Woodlands Surgery

Updated 8 August 2017

Woodlands Surgery is a GP practice located in Banbury in north Oxfordshire offering general medical services to approximately 7,000 patients in the Banbury area. Woodlands Surgery is one of the practices within Oxfordshire Clinical Commissioning Group (CCG). 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.

According to data from the Office for National Statistics, Oxfordshire has minimal economic deprivation. However, the practice provides GP services within the highest area of deprivation within Oxfordshire. The age distribution of the registered patients is largely similar to the national averages, although there is a slightly lower than average number of patients aged between 20 and 29 years of age. Ethnicity based on demographics collected in the 2011 census shows the population of Banbury and the surrounding area is predominantly White British with 5.7% of the population composed of people with an Asian background and 1.4% of the population composed of people with a Black background.

The practice has three GP partners (one male and two female), one long term locum GP, two practice nurses (all female) and one health care assistant (female). The clinical staff are supported by a practice manager, 10 receptionists, administration staff and a receptionist team leader.

Woodlands Surgery is a two storey building with easy access for disabled patients. The entrance has wide doors, with a bell for those requiring assistance and all consultation and treatment rooms are accessible. The reception area is clearly signed and is within the waiting area. There are toilet facilities available including disabled access with wide doorways.

The opening hours at Woodlands are:

• Mondays to Friday between 8am and 6.30pm.
• Late Monday until 8pm

Woodlands Surgery operates with a General Medical Services contract. They offer enhanced services for childhood immunisations, influenza and pneumococcal immunisations.

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.

All services are provided from:

Woodlands Surgery, 4 Burchester Place, Banbury, Oxfordshire, OX16 3WT

Updated 8 August 2017

Letter from the Chief Inspector of General Practice

At our previous comprehensive inspection at Woodlands Surgery in Banbury, Oxfordshire on 16 November 2016 we found a breach of regulation relating to the provision of effective services. The overall rating for the practice was good. Specifically, the practice was rated requires improvement for the provision of effective services and good for the provision of safe, caring, responsive and well-led services. The full comprehensive report on the November 2016 inspection can be found by selecting the ‘all reports’ link for Woodlands Surgery on our website at www.cqc.org.uk.

This inspection was a desk-based review carried out on 27 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 in November 2016. This report covers our findings in relation to those requirements and also additional improvements made since our last inspection.

We found the practice had made improvements since our last inspection. Using information provided by the practice we found the practice was now 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.

Our key findings were as follows:

• Understanding of the Mental Capacity Act 2005 had been addressed. All staff had undertaken training and had then been assessed by the trainer at a future session to evidence understanding.
• All staff had an appraisal within the last 12 months to ensure learning needs were identified.
• The practice had implemented systems to improve the uptake of learning disability health checks. This included more patient engagement and contacting patients to encourage uptake.
• The practice had implemented systems to improve the uptake of bowel and breast screening.
• Patient satisfaction has increased regarding GPs treating patients with care and concern. Satisfaction had increased by 7%, from 74% to 81%, over the last 12 months.

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 lead GP and nursing staff had lead roles in chronic disease management and patients at risk of hospital admission were identified as a priority.
• Performance for diabetes related indicators was 92% which was comparable to the clinical commissioning group (CCG) average of 95% and national average of 94%.
• Longer appointments and home visits were available when needed.
• All these patients had a structured annual review to check their health and medicines needs were being met. For those patients with the most complex needs, the lead GP worked with relevant health and care professionals to deliver a multidisciplinary package of care.
• The practice participates in the clinical commissioning group complex case management scheme which provides proactive care for those at highest risk of emergency admission.
• Long term condition review clinics were held by the practice nurses. The nurses were trained in management of chronic obstructive pulmonary disease, cardiovascular disease, asthma and diabetes.
• Performance for chronic obstructive pulmonary disease (COPD, a collection of lung diseases including chronic bronchitis and emphysema) indicators showed the practice had achieved 100% of targets which was above the CCG average (98%) and the national average (96%).

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.
• Woodlands Surgery sent a new baby card to new parents that included further information on the new baby check and vaccinations.
• The practice was fully involved with safeguarding procedures. They held regular meetings with health visitors to discuss vulnerable children and families, and those on the safeguarding register.
• Safeguarding is an agenda item on the weekly clinical meeting and referrals made to, or received by the multi-agency safeguarding hub are discussed.
• Childhood immunisation rates for the vaccinations given were comparable to the CCG average. For example, childhood immunisation rates for the vaccinations given to under two year olds ranged from 93% to 99% compared to the CCG range of 95% to 97% and five year olds from 93% to 97% compared to the CCG range of 92% to 97%.
• Patients told us that children and young people were treated in an age-appropriate way and were recognised as individuals.
• Appointments were available outside of school hours and the premises were suitable for children and babies. The practice offered after school appointments and would see young people without their parents if deemed appropriate.
• We saw positive examples of joint working with midwives, health visitors and school nurses.
• The practice provides a range of in-house contraceptive, maternity and child health services.
• Woodlands Surgery had a young people’s noticeboard in the waiting area.

Updated 13 January 2017

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

• 100% of patients diagnosed with dementia that had their care reviewed in a face to face meeting in the last 12 months, which is comparable to the local average of 99% and the national average of 96%.
• The practice offered proactive, personalised care to meet the needs of the older people in its population.
• The practice is part of a local GP federation urgent care service and a hospital at home service to avoid unplanned hospital admissions.
• The practice was responsive to the needs of older people, and offered home visits and urgent appointments for those with enhanced needs.
• The practice worked with multi-disciplinary teams in the care of older vulnerable patients.
• Nationally reported data showed that outcomes for patients for conditions commonly found in older people were in line with local and national averages. For example, 100% of patients aged between 50 and 74 with a fragility fracture and confirmed diagnosis of osteoporosis, were currently treated with an appropriate bone-sparing agent. This was higher when compared to the local clinical commissioning group average (97%) and national average (88%).
• Woodlands Surgery undertook proactive vaccination campaigns, including a drop-in flu clinic.

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.
• The surgery offered extended pre-bookable appointments every week.
• The practice was proactive in offering online services for repeat prescriptions as well as a full range of health promotion and screening that reflects the needs for this age group.
• The practice used IT to improve access for patients. Including online appointment booking and automated 24 hour telephone cancellation of appointments. Text reminders were used to encourage attendance at appointments and to remind patients of services such as flu clinics.
• The practice’s uptake for the cervical screening programme was 97%, which was above the CCG average of 83% and the national average of 82%, with exception reporting at 3% (CCG 7% and national average 7%).

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 had a dedicated GP lead for mental health and dementia.
• 96% of patients with a severe mental health issue who had a comprehensive, agreed care plan documented in the last 12 months, which was above the local average of 92% and the 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.
• Proactive dementia screening was undertaken for at risk patients.
• 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. However, understanding of Mental Capacity Act 2005 required improvement.
• The administration team regularly recall patients for mental health checks and offer reminder calls on the day of appointment for those with dementia.

Updated 13 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 including homeless people, travellers and those with a learning disability.
• The practice offered longer appointments for patients with a learning disability.
• An audit had been completed to highlight areas of development with uptake of learning disability health checks.
• The practice have appointed a patient liaison officer to provide emotional support to vulnerable patients and to improve the uptake of learning disability health checks. The number of health checks undertaken was 30%, which is below the national average of 44%.
• Practice staff were trained to recognise signs of abuse within their vulnerable patients.
• GPs worked within a multi-disciplinary team to ensure the best outcomes for vulnerable patients.
• 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. The practice hosts on-site substance misuse services.
• 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.