Archived: Cropredy Surgery

Updated 13 January 2017

Dr JA Wright and Dr B Tucker is more commonly known as Cropredy Surgery and is a GP dispensing practice located in Cropredy in rural north Oxfordshire. Cropredy Surgery is one of the practices within Oxfordshire Clinical Commissioning Group (CCG) and provides general medical services to approximately 3,650 registered patients.

The patient population has been increasing by approximately 50 patients a week as the local health economy changes and Cropredy continues to grow with the development of an 800+ housing development and 249 berth marina.

All services are provided from:

• Cropredy Surgery, Claydon Road, Cropredy, Banbury, Oxfordshire, OX17 1FB.

According to data from the Office for National Statistics, Oxfordshire has high levels of affluence, low incidence of substance misuse and severe mental health problems and low levels of deprivation.

Ethnicity based on demographics collected in the 2011 census shows the population of Cropredy and the surrounding area is predominantly White British.

The practice population has a lower proportion of patients aged below 39 and a higher proportion of patients aged over 40 when compared to the national average. The prevalence of patients with a long standing health condition is 58% compared to the local CCG average of 50% and national average of 54%. This could result in an increased demand for GP services.

The practice population includes patients from the boating and canal community based at the nearby marina, canals and patients from the local farming community.

The practice comprises of two GP Partners (one female and one male) who are supported by a female salaried GP. The all-female nursing team consists of three practice nurses and a health care assistant.

The practice manager and a team of nine reception, administrative and secretarial staff undertake the day to day management and running of Cropredy Surgery.

The practice is open between 8am and 6.30pm Monday to Friday (appointments between 8am and 5.50pm). Each week extended hours for pre-bookable appointments were available every Monday evening until 7.15pm and every Wednesday morning from 7.30am. The dispensary has core opening hours between 9am and 5pm every weekday and GPs frequently dispense acute prescriptions outside of those times.

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 telephone 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 13 January 2017

Letter from the Chief Inspector of General Practice

We carried out an announced comprehensive inspection at Dr JA Wright and Dr B Tucker, more commonly known as Cropredy Surgery in Oxfordshire on 24 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.

• An understanding of the clinical performance and patient satisfaction of the practice was maintained. The practice had reviewed clinical performance and implemented actions to improve. The practice was seeking to improve already high levels of patient satisfaction.

• Feedback from patients relating to access to services and the quality of care was significantly higher when compared with local and national averages. This was collaborated by written and verbal feedback collected during the inspection.

• The practice implemented suggestions for improvements and made changes to the way it delivered services as a consequence of feedback from patients and from the patient participation group.

• The practice had good 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.

• Cropredy Surgery had a clear vision to deliver high quality, patient-centred care and promote good outcomes for patients. The practice had developed clear aims and objectives. These reflected the principle that patients came first, underpinned by a philosophy of providing safe and personalised high quality general practice care.

The area where the provider should make improvement is:

• Continue to review patient outcomes to ensure that patients receive appropriate care and treatment. This would include a review of the system in place to promote completion of dementia care plans in order to increase patient uptake.

Professor Steve Field CBE FRCP FFPH FRCGP

Chief Inspector of General Practice

Updated 13 January 2017

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

• The number of patients registered at Cropredy Surgery with a long-standing health condition was higher than local and national averages. For example, 58% of patients had a long-standing health condition, this was higher than the local CCG average (50%) and national average (54%). This could result in an increased demand for GP services

• Performance for diabetes related indicators showed Cropredy Surgery had achieved 97% 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 13 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.

• Immunisation rates were higher when compared with local averages and 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.

• The practice’s uptake for the cervical screening programme was 84%, which was similar when compared to the CCG average (83%) and the national average (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 13 January 2017

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. Older people at risk of isolation within a rural community were identified and discussed at meetings including multi-disciplinary meetings to address any additional support required.

• Cropredy Surgery was responsive to the needs of older people, and offered home visits and rapid access appointments for those with enhanced needs. The practice identified if patients were also carers; information about support groups was available in the waiting areas.
• 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, Cropredy 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. The practice had achieved 100% of targets which was higher when compared to the CCG average (97%) and the national average (88%).

Updated 13 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.

• Services were flexible, provided choice and ensured continuity of care for example, telephone and email consultations were available for patients who chose to use this service.

• There was a range of appointments including early morning and evening appointments. These appointments were specifically for patients not able to attend outside normal working hours but there were no restrictions to other patients accessing these appointments. Following patient feedback, the practice had amended the times of nurse clinics to increase appointments for this group of patients.
• Online access was promoted within the practice and 51% of the practice population had registered for online access. The practice had utilised online access for over 10 years and was highlighted as a beacon site for online access. On-line booking for appointments and ordering repeat prescription was available for patients’ convenience. The practice website was well designed, clear and simple to use featuring regularly updated information.

Updated 13 January 2017

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

• The practice offered flexible hour long appointments at the end of usual surgery times for patients with complex mental and physical needs.

• 92% 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 similar when compared to the CCG average (91%) and the national average (89%).

• 80% of patients diagnosed with dementia had their care reviewed in a face to face meeting in the last 12 months, which was lower 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. Additional training in recognising and supporting people with dementia had been arranged for December 2016.

Updated 13 January 2017

The practice is rated as outstanding 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, canal community, those with caring commitments and those with a learning disability.

• Cropredy Surgery was actively involved in a research project for domestic abuse. Core areas of this project were training and education, clinical enquiry, care pathways and an enhanced referral pathway to specialist domestic violence services. Initially aimed at women who were experiencing domestic violence this also provides information and signposting for male victims and for perpetrators.

• This service enabled a responsive and personal service for the supply of medicines, including the delivery of medicines to vulnerable, frail and housebound patients. This provided an opportunity for any concerns about patient wellbeing to be fed back to the practice.

• The practice offered longer appointments for patients whose circumstances may make them vulnerable.

• In November 2016, the practice patient population list was 3,650. The practice had identified 83 patients, who were also a carer; this amounted to 2.2% of the practice list.

• The practice regularly worked with other health care professionals in the case management of vulnerable patients.
• 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.