The Key Medical Practice Also known as Kidlington and Yarnton Medical Group

Updated 24 October 2016

Letter from the Chief Inspector of General Practice

We carried out an announced comprehensive inspection at The Key Medical Practice on 3 February 2015. Overall the practice is rated as good. It requires improvement for providing safe services. The Key Medical Practice was formed when two practices merged in October 2015. As such national data used in this report from 2015 is relevant to the Kidlington Health Centre and does not relate to all patients’ care. Where possible we have used more recent data and experiences of patients in this report.

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.
• Most risks to patients were assessed and well managed.
• Systems to ensure the control of infection and standards of hygiene and cleanliness were not always effective.
• Medicines were managed safely.
• 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.
• There was a system for monitoring patient care and treatment. Some national data indicators suggested improvements were needed in patient care but the practice had identified where and how to make improvements.
• Patients said they were treated with compassion, dignity and respect and they were involved in their care and decisions about their treatment.
• Information about services and how to complain was available and easy to understand.
• Patients said they could make an appointment with a GP but that the phone system had been difficult to use in recent months. The practice had identified this and implemented measures to improve phone access.
• The practice had facilities 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.
• Governance arrangements were in place for non-clinical aspects of the service.
• Training delivery for staff was in the process of being improved. Staff had the skills they needed to deliver care.
• The provider was aware of and complied with the requirements of the Duty of Candour.

The areas where the provider must make improvement are:

• Implement infection control auditing and greater monitoring of hygiene and cleanliness. Implement any infection control guidance not being followed.

The areas where the provider should make improvement are:

• continue to deliver staff training to those members of staff who have not received training in line with the practice’s own programme.
• Implement care plans for mental health patients

Professor Steve Field (CBE FRCP FFPH FRCGP) 

Chief Inspector of General Practice

Updated 10 March 2016

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

• The practice followed guidance in the management of chronic diseases.
• Patients at risk of hospital admission were identified and had care plans written where appropriate.
• The practice achieved 94% on its quality outcomes framework scores in 2015 (QOF is a voluntary monitoring tool which provides indicators for patients care, treatment and outcomes. Exception reporting was low at 3.7%.
• The care of long term conditions was audited to identify where improvements in the management of a specific condition could be made.
• Longer appointments and home visits were available when needed.
• There was a process to offer a structured review to check patients’ health
• 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 10 March 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 people who had a high number of A&E attendances.
• Childhood immunisation rates for the vaccinations given were comparable to CCG averages. Childhood immunisation rates for the vaccinations given to under two year olds were 94% and for three to five year olds they were 84%. This was compared to the overall CCG average of 89%.
• Staff were aware of the circumstances and rights when gaining consent from patients under 16.
• Baby changing facilities were available but these were located away from patient accessible areas. They were not clearly signed.
• GPs worked with midwives and health visitors in the provision of care.

Updated 10 March 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 patients in its population.
• Care plans were available for patients deemed at high risk of unplanned admissions.
• There was access for patients with limited mobility.
• There were named GPs for this group of patients.
• Screening for conditions which patients in this population group may be at risk of was provided, such as dementia.

Updated 10 March 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 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 were extended hours appointments available which had been tailored to patient demand.

• Patient feedback on the availability of appointments from the national survey was positive but this was based on survey data prior to the merger of the two practices. Changes had been made to the telephone system and reception staff numbers in response to patient feedback on the appointment system.

• Phone consultations were offered to patients.

• Online appointment booking was available.

Updated 10 March 2016

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

• Performance for mental health related indicators was lower than national averages. This had been identified and there was a plan to improve processes for delivering care to patients with mental health difficulties.

• Out of 81 patients eligible for a mental health care plan 40 had been provided with one. There was a new care plan template being implemented.
• During 2014/2015, there were 204 patients offered assessments for dementia.

• The practice regularly worked with multi-disciplinary teams in the case management of patients experiencing poor mental health, including those with dementia.

Updated 10 March 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 those with a learning disability.
• The practice offered longer appointments for vulnerable patients.
• GPs regularly worked with multi-disciplinary teams 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.