Principal Medical Limited Registered Office

Updated 31 May 2017

Principal Medical Limited is a GP federation providing specific services for the majority of GP practices in Oxfordshire and also South Northamptonshire. It has been owned by GPs since being created in 2004 and run by a variety of clinical and non-clinical staff. They deliver services directly as well as sub-contracting services to GP practices. All the staff who deliver services for Principal Medical Limited are employed. In addition there are regular locum GPs used when required on the neighbourhood access hubs. Approximately 70% of GP providers in Oxfordshire and 30% in Northamptonshire are affiliated in terms of federated or shared services with Principal Medical Limited. This means they use the provider for delivering aspects of their patients care.

Principal Medical Limited provides the following services directly to patients registered with GP practices:

• The Primary Care Visiting Service provides care to patients registered at GP practices in Oxfordshire and Northamptonshire who benefit from early home visits from specifically trained staff. These were provided during normal working hours. The staff who work on the service can provide assessments of patients’ needs, diagnose problems which may require other professional care or treatment or provide care directly to those patients. Of these patients 90% are aged 65 and over with the largest proportion aged between 86 and 90 years. There are approximately five whole time equivalent (WTE) staff providing care on this service.
• Those patients who use the hospital at home service receive a variety of support, primarily from nursing staff but, also assistant practitioners (staff with a healthcare diploma) and support workers. The patients could access care such as dressing changes, intravenous medicines and support with care planning. Of these patients, 86% are aged 65 and over with the largest proportion aged between 86 and 90 years. There are eight whole time equivalent staff providing care in this part of the service. There were 5.4 WTE clinical staff including nurses and 2.2 WTE care assistant and support workers providing care on this service. The provider takes responsibility for the provision of care they provide but the overall duty of care to patients remains with their GP practice and any other services responsible for their ongoing needs.

• The primary care hubs (neighbourhood access hubs) provide GP and nurse appointments to support GP providers and patients across Oxfordshire. The hubs are provided in Witney, Banbury and Bicester. Any patient registered with a GP practice within these areas can access the hubs through working agreements between the practices and Principal Medical Limited. The opening times vary across these sites but the service is available in Oxfordshire from 8am to 8pm seven days a week. GPs and nurses are employed across various times to support the service.

The provider also supports general practice with various other services including counselling, a collaborative care team and public health services. These services are either sub-contracted directly to GP practices, who are responsible for delivering and monitoring these services or are out of scope of CQC regulated activities. Where sub-contracting arrangements occur practices are solely responsible for the provision and monitoring of this service Therefore these services have not been included in this inspection.

• The collaborative care team supports patients who are in need of specific care planning including social interventions such as adaptions in their homes. These patients can be compromised by social isolation, long term conditions and disabilities. Of these patients 90% are aged 65 and over with the largest proportion aged between 86 and 90. There are 3.5 whole time equivalent staff providing care within this service.
• The public health services include contraceptive, sexual health screening and immunisation programmes.
• The counselling service falls outside the scope of registration in relation to any CQC regulated activities.
• In addition some of the GP neighbourhood access hubs are subcontracted directly to GP practices to deliver the service.

The provider was inspected in 2013 under the previous CQC methodology. No breaches of regulation were identified at that time.

Updated 31 May 2017

Letter from the Chief Inspector of General Practice

We carried out an announced comprehensive inspection at Principal Medical Limited on 21 and 22 March 2017. Principal Medical Limited is a GP federation providing specific services for the majority of GP practices in Oxfordshire and also South Northamptonshire. It has been owned by GPs since being created in 2004 and is run by a variety of clinical and non-clinical staff. They deliver services via associated member GP practices by sub-contracting services or directly via employed staff. Overall the provider is rated as good.

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

• There was an open culture of learning and the provider enabled their services to be dynamic in their design and delivery.
• There was an open and transparent approach to safety and a system in place for reporting and recording significant events. However, due to the difficulty in gathering all staff groups for meetings at one time, sharing of outcomes was not always formalised. There was good alternative communication.
• The provider had clearly defined and embedded systems to minimise risks to patient safety.
• Staff were aware of current evidence based guidance. Staff had been trained and provided with the skills, resources and knowledge to deliver effective care and treatment.
• Results from the national GP patient survey showed patients were treated with compassion, dignity and respect and 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.
• Patients we spoke, those who left feedback and survey data showed that the level of satisfaction among those who used the service was high. This included access to staff, communication and the quality of services received.
• The provider ensured there were the required facilities and equipment to enable staff to treat patients and meet their needs.
• There was a clear leadership structure and staff felt supported by management. The provider proactively sought feedback from staff and patients, which it acted on.

• The provider was aware of the requirements of the duty of candour. Examples we reviewed showed the provider complied with these requirements.

The areas where the provider should make improvement are:

• Review the processes for ensuring relevant staff receive learning outcomes from significant events.

Professor Steve Field (CBE FRCP FFPH FRCGP) 

Chief Inspector of General Practice

Updated 31 May 2017

The provider is rated as good for the care of Families children and young people.

• Neighbourhood access / GP access hubs provided children with quick access to GP and nurse appointments that they may not otherwise be able to access at their own registered GP practice.
• GPs and nurses were trained in safeguarding children and had access to information making referrals to local safeguarding teams.

• Staff received training on obtaining consent from patients under 16 years old and had access to guidance.

Updated 31 May 2017

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

• Staff were able to recognise the signs of abuse in older patients and knew how to escalate any concerns.
• The provider offered proactive, personalised care to meet the needs of the older patients. The hospital at home service assessing their circumstances and delivered tailored care to meet their needs.
• The home visiting service was organised in coordination with GP practices, enabling the information staff needed to be shared in a timely way.
• As part of the services delivered the provider followed up on older patients discharged from hospital and ensured that their care plans met their needs and identified any additional requirements.
• Older patients were provided with health promotional advice and support to help them to maintain their health and independence for as long as possible.
• During assessments of patients’ needs the collaborative care team and hospital at home teams assessed the impact of a patient’s condition on their daily lives including any hospital admissions and the needs of their carers.

Updated 31 May 2017

The provider is rated as good for the care of Working age people (including those recently retired and students)

• Neighbourhood access / GP access hubs provided working age people with quick access to GP and nurse appointments that they may not otherwise be able to access at their own registered GP practice. This enabled consultations and care for acute problems that were not related to the ongoing care for any long term conditions.
• Staff across all the services were facilitated to signpost patients to, where appropriate, to public health programmes such as smoking cessation and weight management.

Updated 31 May 2017

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

• The provider was taking part in an initiative along with other providers to support patients with potential mental health needs. Specifically anxiety and depression associated with specific long term conditions. This was partly aimed at identifying training that would benefit staff to support patients.

Updated 31 May 2017

The provider is rated as good for the care of people whose circumstances may make them vulnerable.

• Help and information was provided to support daily living including signposting to financial help charities, allowance applications, blue badge applications for patients with disabilities, an emergency carers’ service and befriending services.
• Staff were facilitated to signpost patients to, where appropriate, public health programmes such as smoking cessation and weight management.
• All staff were able to access translation services for patients that required this.
• There was access to interpreters for patients requiring signing.
• Assessments of any patients’ sensory impairments were undertaken on or before the provision of care and access to the service. For example, the hospital at home service used warning alerts to notify if a patient was unable to utilise the phone through hearing impairment and thus how communication was facilitated.
• The provider regularly worked with other health care professionals in the case management of vulnerable patients.
• Staff interviewed knew how to recognise signs of abuse in children, young people and adults whose circumstances may make them vulnerable. They 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.