Archived: Oakfield Surgery

Updated 13 February 2017

Oakfield Surgery provides a range of medical services to approximately 7000 patients and provided these services to patients living in 24 nearby villages. The practice is in the NHS West Suffolk CCG (Clinical Commissioning Group).

The practice holds a General Medical Services (GMS) contract to provide GP services. The practice dispenses medicines to some patients. Data from Public Health England shows the practice serves an area where income deprivation affecting children and older patient’s people is lower than the England average. The practice has a lower number of older patients and a h igher number of patients aged 30 to 50 years.

The practice has a team of four GPs meeting patients’ needs. These GPs (two male and two female) are partners and they hold managerial and financial responsibility for the practice. There are two female advance nurse practitioners, three female practice nurses, and a female

Phlebotomist. There is a practice manager, a dispensary manager and a dispenser. A team of six reception/ administration staff and an office manager support the practice manager.

Patients using the practice have access to a range of services and visiting healthcare professionals. These included midwives, a diabetic specialist nurse, and a community mental health nurse.

Appointments are available Monday to Friday from 8.30am to 6.30pm. With extended hours offered on Wednesday evening between 6.30pm to 8.30pm. Outside of practice opening hours the patients contact 111 for an emergency service. Details of how to access emergency and non-emergency treatment and advice is available within the practice and on its website.

Updated 13 February 2017

Letter from the Chief Inspector of General Practice

We carried out an announced comprehensive inspection at Oakfield Surgery on 2 June 2016. Overall the practice is rated as good.

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

• The appointment system was flexible and ensured that patients who requested to be seen on the same day were.

• The practice had good facilities including for those with reduced mobility.

• Information about services and how to complain was available. The practice sought patient views about improvements that could be made to the service, including having a patient participation group (PPG).

• The practice proactively managed care plans for vulnerable patients and had effective management strategies for patients at the end of their life.

• The practice had a number of policies and procedures to govern activity; however, the oversight to ensure that they were reviewed timely needed to be improved.

• Systems to reduce risks to patient safety for example, ensuring that all devices and dressings are within their expiry date, needed to be improved.

• There was a leadership structure, staff felt supported by the management team and were an integral art of the running of the practice.

• Patients’ needs were assessed and care was planned and delivered following best practice guidance.

The areas where the provider must make improvements are:

• Ensure that all medical devices and dressings available for use are within the expiry dates.

In addition the provider should;

• Improve and embed processes for reporting, recording, acting on and monitoring incidents and verbal complaints to ensure reflective and shared learning.

• Review the national screening programmes for bowel and breast cancer screening data and develop a strategy to encourage patients to attend.

Professor Steve Field (CBE FRCP FFPH FRCGP) 

Chief Inspector of General Practice

Updated 14 July 2016

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

Nursing staff had roles in chronic disease management; data showed that patient outcomes were similar when compared with other practices in the locality. Patients that had attended appointments had a structured annual review to check that their health and medication needs were being met. The practice held monthly meetings attended by GP, and nurses to ensure that patients received appropriate re-calls and follow up.

Home visits were available to those patients who could not attend the surgery.

Longer appointments were available and could be booked by patients if required. Practice staff followed up patients who did not attend their appointments by telephone to encourage attendance.

Updated 14 July 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 patients who had a high number of A&E attendances. Immunisation rates were in line with local averages for all standard childhood immunisations. Young children were given priority appointments for urgent needs.

Appointments were available outside of school hours and the premises were suitable for children and babies. We saw examples of joint working with midwives, health visitors, and school nurses.

Updated 14 July 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 older people in its population. Home visits were available for those unable to attend the practice. Continuity of care was maintained for older people through a stable GP workforce and personalised patient centred care. The practice provided visits to local care homes.

The practice regularly reviewed attendances at the accident and emergency department to ensure that those patients identified as vulnerable to admission were reviewed.

We saw evidence that the practice had worked to the Gold Standards Framework for those patients with end of life care needs.

Updated 14 July 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, including 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 was proactive in offering online services as well as a full range of health promotion and screening that reflected the needs for this age group. The practice did not restrict patients to certain appointment times to attend for their annual reviews; patients who worked were able to book at times that were convenient to them.

Telephone consultations were available for those patients who wished to seek advice from a GP. NHS health checks were available.

Updated 14 July 2016

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

The practice regularly worked with multi-disciplinary teams in the case management of patients experiencing poor mental health, including those with dementia.

Staff told us that 68% of patients with dementia had received advance care planning and had received appropriate reviews. These patients had a named GP and continuity of care was prioritised for them.

Same day appointments and telephone triage with a GP was offered to ensure that any health needs were quickly assessed for this group of patients.

The practice told patients experiencing poor mental health about how to access various support groups and voluntary organisations. Staff had knowledge on how to care for patients with mental health needs and dementia.

Updated 14 July 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 those with a learning disability. It offered longer appointments and carried out annual health checks.

The practice told us that 65% of patients with a learning disability had received an annual review.

The practice regularly worked with multi-disciplinary teams in the case management of vulnerable patients. We saw the practice provided vulnerable patients with information about how to access various support groups and voluntary organisations.

Staff knew how to recognise signs of abuse or neglect 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.

Practice staff were intuitive to the needs of this group of patients and demonstrated that they had a personalised approach to helping them. Phlebotomy appointments were available at the practice.

The practice told us that 82% of the patients on the Gold Standards Framework died in their preferred place of care.