Archived: Oxford Health NHS Foundation Trust - HQ

Updated 4 June 2018

GP out of hours services in Oxfordshire are provided by Oxford Health NHS Foundation Trust. The service covers the total population of Oxfordshire (approximately 660,000 patients). Between April 2017 and February 2018, the service received 103,683 contacts from patients. Initial assessment when a patient calls for advice and treatment is undertaken by the NHS 111 service operated by South Central Ambulance Service. Once the assessment has been completed the NHS 111 team can book patients directly into the out of hours service. This could involve direct booking for a visit to one of the six out of hours bases or for a further review by the out of hours GPs. The second stage assessment can result in either a home visit, request to attend one of the out of hours centres or immediate telephone advice. All bases also accepted walk in patients (patients who arrived at the service without an appointment or accessed via NHS 111).

Services are provided from six locations across the county on every day of the year. They are:

• Oxford City Out of Hours base – East Oxford Health Centre, Manzil Way, Oxford, OX4 1XD. This is a dedicated out of hours facility located in a large health centre. It is open from 6.30pm to 8am (overnight) Monday to Saturday and from 8am on a Saturday through to 8am Monday morning. This centre is also open on bank holidays from 8am to 8am the next day.
• Witney Out of Hours base – Witney Community Hospital, Welch Way, Witney, OX28 6JJ. It is open from 6.30pm to 8am (overnight) Monday to Saturday and from 8am on a Saturday through to 8am Monday morning. This centre is also open on bank holidays from 8am to 8am the next day. The out of hours provision is co-located with a minor injuries unit that is also managed by the Trust and accepts walk in patients either directly or via the minor injuries unit.
• Abingdon Out of Hours base - Abingdon Community Hospital, Marcham Road, Abingdon OX14 1AG. At Abingdon the out of hours provision is co-located with a minor injuries unit that is also managed by the Trust and accepts walk in patients either directly or via the minor injuries unit. It is open from 6.30pm to 8am (overnight) Monday to Saturday and from 8am on a Saturday through to 8am Monday morning. This centre is also open on bank holidays from 8am to 8am the next day.
• Henley Out of Hours base - Townlands Memorial Hospital, York Road, Henley, RG9 2EB. This service is co-located with a minor injuries unit which is also managed by the Trust. Nursing and paramedic staff are able to work between both services. The out of hours service is open from 6.30pm to 11pm every weekday and from 8am to 11pm at weekends and on bank holidays. When the base is closed overnight services are provided from either the Abingdon or Oxford City bases.
• Bicester Out of Hours base - Bicester Community Hospital, Piggy Lane, Bicester, OX26 6HT. This site is located alongside a first aid unit also managed by the Trust. The out of hours service is open from 6.30pm to 11pm every weekday and from 8am to 11pm at weekends and on bank holidays. The overnight service for the north of the county is then provided from the Banbury base.
• Banbury Out of Hours base - Horton General Hospital, Hightown Road, Banbury, OX16 9AL. The out of hours service shares this facility with the outpatients department of the Horton General Hospital. It is open from 6.30pm to 8am (overnight) Monday to Saturday and from 8am on a Saturday through to 8am Monday morning. This centre is open on bank holidays from 8am to 8am the next day. The out of hours service is close to the hospital emergency department and accepts patients from this department who require primary care treatment.

We visited Oxford City and Bicester bases and the Corporate services at Littlemore Mental Health Centre during this inspection.

Patients can access information from the service website: www.oxfordhealth.nhs.uk

Updated 4 June 2018

This service is rated as Good overall. (Previous inspection 7, 8 & 9 November 2016 – Requires improvement overall)

The key questions are rated as:

Are services safe? – Good

Are services effective? – Good

Are services well-led? – Requires improvement

We carried out an announced focused inspection at Oxford Health NHS Foundation Trust - HQ on 28 March 2018. We undertook this inspection to follow up on breaches of regulation following the inspection in November 2016. We inspected the safe, effective and well led domains during this focussed follow up inspection.

At this inspection we found:

• The provider had reviewed the governance arrangements for all identified concerns from the previous Care Quality Commission inspection report and implemented changes.
• Staff training for basic life support had been completed, but there were still some gaps in chaperoning training for drivers/receptionists. There were also gaps in safeguarding training for GPs.
• The provider showed us their National Quality Requirements data (a key performance measure for out of hours services) for April 2017 to February 2018, which demonstrated some improvements on the previous reported figures although they remained below target for some indicators.
• The provider had undertaken a recruitment programme to improve staffing levels and ensure enough clinical staff were in post.
• The provider had introduced blank printed prescription tracking and monitoring systems since the last inspection, although we found these were inconsistently applied across different sites.
• Cleaning schedules and spot checks had been improved to ensure infection control risks were minimised.
• Recruitment documentation had been reviewed to identify any gaps in stored information. Disclosure and Baring Service (DBS) checks for GPs had improved and those identified as not yet in receipt of a DBS check had been risk assessed.
• Calibration of blood glucose monitoring equipment had been implemented although staff required further training on when a calibration was required.
• The Controlled Drugs (CD) order book at one of the sites (Oxford City) had still not been completed appropriately when they received CD stock into the base.

The areas where the provider must make improvements as they are in breach of regulations are:

• Establish effective systems and processes to ensure good governance in accordance with the fundamental standards of care.

The areas where the provider should make improvements are:

• Continue to review and improve staffing levels with a view to achieving the 98% target for session fulfilment.
• Review calibration of blood glucose monitors and ensure staff are aware of best practice guidelines for use.
• Review arrangements for monitoring and recording chaperone training to ensure it has been completed for all required staff.

Professor Steve Field CBE FRCP FFPH FRCGP

Chief Inspector of General Practice