Archived: Oakridge Park Medical Centre

Updated 24 February 2017

Oakridge Park Medical Centre provides a range of primary medical services, including minor surgical procedures from its location at Texel Drive, Oakridge Park in Milton Keynes.

The practice serves a population of approximately 12,300 patients with slightly higher than average populations of males and females aged 0 to 9 years and 25 to 39 years. The practice population is largely White British, with increasing populations of European and Asian patients. National data indicates the area served is one of slightly less than average deprivation in comparison to England as a whole.

The clinical team consists of two male GP partners, a female salaried GP (currently on maternity leave) a lead nurse, three practice nurses (one of which had recently qualified as a prescriber), three health care assistants (HCAs) and two phlebotomists. The practice had recently employed a pharmacist to support clinicians with medicines optimisation. The team is supported by a practice manager, an assistant practice manager, a reception manager and a team of administrative staff. In addition the practice employed four long term locums (three female and one male), a locum Independent Nurse Practitioner (qualified as a prescriber), a community HCA and an Age UK worker.

In the 18 months preceding our inspection the practice had experienced an unusually high turnover of both clinical and non clinical staff. The practice told us that this had impacted on access to appointments and patient satisfaction. We saw that the practice had successfully recruited additional nursing and administrative staff and at the time of our inspection were making continued efforts to recruit more doctors on a long term basis. The practice was being supported by the Milton Keynes Clinical Commissioning Group (CCG) and NHS in the recruitment and retention of GPs.

The practice holds a General Medical Services (GMS) contract for providing services, which is a nationally agreed contract between general practices and NHS England for delivering general medical services to local communities.

The practice operates from a two storey purpose built property which opened in 2012. Patient consultations and treatments take place on the ground level and first floor. There is a large car park outside the surgery, with disabled parking available. The building is owned by NHS property services and the practice shares these premises with Trust community staff (District nurses).

Oakridge Park Medical Centre is open between 8am and 6.30pm Monday to Friday. The practice is a member of the local ‘Prime Ministers Challenge fund’ (PMCF) collaboration called MKExtra, enabling their patients, wishing to be seen outside of the practice’s extended and core hours, to receive routine GP care at a network of practices across the locality.

The out of hours service is provided by Milton Keynes Urgent Care Services and can be accessed via the NHS 111 service. Information about this is available in the practice and on the practice website and telephone line.

Updated 24 February 2017

Letter from the Chief Inspector of General Practice

We carried out an announced comprehensive inspection at Oakridge Park Medical Centre on 17 January 2017. Overall the practice is rated as good.

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.
• Risks to patients were assessed and well managed.
• Staff assessed patients’ needs and delivered care in line with current evidence based guidance. Staff had been trained 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 and easy to understand. Improvements were made to the quality of care as a result of complaints and concerns.
• The majority of patients said they found it easy to make an appointment, with urgent appointments available the same day.
• 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 saw two areas of outstanding practice:

• The practice was classed as a POCT (point of care testing) hub practice within the locality, and alongside six other practices was offering patients additional services not normally found within a GP setting. For example, the practice was able to offer D-dimer testing for patients. (D-dimer tests are used to rule out the presence of a blood clot).
• The practice invested considerably in the provision of an Echocardiography service, for both patients registered at the practice and those registered at other practices within the locality. (An echocardiogram (echo) is a test that uses high frequency sound waves (ultrasound) to make pictures of your heart).The service was established 25 years prior to our inspection, by the lead GP. Appointments were available throughout the week and during a dedicated Saturday Clinic. We saw that between June 2016 and October 2016 the practice saw 264 patients under the cardiology service.

The areas where the provider should make improvements are:

• Monitor systems to record actions taken in response to safety alerts, to ensure they are effectively implemented.
• Continue to monitor and improve provisions for patients with mental health concerns.
• Develop systems to identify and support more carers in their patient population.
• Continue to monitor and ensure improvement to patient access to GP appointments.
• Encourage all staff to complete mandatory training in a timely manner and in accordance with the practice schedule for completion.
• Continue with efforts to stabilise the clinical team through active recruitment.

Professor Steve Field (CBE FRCP FFPH FRCGP) 

Chief Inspector of General Practice

Updated 24 February 2017

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

• Specialist nurses for long term conditions led chronic disease management clinics supported by GPs and patients at risk of hospital admission were identified as a priority.
• Performance for diabetes related indicators was comparable to the clinical commissioning group (CCG) and national averages. For example, the percentage of patients with diabetes, on the register, in whom the last blood glucose reading showed good control in the preceding 12 months (1 April 2015 to 31 March 2016), was 76%, where the CCG average was 77% and the national average was 78%.
• Longer appointments and home visits were available when needed.
• The practice provided an insulin initiation service for diabetic patients.
• A recall system was utilised to manage these patients.
• Patients with long term conditions benefitted from continuity of care with their GP or nurse. All these patients had a named GP and a structured annual review to check their health and medicines needs were being met. For those patients with more complex needs, the named GP worked with relevant health and care professionals to deliver a multidisciplinary package of care.
• All discharge summaries were reviewed on the day they were received ensuring medicines were adjusted and appropriate primary care follow-up was arranged.

Updated 24 February 2017

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 may be at risk, for example, children and young people who had a high number of A&E attendances.
• 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.
• The practice’s uptake for the cervical screening programme was 82%, which was comparable to the CCG average of 82% and the national average of 81%.
• Appointments were available outside of school hours and the premises were suitable for children and babies.
• Children and infants who were unwell were always seen on the same day.
• The practice organised their own appointments and follow ups for childhood immunisations. As a result the practice had no waiting lists for children needing immunisations and there was provision of appointments outside of school hours or at a flexible time to increase access.
• We saw positive examples of joint working with midwives, health visitors and school nurses.
• Family planning and contraceptive advice was available. The practice provided a variety of health promotion information leaflets and resources for this population group for example the discreet provision of chlamydia testing kits.

Updated 24 February 2017

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

• The practice were passionate about providing care for elderly patients, employing a dedicated community health care assistant and an AgeUK worker to support elderly patients at risk within their own homes. These patients all had direct access to the practice via a designated telephone number and all had tailored care plans in place.

• The practice offered proactive, personalised care to meet the needs of the older people in its population.
• All patients over the age of 75 had a named GP.
• The practice was responsive to the needs of older people, and offered home visits and urgent appointments for those with enhanced needs.
• The practice provided influenza, pneumonia and shingles vaccinations.
• A phlebotomy clinic ran daily enabling patients to have blood tests conducted locally rather than at the local hospital.
• The practice ran an anticoagulant clinic for patients to monitor their treatment. (Anticoagulants are medicines used to prevent blood from clotting). This clinic had been well received by patients as it reduced the need for them to travel to secondary care for the service.
• The practice offered health checks for patients over the age of 75.

Updated 24 February 2017

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 provided telephone consultations daily.
• The practice had enrolled in the Electronic Prescribing Service (EPS). This service enabled GPs to send prescriptions electronically to a pharmacy of the patient’s choice.
• The practice encouraged the use of the on line services to make it easier to book appointments and order repeat prescriptions.
• The practice encouraged screening for working age people such as bowel screening and cervical screening. Practice staff followed up any patients who did not respond to screening invitations so that they knew they were welcome to make contact if they wished to re-engage.
• The practice was a member of the local ‘Prime Ministers Challenge fund’ (PMCF) collaboration called MKExtra, enabling their patients, wishing to be seen outside of the practice’s extended and core hours, to receive routine GP care at a network of practices across the locality.

Updated 24 February 2017

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

• The percentage of patients with dementia whose care had been reviewed in a face-to-face review in the preceding 12 months (1 April 2015 to 31 March 2016) was 72% where the CCG average was 86% and the national average was 84%. The practice recognised mental health as an area in need of improvement and we saw that efforts were being made to recall patients, with all patients receiving three reminders. Patients with mental health concerns also received a phone call from the practice inviting them in for review. We saw evidence that these efforts were being effectively implemented and were improving performance over time.
• The practice provided dementia screening services for patients identified as at risk of developing dementia to allow for early intervention and support if needed.
• The practice regularly worked with multi-disciplinary teams in the case management of patients experiencing poor mental health, including those with dementia.
• The practice held a register of patients experiencing poor mental health and invited them to attend annual reviews. The practice had told patients experiencing poor mental health about how to access support groups and voluntary organisations.
• The practice had a system in place to follow up patients who had attended A&E where they may have been experiencing poor mental health.
• Staff had a good understanding of how to support patients with mental health needs and dementia.

Updated 24 February 2017

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

• The practice had developed a register of patients in vulnerable circumstances including patients with no fixed address and those from traveller communities.
• The practice offered longer appointments for patients with a learning disability.
• The practice regularly worked with other health care professionals in the case management of vulnerable patients, including corroborative working at locality wide multi-disciplinary meetings.
• The practice informed vulnerable patients about how to access support groups and voluntary organisations.
• The practice held palliative care meetings in accordance with the national Gold Standards Framework (GSF) involving district nurses, GP’s and the local MacMillan Hospice nurses.
• 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.

• The practice had identified less than 1% of the practice list as carers. The practice was continuing with efforts to ensure all carers within their population were identified and supported. We saw that a member of staff had trained as a Carers Champion.