Archived: The Nuffield Practice

Updated 8 November 2016

We undertook an inspection of this practice on 22 August 2016. The practice provides services from Nuffield Health Centre, Witney, Oxfordshire OX28 6JQ.

The Nuffield Practice has a purpose built location with good accessibility to all its consultation rooms. The practice serves 11,700 patients from the surrounding town and villages. The practice demographics show that the population has a higher proportion of patients over 65 compared to the national average and lower prevalence of younger patients. According to national data there is minimal deprivation among the local population. There are patients from minority ethnic backgrounds, but this is a small proportion of the practice population.

• There are five GP partners working at the practice and three salaried GPs (three male and five female). There are three practice nurses, two healthcare assistants and two emergency care practitioners (ECPs). A number of administrative staff and a practice manager support the clinical team.
• There are six whole time equivalent (WTE) GPs, 2.1 WTE nurses 1.1 ECPs and 1.2 WTE healthcare assistant.

• The Nuffield Practice is open between 8am and 6.30pm Monday to Friday. There are no extended hours appointments available.
• The practice is a training practice and is accredited by the University of Oxford Deanery for training doctors in general practice.
• 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.

This is the first inspection of The Nuffield Practice using the CQC comprehensive inspection methodology under regulations that came into force after April 2014.

Updated 8 November 2016

Letter from the Chief Inspector of General Practice

We carried out an announced comprehensive inspection at The Nuffield Practice on 22 August 2016. Overall the practice is rated as good. Our key findings were as follows:

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

• There was a system in place for reporting and recording significant events. Reviews of complaints, incidents and other learning events were thorough.
• Risks to patients were assessed and well managed. However, there were issues with the organisation of emergency medicines.
• Staff assessed patients’ ongoing needs and delivered care in line with current evidence based guidance.
• National data suggested patients received appropriate care for long term conditions.
• The practice planned its services based on the needs and demographic of its patient population.
• Staff were trained in order to provide them with the skills, knowledge and experience to deliver effective care and treatment.
• 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. Improvements were made to the quality of care as a result of complaints and concerns.
• However, feedback from the national GP survey was not fully considered and responded to.
• Patient feedback in CQC comment cards suggested patients felt staff were caring and considerate.
• 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.

We found one area of outstanding practice:

• The practice’s uptake for the cervical screening programme was 92%, which was higher when compared to the national average of 82%.

Areas the provider should make improvements are:

• Ensure all emergency medicines are easily accessible to staff.
• Review the process and levels of exception reporting to ensure as many patients as possible are included in reviews and treatment in line with national guidance.
• Continue to undertake infection control audits in the frequency suggested by national guidance.
• The provider should consider acting on feedback from patients and evaluate poor feedback on waiting times and consultations from the national survey in respect of the processing of such information towards improvement.

Professor Steve Field CBE FRCP FFPH FRCGP

Chief Inspector of General Practice

Updated 8 November 2016

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 had appropriate training.
• Patients at risk of hospital admission were identified as a priority.
• The most recent published results showed the practice was performing well compared to the clinical commissioning group (CCG) averages.
• All these patients were offered 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 multi-disciplinary package of care.

Updated 8 November 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.
• Immunisation rates were similar to average for all standard childhood immunisations.
• Staff explained how they treated children and young people in an age-appropriate way including recognition of their rights to access treatment.
• We saw positive examples of joint working with midwives and health visitors.
• Joint working with external organisations took place in the management of children at risk of abuse.
• The practice’s uptake for the cervical screening programme was 92%, which was much higher than the national average of 82%.
• Private breast feeding and baby changing facilities were available.

Updated 8 November 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 high proportion of older people in its population.
• High chairs had been purchased to make it easier for patients with limited mobility to sit in the waiting room
• GPs offered personalised care to patients in care and nursing homes.
• The premises were accessible for patients with limited mobility and there was a hearing aid loop available for patients with poor hearing.
• Patients over 75 had a named GP.
• Care planning was provided for patients with dementia.

Updated 8 November 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 considered and the practice had adjusted the services it offered enable continuity of care.
• However, feedback regarding appointment waiting times had not been fully considered or acted on. This meant that patients from the working age population may not have had appropriate access to appointments and other services provided by the practice.
• The appointment system was not fully monitored to identify improvements.
• 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.
• Travel vaccines were available.

Updated 8 November 2016

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

• Performance for mental health related indicators was 100% compared to the national average 92% and regional average of 95%.
• The proportion of patients on the mental health register with an up to date care plan in 2015/16 was 93% compared to the regional 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 advanced 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.

Updated 8 November 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 vulnerable patients.
• The practice participated in the enhanced service of offering annual health checks to patients with a learning disability. Eighty four patients had received an annual review. 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.
• Joint working with external organisations took place in the management of patients at risk of abuse or harm.