP FFPH FRCGP) 

Chief Inspector of General Practice

Updated 12 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.

• 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. These reviews were scheduled using a recall programme. 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.

• Performance for diabetes related indicators was 90% which was comparable to the clinical commissioning group (CCG) average of 94% and national average of 89%. More patients than the national and local averages attended for checks related to their diabetes.

• Every effort was made to reduce the number of review appointments for patients with more than one long term condition. Recall programmes were kept under review to co-ordinate one recall for this group of patients.

Updated 12 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 patients 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 patients 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 98%, which was significantly higher 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.

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

Updated 12 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 patients in its population.

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

• The GPs undertook a weekly visit to the local care home where fifty patients lived who were registered with the practice.

• Practice nurses visited older patients in their homes to administer their annual flu immunisations.

• The practice worked closely with a local voluntary group to support older patients to maintain independence.

• The practice had worked with other local organisations to set up a website for carers. The website contained additional information about local support organisations.

Updated 12 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.

• 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.

• Extended hours clinics were held on a Monday evening and Tuesday and Thursday mornings in response to patient feedback.

• Saturday morning extended hours clinics included both pre-bookable and walk in appointments.

Updated 12 September 2016

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

• 94% of patients diagnosed with a severe and enduring mental health problem had an agreed care plan in place. This was above the CCG average of 89% and 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.

• The practice offered a dementia screening programme to identify signs of dementia at an early stage. We saw that 35 patients had attended for screening in the last year and 18 had been identified with early onset of the disease. Early intervention to support these patients had been possible.

• Staff had a good understanding of how to support patients with mental health needs and dementia.

• The practice used their mental health and dementia registers to identify patients who may need more flexible access to see the GPs and nurses.

Updated 12 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 carers and those with a learning disability.

• The practice had identified 28 patients whose social circumstances or complex health needs also made them vulnerable. The patients identified were not included on any other patient register. The medical records for these patients carried an alert to identify them as needing either urgent or longer appointments.

• 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.

• There were nine patients registered with the practice who were diagnosed with a learning disability. Three patients had an annual health check in the previous year.