Bicester Health Centre

Updated 4 October 2016

Dr G C Moncrieff and Partners is more commonly known as Bicester Health Centre and is located in Bicester, north-east Oxfordshire. Bicester Health Centre is a dispensing practice within Oxfordshire Clinical Commissioning Group and provides personal medical services to approximately 13,000 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:

• Bicester Health Centre, Coker Close, Bicester, Oxfordshire, OX26 6AT.

According to data from the Office for National Statistics, Oxfordshire has a high level of affluence and minimal economic deprivation.

The age distribution of the registered patients is largely similar to the national averages. Although there is a slightly higher than average number of patients aged between 25 and 39 years of age.

The patient population is increasing by approximately 100 patients a week as the local health economy changes and Bicester continues to grow and develop.

Ethnicity based on demographics collected in the 2011 census shows the population of Bicester and the surrounding area is predominantly White British with 3% of the population composed of people with an Asian background and 1% of the population composed of people with a Black background. In addition, Bicester has a growing Eastern European community; this is reflected in the patient population list as there is a growing number of Polish and Romanian patients registered with Bicester Health Centre.

The practice provides GP services to a local care home (approximately 42 registered patients) and the local 12 bed community hospital.

Bicester Health Centre comprises of six GP Partners (two female and four male) and two salaried GPs (both female) who are supported by two long term locum GPs (both male). The practice is a training practice for GP Registrars. GP Registrars are qualified doctors who undertake additional training to gain experience and higher qualifications in general practice and family medicine.

The all-female nursing team consists of a nurse practitioner, three practice nurses, one assistant practitioner and two health care assistants who also fulfil phlebotomist duties.

The practice manager is supported by a team of reception, administrative and secretarial staff who undertake the day to day management and running of Bicester Health Centre.

One of the GPs is the designated dispensary lead and the dispensary team consists of five dispensers, two of whom also fulfil reception duties. The dispensary dispenses to approximately 2,800 patients.

The practice had core opening hours between 8am and 6.30pm Monday to Friday with appointments available from 8.20am to 6.30pm daily. Extended hours were available for routine pre-bookable appointments every Monday between 6.30pm and 8pm and every Tuesday between 7am and 8am. The dispensary has core opening hours between 8.30am and 1pm and 4pm and 6pm every weekday.

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 the practice door and over the telephone when the surgery is closed.

Updated 4 October 2016

Letter from the Chief Inspector of General Practice

We carried out an announced comprehensive inspection at Dr G C Moncrieff and Partners, more commonly known as Bicester Health Centre in Bicester, Oxfordshire on 10 August 2016. The practice is rated as outstanding for the care and treatment of one population group – people with long-term conditions and overall Bicester Health Centre is rated as good. 

Our key findings across all the areas we inspected were as follows:

• 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.

• 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.

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

• The continued development of staff skills, competence and knowledge was recognised as integral to ensuring high-quality care. We saw evidence and staff we spoke with told us they are supported to acquire new skills and share best practice.

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

• High standards were promoted and owned by all practice staff with evidence of team working across all roles.

• We observed the practice proactively sought feedback from staff and patients, which it acted on.

• The practice had a clear vision which had quality and safety as its top priority. The strategy to deliver this vision was regularly reviewed and discussed with staff.
• The leadership at Bicester Health Centre drove continuous improvement and staff were accountable for delivering change. There was a clear proactive approach to seek out and embed new ways of providing care and treatment.

We saw areas of outstanding practice including:

• The continued development of Bicester Health Centre staff skills, competence and knowledge was recognised as integral to ensuring high-quality care. We saw evidence and staff we spoke with told us they are supported to acquire new skills and share best practice. There was designated time every Friday for staff members to complete training, this included a weekly “lunch and learn” forum to complete training and individual role specific work books which proactively managed future training.

• There was a clear proactive approach to seeking and embedding the provision of new strategies in the delivery of care and treatment. The practice team was forward thinking and proud to be initiators of many pilot schemes to improve outcomes for patients in the area.

Professor Steve Field CBE FRCP FFPH FRCGP

Chief Inspector of General Practice

Updated 4 October 2016

The practice is rated as outstanding 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.

• The nurse practitioner and one of the GPs had a special interest and further qualifications in the management of diabetes. We saw evidence of comprehensive diabetes care for over 500 diabetic patients. There were detailed diabetic care plans, innovative initiation programmes of new diabetic therapies, in-house insulin initiation, email service diabetes dialogue with the Oxford Centre for Diabetes, Endocrinology and Metabolism (OCDEM). The nurse specialising in diabetes was active in the Oxford diabetes nurse forum. Performance for diabetes related indicators showed the practice had achieved 100% of targets which was higher when compared to the CCG average (94%) and similar when compared to the national average (89%).

• 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 (99%) and higher when compared to the national average (96%).

• Bicester Health Centre supported a number of clinical National Institute of Clinical Research (NIHR) portfolio studies with an aim of supporting patients to live healthier lives. We saw two current studies relating to obesity. There had been several success stories including a diabetic patient who had lost a significant amount of weight and as a result managed to halve their medicine used to manage their diabetes.
• Longer appointments and home visits were available when needed.

Updated 4 October 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 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 83%, 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, health visitors and school nurses.

Updated 4 October 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 people in its population.

• Bicester Health Centre was responsive to the needs of older patients, 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.

• Bicester Health Centre provided GP services to a local care home; a designated GP provided GP services to 42 of the 43 care home residents which included a weekly ward round. Feedback from the care home praised the designated GP and said the service they received was professional and empathic and they were very happy with the GP service they receive.

• The practice worked with the multi-disciplinary teams in the care of older vulnerable patients.
• All of 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, Bicester Health Centres 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 (81%).

Updated 4 October 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 appointment system was flexible, it was continually reviewed and changes were made accordingly to meet patient demand in a changing local health economy.

• 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. There was an increasing contact from patients by email. They had identified a lead role within the practice to encourage and enable patients to use on-line services.

• Bicester Health Centre had core opening hours between 8am and 6.30pm Monday to Friday with appointments available from 8.20am to 6.30pm daily. Extended hours were available for routine pre-bookable appointments every Monday between 6.30pm and 8pm and every Tuesday between 7am and 8am. The dispensary dispensed to approximately 2,800 patients and had core opening hours between 8.30am and 1pm and 4pm and 6pm every weekday.
• Phlebotomy services were available at the practice which meant patients did not have to attend the hospital for blood tests.

Updated 4 October 2016

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

All the quality indicators relating to mental health were higher than the local and national averages with very low exception rates. For example:

• 93% of patients 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 better when compared to the CCG average (89%) and national average (88%).

• 93% of patients experiencing poor mental health have had a record of blood pressure in the preceding 12 months. This was better when compared to the CCG average (89%) and national average (90%).

• 91% of people 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 (85%) and higher than 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.

Updated 4 October 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 and those with a learning disability.

• The practice offered longer appointments for patients with a learning disability. There was an action plan which included an accelerated recall programme due to commence in September 2016 to increase the number of learning disability patients having an annual health check.

• The practice provided GP services to a local 12 bed community hospital. The community hospital provided inpatient rehabilitation and palliative care for patients no longer requiring acute care. The designated GP undertook daily visits to the community hospital with a formal ward round every Wednesday where every patient was reviewed and their care plan updated. Contact details of the designated GP were shared with the relevant staff, patients and their families, enabling continuity of care and quick access to the right staff at the practice.

• 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.