St Clement's Surgery

Updated 14 December 2016

St Clement’s Surgery is a GP training practice located in a purpose built building which was renovated in 1991, in an area on the outskirts of Oxford city centre. St Clement’s Surgery is one of the practices within Oxfordshire Clinical Commissioning Group (CCG) and provides general medical services to approximately 4,700 registered patients. A CCG is a group of general practices that work together to plan and design local health services in England. They do this by 'commissioning' or buying health and care services.

All services are provided from one site:

• St Clement’s Surgery, 39 Temple Street, Oxford, Oxfordshire OX4 1JS.

The practice population continues to grow; (it increased by 10% in the last 12 months. There is a significantly higher proportion of patients aged between 15-34 due to registering high numbers of university students (attending the local universities and colleges) and significantly lower numbers of older patients when compared with national averages. The student population includes high numbers of students from various different countries which creates a transient patient population; patients are often outside of the country for long periods specifically when some students return home between periods of study and exams. This has an impact on screening and recall programmes.

The prevalence of patients with a long standing health condition is 36% compared to the local CCG average of 50% and national average of 54%.

Ethnicity based on demographics collected in the 2011 census shows there is ethnic diversity, especially in the student population the practice served. Although Oxford city centre is an area with low instances of social and economic deprivation, St Clement’s Surgery sits within a pocket of deprivation which includes increased levels of addiction (drug and alcohol) alongside higher levels of patients experiencing poor mental health conditions.

St Clement’s Surgery also provides primary care GP services for a local nursing and residential home (approximately 60 patients) and students at one of colleges within Oxford University and students at a private international boarding school.

The practice comprises of two GP Partners (one female and one male) who are supported by two salaried GPs (one female and one male), one female GP Registrar and one male FY2 Doctor. St Clement’s Surgery is a training practice for GP Registrars and FY2 Doctors. GP Registrars are qualified doctors who undertake additional training to gain experience and higher qualifications in general practice and family medicine. FY2 Doctors are Foundation Year 2 Doctors, they are 2 years qualified and complete placements within General Practice as part of their training programme. There is also an in house practice counsellor who runs a weekly clinic, improving access and speed of appointments for patients with mental health issues.

The all-female nursing team consists of two practice nurses, one locum nurse prescriber and a health care assistant who also performs phlebotomy duties.

The practice manager (currently away from the practice) is supported by an interim practice manager and a team of reception, administrative and secretarial staff who undertake the day to day management and running of St Clement’s Surgery.

St Clement’s Surgery is open between 8.20am and 6pm Monday to Friday (appointments between 8.45am and 5.30pm). In agreement with the CCG the out-of-hours service provide a message handling service between the hours of 8am and 8.20am and 6pm and 6.30pm. Each week extended hours for pre-bookable appointments were available every Tuesday morning between 7am-7.45am and every Tuesday evening between 6.30pm – 8pm.

The practice has opted out of providing the out-of-hours service. This service is provided by the out-of-hours service accessed via the NHS 111 service. Advice on how to access the out-of-hours service is clearly displayed on the practice website, on both practices door and over the telephone when the surgery is closed.

Updated 14 December 2016

Letter from the Chief Inspector of General Practice

We carried out an announced comprehensive inspection at St Clement’s Surgery in Oxford on 10 November 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.

• Staff understood and fulfilled their responsibilities to raise concerns and report incidents and near misses. All opportunities for learning from internal and external incidents were maximised.

• Staff assessed patients’ needs and delivered care in line with current evidence based guidance. Staff had the skills, knowledge and experience to deliver effective care and treatment.

• The practice worked closely with other organisations and with the local community in planning how services were provided to ensure that they meet patients’ needs. For example, as a member of OxFed (Oxford Federation for General Practice and Primary Care), St Clement’s Surgery utilised an OxFed pilot project and accessed local Care Navigators, who coordinated support for the most vulnerable patients and liaised with GPs, families and carers to ensure care was proactive.

• The practice had adapted and accessible facilities and was well equipped to treat patients and meet their needs.

• The practice actively reviewed complaints and how they are managed and responded to, and made improvements as a result.

The areas where the provider should make improvement are:

• Continue to complete retrospective reviews of all national safety and medicines alerts ensuring appropriate action is taken in relation to the care and treatment of patients.

• Ensure that the practice engages with patients whilst reviewing the outcomes of the July 2016 national GP patient survey to determine appropriate action. Notably, improve patient satisfaction for aspects of care provided by the nursing team and the overall patient experience.

• Ensure appropriate arrangements are put in place to assess, monitor and mitigate the risks relating to the health, safety and welfare of service users arising from low uptake of cancer screening programmes. Also ensuring the risks to service users with a learning disability are assessed with a view to increasing uptake of annual health checks.

Professor Steve Field CBE FRCP FFPH FRCGP

Chief Inspector of General Practice

Updated 14 December 2016

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

• The number of patients registered at St Clement’s Surgery with a long-standing health condition was significantly lower than local and national averages. For example, 36% of patients had a long-standing health condition, this was lower than the local CCG average (50%) and national average (54%).

• Performance for diabetes related indicators showed St Clement’s Surgery had achieved 94% of targets which was similar when compared to the CCG average (95%) and higher when compared to the national average (90%).

• Performance for Chronic Obstructive Pulmonary Disease (known as COPD, a collection of lung diseases including chronic bronchitis and emphysema) indicators showed the practice had achieved 100% of targets which was similar when compared to the CCG average (98%) and higher when compared to the national average (96%).
• Longer appointments and home visits were available when needed.

Updated 14 December 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 lower when compared with local averages and higher when compared to national averages 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.

• St Clement’s Surgery Patient Participation Group (PPG) was the first PPG within Oxford to include children into the group. We saw the practice implemented children’s suggestions, for example a children’s comment book to capture younger patient’s opinions, this book was called ‘young views’.

• The practice’s uptake for the cervical screening programme was 73%, which was lower when compared to the CCG average (82%) and the national average (81%).

• 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.

Updated 14 December 2016

The practice is rated as good for the care of older patients.

• The practice offered proactive, personalised care to meet the needs of the older people in its population.

• St Clement’s Surgery was responsive to the needs of older people, and offered home visits and rapid access appointments for those with enhanced needs.

• The practice provided GP services to a local nursing and residential home. This included weekly ward rounds. There were regular GP sessions at the home to review patients with non-urgent health problems. The time was also used to proactively identify and manage any emerging health issues and undertake medication reviews.
• Nationally reported data showed that outcomes for patients for conditions commonly found in older patients were higher when compared with local and national averages. For example, St Clement’s Surgery performance for osteoporosis (osteoporosis is a condition that weakens bones, making them fragile and more likely to break) indicators was higher than both the local and national averages. In 2015/16, the practice had achieved 100% of osteoporosis targets which was higher when compared to the CCG average (97%) and the national average (88%).

Updated 14 December 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 the very high numbers of students had been identified and the practice had adjusted the services it offered to ensure these were accessible, flexible and offered continuity of care.

• Visits to local University colleges took place to enable new students to register at the practice and also provide them with information about NHS services. Students were also offered face to face registration, checking and updating any immunisations required and reviewing of medical histories during their first week at university.

• St Clement’s Surgery provided primary care GP services for students at one of the colleges within Oxford University. We saw the practice actively supported patients to live healthier sex lives, provide sexual health advice, offer chlamydia screening kits and recently supported the college in facilitating a chlamydia awareness and screening event called ‘chlamydia and cookies’. In the last 12 months, 91 patients had a chlamydia test via St Clement’s Surgery, this represented 8% of patients eligible for chlamydia tests overall, which was the top performing practice when compared to the other GP practices in the CCG which provided GP services for students at the colleges within Oxford University.
• There was a range of appointments including early morning, evening and telephone consultations available for patients. Online appointments can also be booked for appointments with GPs, the practice nurse and health care assistant.

Updated 14 December 2016

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

• 98% of people experiencing poor mental health had a comprehensive care plan documented in their record, in the preceding 12 months, agreed between individuals, their family and/or carers as appropriate. This was higher when compared to the CCG average (91%) and the national average (89%).

• 91% of patients diagnosed with dementia had their care reviewed in a face to face meeting in the last 12 months, which was higher when compared to the local CCG average (87%) and the national average (84%).

• The practice regularly worked with multi-disciplinary teams in the case management of patients experiencing poor mental health, including those 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 had an in-house practice counsellor who ran a weekly clinic, which improved access and speed of appointments for patients with mental health issues. This was a busy service, especially around university exam and subsequent results.

Updated 14 December 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, those with caring commitments and those with a learning disability.

• The practice offered longer appointments (double appointments, 20 minutes in length) for vulnerable patients and patients with a learning disability.

• We saw there was written information available to direct carers to the various avenues of support available to them. This included information for young carers which aligned with the practice populations significantly higher proportion of patients aged between 15-34.

• The practice regularly worked with other health care professionals in the case management of vulnerable patients, including a monthly meeting with the district and palliative care nurses. The practice employed a colour coded prioritisation system that identified the requirements and specific needs of the patients to ensure each patient received the most appropriate care and treatment.
• 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.