Mytton Oak Medical Practice

Updated 23 November 2017

Mytton Oak Medical Practice is registered with the Care Quality Commission as a partnership provider, which includes four GP partners. The provider holds a General Medical Services contract with NHS England. At the time of our inspection 10,658 patients were registered at the practice. The practice population has a higher percentage of male 15 to 19 year olds and is slighter higher in this age group for females.

Mytton Oak Medical Practice is located in a purpose built building. As well as providing the contracted range of primary medical services, the practice provides additional services including:

• Minor surgery

• Venepuncture (blood sample taking)

The practice is open each weekday from 8am to 6pm. Extended hours are provided from 7.30am on Monday, Tuesday and Wednesday.  The practice has opted out of providing cover to patients outside of normal working hours. The out-of-hours services are provided by Shropdoc.

Staffing at the practice includes five GP partners and a salaried GP (three male and three female GPs) who provide 4.22 whole time equivalent hours (WTE). The clinical staff includes; two advanced nurse practitioners and two practice nurses, as well as a healthcare assistant. The nursing team provide 4.11 WTE hours. The practice management includes a primary care manager/practice manager and two patient service supervisors. Two data entry administrators, an administrator/cleric, eight reception staff and three secretarial staff, support the practice. The whole practice administration and reception team provide 10.81 WTE hours. The practice hosts a Community Care Co-ordinator employed by The Red Cross. There are 27 staff in total, working a mixture of full and part time hours.

Updated 23 November 2017

Letter from the Chief Inspector of General Practice

This practice is rated as Good overall. (Previous inspection 14 June 2016 – Good)

The key questions are rated as:

Are services safe? – Good

Are services effective? – Good

Are services caring? – Good

Are services responsive? – Good

Are services well-led? - Good

As part of our inspection process, we also look at the quality of care for specific population groups. The population groups are rated as:

Older People – Good

People with long-term conditions – Good

Families, children and young people – Good

Working age people (including those recently retired and students – Good

People whose circumstances may make them vulnerable – Good

People experiencing poor mental health (including people with dementia) - Good

We carried out an announced comprehensive inspection at Mytton Oak Medical Practice on 2 November 2017 as part of our inspection programme.

At this inspection we found:

• The practice had clear systems to manage risk so that safety incidents were less likely to happen. When incidents did happen, the practice learned from them and improved their processes.

• The practice routinely reviewed the effectiveness and appropriateness of the care it provided. It ensured that care and treatment was delivered according to evidence- based guidelines.

• Staff involved and treated patients with compassion, kindness, dignity and respect.

• Patients found the appointment system easy to use and reported that they were able to access care when they needed it.

• There was a strong focus on continuous learning and improvement at all levels of the organisation.

We saw one area of outstanding practice:

• The practice had identified an increase in younger patients with mental ill health including eating disorders and self-harm. They had proactively actioned their findings by supporting appropriate health education sessions on eating disorders and self-harm at a local school. They had noted these changes over a recent period of change at the school from a boys only to a co-education school. They had found increases in patient attendance and in the number of mental health referrals made. This was conducted in co-operation with the school itself, staff and school nurses.

The areas where the provider should make improvements are:

• Introduce a system to demonstrate any resultant actions taken to patient safety alerts.

• Consider implementing a concise care plan document for patients, carers or locum GPs from the coded information currently held in a template format.

• Consider the production of a dated, time scaled action plan following the Infection Prevention and Control audits.

• Consider developing and implementing a children’s and adult sepsis protocol for all staff to access.

• Enable a whole staff approach to the learning from significant event analysis annual reviews and the identification of any trends.

• Consider documenting the practice business strategy.

• Ensure that copies of the business continuity plan are held off site by all partners.

• Consider producing a practice organisational structure document, which includes staff identified as having specific lead roles.

Professor Steve Field (CBE FRCP FFPH FRCGP) 

Chief Inspector of General Practice

Updated 4 August 2016

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

• Patients at the highest risk of unplanned hospital admissions were identified and care plans had been implemented to meet their health and care needs.
• Longer appointments and home visits were available when needed.
• All these patients had a named GP and a structured annual review to check that their health and medicines needs were being met. For people with the most complex needs, the named GP worked with relevant health and care professionals to deliver a multidisciplinary package of care.
• Nursing staff had lead roles in chronic disease management and had undertaken additional training. For example, all newly diagnosed diabetics were referred to a local ‘Expert Programme’ and patients with Chronic Obstructive Pulmonary Disease (COPD) were referred locally for pulmonary rehabilitation. COPD is the name for a collection of lung diseases including chronic bronchitis.

Updated 4 August 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 relatively high for all standard childhood immunisations. For example, o n a monthly basis a search was completed for A&E attendances and their GP informed about any child who attends on four or more occasions in one year and of any attendance by a child known to be at risk.

• 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 uptake of flu vaccinations in pregnant women was 63%, where there was no other risk, and 86% where patients had identified additional risks.

• The practice’s uptake for the cervical screening programme was 80% which was comparable with the CCG average of 83% and national average of 82%.

• The practice was young person-friendly and offered condoms, pregnancy testing and chlamydia testing for all aged 15-24.

• The practice provided GP services to a Shrewsbury school and held a daily surgery on the school site.

• The practice nurses ran immunisation clinics and patients who did not attend these clinics were followed up by the practice and referred to the health visitor.

Updated 4 August 2016

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

• The uptake of the shingles vaccination for the eligible age groups was 74%.

• The percentage of patients who lived in a care home setting of the 10,198 patients registered was 0.65%, (67) patients. All patients had a care plan and these had been reviewed at least annually.

• The practice offered proactive, personalised care to meet the needs of the older people in its population. They were responsive to the needs of older people, and offered home visits and urgent appointments for those with enhanced needs.

• The practice had an associated part-time care coordinator who for example could refer patients who were isolated and in need of support, provide information and signposting to other services and could organise day centre and support for carers.

• The practice participated in the local enhanced service for the avoidance of unnecessary admissions to hospital. Care plans for these patients were reviewed on an annual basis. Patients were discussed at regular multi-disciplinary team meetings, with their own GP being responsible for coordinating their care.

• The practice engaged with the ‘Good Neighbours’ scheme associated with the practice. This was a group of patients who worked on a voluntary basis to provide transport to appointments and some non-clinical support services to older patients. They also fundraised for the practice and transformed the flu vaccination clinics into more of a social event.

Updated 4 August 2016

The practice is rated as good for the care of working-age people (including those recently retired and students).

• The practice offered extended hours evening appointments from 7.30am on Mondays, Tuesdays and Wednesdays, and an appointment only surgery on one Saturday each month. .

• The practice provided online services to enable patients to book appointments, order repeat medicines and access some parts of their health records online.

• Health promotion and screening services reflected the health needs of this group.

• Patients were able to request telephone advice/consultation and the response to this was made the same day, or the evening of the request.

• 57% of eligible patients had been invited for an NHS health check and 27% of eligible patients had attended to date.

Updated 4 August 2016

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

• The practice had told patients experiencing poor mental health about how to access various support groups and voluntary organisations.

• The practice had a system in place to follow up patients who had attended accident and emergency 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.

• The practice had 99 patients on their mental health register, 88% had care plans agreed and to date 86% had had an annual review. All patients prescribed a particular medicine used to treat bipolar disorder, manic-depressive illness had had appropriate blood tests completed.

• There were 79 patients on the patient dementia register at the practice and of these 80% had been in receipt of a care plan review in the previous 12 months.

• Patients living with poor mental health were encouraged to see the same GP and there were systems in place to facilitate this. Patients who were diagnosed with depression, known to be vulnerable or who missed appointments were then phoned by the GP who knew them.

Updated 4 August 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 known vulnerable adults, those who were housebound and patients with a learning disability. For example, t he practice supported a local residential school for children with learning and behavioural difficulties and the GPs provided annual medicals and prescriptions in line with shared care agreements.

• 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.

• The practice held a register of the practices’ frail and vulnerable patients and had identified patients who may be at risk of unplanned hospital admissions.

• The practice facilitated patients requiring GP services with drug and alcohol rehabilitation needs.

• The practice associated care co-ordinator supported patients and signposted to other allied health and social care professionals, voluntary agencies and charitable agencies when required.

• The practice provided GP services to a Shrewsbury school, which has boarders who may be from overseas without English as their first language and held a daily surgery on the school site.