Background to this inspection
Updated
5 March 2018
Alchester Medical Group provides services to approxiamately 20,000 patients fromtwo sites:
• Langford Medical Practice, 9 Nightingale Place, Bicester, Oxon, OX26 6XX
•Victoria House Surgery, 119 Buckingham Road, Bicester, Oxon, OX26 3EU
We visited both sites as part of this inspection.
The practice population is younger than the national average, made up of a higher proportion of children and teenagers, the proportion of over 65 year olds is much lower. The 2011 census shows that 7% of the resident population of the local population is from a Black and Minority Ethnic (BME) groups.
The premises are purpose built and accessible for patients including those with limited mobility.
Victoria House Surgery and Langford Medical Practice merged in 2016 to form Alchester Medical Group. The practice’s registration with CQC continued with the existing Langford Medical Practice, therefore the partnership is not a new registration. During the same time as the merger another local practice closed at short notice and 2,500 patients required registration at Alchester Medical Group. This put the practice under immense pressure to deliver care to all of its patients. Since this time the practice has successfully recruited GPs and nurse to eliminate the need for locum clinical staff. They have reorganised their appointment system and improved services.
The practice has five GP partners and 10 salaried GPs, including females and males. The practice has six female practice nurses and three health care assistants. The GPs and the nursing staff are supported by a team of administration staff who carry out, reception, and other support roles. There is a practice manager in post. The practice opens between 8.00am and 6.30pm on Monday to Friday. Early and later appointments are available in addition to Saturday appointments.
The practice has opted out of providing out-of-hours (OOHs) services to their own patients and refers them to a GP OOHs provider.
Updated
5 March 2018
Letter from the Chief Inspector of General Practice
This practice is rated as Good overall.
At our previous inspection in October 2015 the practice had an overall rating as Good.
Following the January 2018 inspection, the key questions are rated as:
- Are services safe? – Good
- Are services effective? – Good
- Are services caring? – Good
- Are services responsive? – Good
- Are services well-led? - Good
As part of our inspection process, we also look at the quality of care for specific population groups. The population groups are rated as:
- People with long-term conditions – Good
- Families, children and young people – Good
- Working age people (including those recently retired and students – Good
- People whose circumstances may make them vulnerable – Good
- People experiencing poor mental health (including people with dementia) - Good
We carried out an announced comprehensive inspection at Alchester Medical Group in Bicester, Oxfordshire on 16 January 2018. We carried out this inspection under Section 60 of the Health and Social Care Act 2008 as part of our regulatory functions. This inspection was planned to check whether Alchester Medical Group was meeting the legal requirements and regulations associated with the Health and Social Care Act 2008.
At this inspection we found:
- The practice had clear systems to manage risk so that safety incidents were less likely to happen and any notable events either positive or negative were learned from.
- The practice had defined and embedded systems, processes and practices to minimise risks to patient safety.
- Staff had received training appropriate to their roles and the population the practice served. Any further training needs had been identified and planned.
- Our findings showed that systems were in place to ensure that all clinicians were up to date with both National Institute for Health and Care Excellence (NICE) guidelines and other locally agreed guidelines.
- Patients ongoing care needs was assessed, monitored and managed, including planned reviews of their needs.
- We received positive feedback from patients regarding staff, care and treatment.
- There had been significant difficulties with the phone and appointment system for several months following a merger which formed Alchester Medical Group and the closure of a local practice. However, patient feedback had improved significantly during the course of 2017.
- The practice learned lessons from individual concerns and complaints and also from analysis of trends..
- The practice had clear and visible clinical and managerial leadership and supporting governance arrangements.
- There was an open and supportive culture among the staff group.
There were areas the provider should make improvements:
- Continue to improve and review the system for ensuring medicine reviews are completed within set timescales.
Professor Steve Field (CBE FRCP FFPH FRCGP)
Chief Inspector of General Practice
People with long term conditions
Updated
10 December 2015
The practice is rated as good 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. Longer appointments and home visits were available when needed. All these patients had a named GP and a structured annual review to check that their health and medicine needs were being met. For those people with the most complex needs, the named GP worked with relevant health and care professionals to deliver a multidisciplinary package of care.
Families, children and young people
Updated
10 December 2015
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 relatively high 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. Appointments were available outside of school hours and the premises were suitable for children and babies. We saw good examples of joint working with midwives, health visitors and school nurses.
Updated
10 December 2015
The practice is rated as good for the care of older people. Nationally reported data showed that outcomes for patients were good for conditions commonly found in older people. The practice offered proactive, personalised care to meet the needs of the older people in its population and had a range of enhanced services, for example, in dementia and end of life care. It was responsive to the needs of older people, and offered home visits and rapid access appointments for those with enhanced needs.
The dispensary uses medical compartment boxes for a small number of patients and these were hand delivered by practice staff.
Working age people (including those recently retired and students)
Updated
10 December 2015
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 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.
A diabetic clinic is run monthly on Saturday mornings, enabling patients that routinely commute to work away from Bicester, to be seen by the practice staff.
People experiencing poor mental health (including people with dementia)
Updated
10 December 2015
The practice is rated as good for the care of people experiencing poor mental health (including people with dementia). 92.31% of people experiencing poor mental health had received an annual physical health check. The practice regularly worked with multi-disciplinary teams in the case management of people experiencing poor mental health, including those with dementia. It carried out advance care planning for patients with dementia.
The practice had told patients experiencing poor mental health about how to access various support groups and voluntary organisations. It had a system in place to follow up patients who had attended accident and emergency (A&E) where they may have been experiencing poor mental health. Staff had received training on how to care for people with mental health needs and dementia.
People whose circumstances may make them vulnerable
Updated
10 December 2015
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. It had carried out annual health checks for people with a learning disability. It offered longer appointments for people with a learning disability.
The practice regularly worked with multi-disciplinary teams in the case management of vulnerable people. It had told 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.