Dr Arthur & Partners Also known as Church Street Practice

Updated 2 March 2017

Dr Arthur and Partners is based at Church Street Practice, Wantage, Oxfordshire OX12 9BN. The practice has level access from the car park and to all treatment rooms. It has a clinical team of a senior partner, five GP partners, two salaried GPs, one registrar, one locum, an emergency care practitioner, a senior healthcare assistant (HCA), three HCAs, a nurse manager, an advanced nurse practitioner, nurse prescriber and three practice nurses. Seven doctors were female and three doctors were male. The non-clinical team consists of a practice manager, an information manager, a reception manager, a deputy reception manager, five receptionists, four prescription team administrators, a medical secretary and a finance assistant.

The practice is readily accessible for people who use wheelchairs and by parents with pushchairs. A portable hearing loop system is available and there are quiet waiting facilities for patients who find the main waiting area can cause anxiety. Private space is available for breast-feeding. Patients can check-in using a self-service kiosk, which provides instructions in several languages.

The practice services a patient list of 13,600 and is in an area of very low deprivation. Of the patient list, 52% are living with a long-term condition and 70% are in paid employment or full time education.

This is a teaching and training practice, including for foundation level and specialty trainee doctors, medical students from two universities and student nurses.

Appointments are from 8am to 8pm on Mondays and 8am to 6.30pm Tuesdays to Fridays. Appointments were available on one Saturday per month from 8am to 11am and late appointments were offered until 8pm on some Wednesdays. Out of hours patients were directed to use the NHS 111 service.

We had not previously carried out an inspection at this practice.

Updated 2 March 2017

Letter from the Chief Inspector of General Practice

We carried out an announced comprehensive inspection at Dr Arthur and Partners on 26 October 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. This was shared with all staff who demonstrated a detailed knowledge of learning from previous events.
• Risks to patients were assessed and well managed through good emergency planning strategies and staff training. The practice was proactive in responding to risks outside of the building, such as in the provision of emergency grab bags for road accidents following a number of incidents.

• 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 and this was regularly assessed with a programme of audits.
• Patients said they were treated with compassion, dignity and respect and they were involved in their care and decisions about their treatment. A highly active patient participation group encouraged involvement from patients.
• 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 and additional capacity provided by an emergency care practitioner.
• 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 was significant, seamless provision for patients at the end of their life through a robust palliative care programme. This included multidisciplinary team coordination, home visits, regular meetings and a review of every patient death to ensure every effort was made to ensure patients died in their preferred location. In addition, staff sent a bereavement support letter to carers on the first anniversary of a death with details of how to obtain extra support if needed.

We also saw areas of outstanding practice:

• Staff demonstrated consistent attention to detail and embed and maintain individualised care. This included a home visit to support a patient to use the online booking system and matching appointment times to the local bus timetable for patients who relied on it for transport.
• The practice proactively engaged with the local community to provide additional services and opportunities for patients. This included devising an introductory programme to primary care for students applying to university and opportunistic health checks offered in a local supermarket. The patient information group had successfully organised a health and wellbeing event that attracted 25 local services or organisations to help improve health promotion and reduce social isolation, which received praise from the town’s mayor.
• The practice worked with the clinical commissioning group and community service providers to support homeless and refugee patients. This included providing staff with specialist safeguarding training and updating patient protection policies.

Professor Steve Field (CBE FRCP FFPH FRCGP) 

Chief Inspector of General Practice

Updated 2 March 2017

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

• Practice nurse prescribers and supervised healthcare assistants had lead roles in chronic disease management and patients at risk of hospital admission were identified as a priority.
• A nurse-led diabetic service was offered with insulin conversion support on a weekly basis. Nurses provided this service in accordance with the latest treatment advice, which they maintained through attendance at quarterly diabetes forums.
• Specialist practice nurses and trained healthcare assistants visited housebound patients with long term conditions.
• A recall system was in place to identify patients with multiple conditions or complex needs and worked to reduce the need for multiple attendances.
• Longer appointments and home visits were available when needed.
• All patients with a long term condition 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 2 March 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, including children on a child protection register and adolescents who presented with intoxication or sexual health risks.

• Immunisation rates were high for all standard childhood immunisations and the practice performed at 100% for all childhood immunisations for those 12 months old or under. In addition, the uptake of the flu vaccine for children aged two to four years was significantly higher than the national average, at 78% compared to 34%.
• Patients provided good feedback about how well the practice managed the care of children and were positive about urgent and emergency care.
• Appointments were available outside of school hours and the premises were suitable for children and babies. Flu clinics and asthma clinics were offered after school hours and on one Saturday morning per month in response to demand.
• We saw positive examples of joint working with midwives, health visitors and school nurses.
• The practice demonstrated high uptake of adult immunisation programmes. For example, uptake of the teenage meningitis vaccines in 2015 was 61%, compared with the national average of 34%.
• The child safeguarding lead met formally with health visitors every three months and liaised proactively on a case by case basis.
• Reception staff were trained in ensuring teenagers had appropriate access to appointments for emergency contraception and the practice performed better than the national average for Chlamydia screening.

Updated 2 March 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. Staff recognised the challenges of providing continuity of care to a population disproportionately represented by older people.
• The practice was responsive to the needs of older people, and offered home visits and urgent appointments for those with enhanced needs, including rapid telephone triage where appropriate.
• Support was provided for carers and family members after a bereavement, including support to access counselling and a support letter on the first anniversary of a death.
• Scheduled weekly surgeries took place in local care homes and nursing homes and home visits were coordinated between GPs, district nurses and practice nurses.
• The emergency care practitioner offered a daily visiting service and was able to refer patients to a local emergency medical unit.
• GPs used a telemedicine system to liaise with secondary care providers for the management of ulcers amongst frail patients, which reduced the need for hospital attendance.

Updated 2 March 2017

The practice is rated as good for the care of working age people.

• 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. This included early, late and Saturday appointments with healthcare assistants, nurses and GPs.
• The practice was proactive in offering online services as well as a full range of health promotion and online repeat prescription requests. In addition, patients who commuted for work were able to coordinate care and treatment in a way that suited them, including by e-mail and through the use of telemedicine.
• A nurse provided a triage service for travel vaccine requests and could provide travel clinics on-demand.
• The clinical skill mix covered a range of specialty areas, including women’s health, ear, nose and throat and dermatology.

Updated 2 March 2017

The practice is rated as good for the care of people experiencing poor mental health.

• 86% of patients diagnosed with dementia who had their care reviewed in a face to face meeting in the last 12 months, which is better than the national average of 84% and better than the clinical commissioning group average of 85%.
• 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 and proactively sought to improve care for patients through pilot schemes and research.
• 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 and attended training specific to their role.

Updated 2 March 2017

The practice is rated as good for the care of people whose circumstances make them vulnerable.

• The practice had policies for the care and treatment of patients living in vulnerable circumstances including homeless people, refugees and those with a learning disability.
• The practice offered longer appointments for patients with a learning disability and letters sent to patients with a learning disability were printed in a font and style of language each patient could understand.
• The practice informed vulnerable patients about how to access various support groups and voluntary organisations and the patient involvement group actively facilitated this.
• 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. The practice had registered refugee families and homeless patients and was able to provide individualised care based on their specific needs.
• The practice prioritised vulnerable patients and staff ensured they were seen if they attended without an appointment.
• Anticipatory care plans were used to provide care for patients at an increased risk of hospital admission or who were expected to need palliative care in the future.