Nettlebed Surgery

Updated 8 February 2017

Nettlebed Surgery is situated in Nettlebed near Henley-on-Thames. The practice resides in a purpose built building. There is access for patients and visitors who have difficulty using steps. All patient services are offered on the ground and first floors. The practice comprises of three consulting rooms, two treatment rooms, one patient waiting area, administrative and management offices, and a meeting room.

The practice has approximately 3726 registered patients. The practice population of patients aged 45 years and above is higher than national averages and Clinical Commissioning Group (CCG) averages There were a large number of patients registered at the practice from white British backgrounds.

There are two GP partners and one salaried GP at the practice. All GPs are female. The GPs work 18 sessions in total between them. The practice employs three female practice nurses who work a total of 12 sessions. Three dispensary staff work at the practice. The practice manager is supported by a team of administrative and reception staff.

The practice is open between 8am and 6.30pm Monday to Friday. Appointment times are 8.30am to 6.30pm on Monday, Tuesday, Thursday and Friday and between 10am and 6.30pm on Wednesdays. When the practice is closed patients can access the NHS

111 service and Oxfordshire out of hours service.

Services are provided via a Personal Medical Services (PMS) contract (PMS contracts are negotiated locally between GP representatives and the local office of NHS England).Services are provided from the following location:

Nettlebed Surgery

Wanbourne Lane,

Henley On Thames,

Oxfordshire

RG9 5AJ

Updated 8 February 2017

Letter from the Chief Inspector of General Practice

In February 2016, during our previous comprehensive inspection of Nettlebed Surgery, we found issues relating to the safe delivery of healthcare services at this practice. As a result of this inspection, we asked the practice to make further improvements; in order to ensure that sharps are disposed of in the correct colour coded bags and bins. (Sharps refers to a medical term used for devices with sharp points or edges that can puncture the skin, for example needles).

We also found that the practice did not have a comprehensive risk assessment for the process of dispensing and delivering medicines to locations other than the practice. Furthermore, the practice had not carried out a legionella risk assessment and plan. The practice also needed to ensure that all staff had carried out appropriate training in infection control, and equality and diversity, and that all training was recorded. Finally at our previous inspection, we also found that the practice needed to implement a process for documenting that action plans for significant events have been carried out.

Following the last inspection, the practice was rated as requiring improvement in safe services, and good for effective, caring, responsive and well led services. The practice had an overall rating of good.

We carried out a desk based inspection in November 2016 to ensure the practice had made improvements since our last inspection. The practice sent us evidence in the form of letters to patients, a copy of a training matrix, evidence of their legionella risk assessment, and minutes from a significant events meeting, to demonstrate the range of improvements they had made, since our last visit. The practice also further supplied a chart outlining the areas the practice had attempted to improve. We found the practice had made improvements since our last inspection in February 2016.

At this inspection we found that:

• The practice advised us that appropriate steps had been taken to ensure, that all sharps were disposed of in the correct colour coded bags and bins.

• Following the last inspection, the practice had ceased the delivery of all medications to rural collection points.

• The practice had produced a summary of their legionella risk assessment, and had provided evidence that this was now being followed.

• The practice had a training matrix detailing the various courses staff had undertaken. The training matrix included infection control and equality and diversity training for all three GPs.

• The practice had supplied minutes from a significant event meeting to demonstrate the learning in place for such events.

The areas where the provider should make improvements are:

• Continue to improve the systems used to document training and significant events.

• Ensure all members of staff receive equality and diversity training and clinical staff receive infection control training.

Following this desk based inspection we have rated the practice as good for providing safe services. The overall rating for the practice remains good. This report should be read in conjunction with the full inspection report of 17 February 2016. A copy of the full inspection report can be found at www.cqc.org.uk.

Professor Steve Field (CBE FRCP FFPH FRCGP) 

Chief Inspector of General Practice

Updated 8 April 2016

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

• Nursing staff had lead roles in chronic disease management and patients at risk of hospital admission were identified as a priority.
• Performance for diabetes related indicators was 92% which was below the CCG average of 94% but higher than the national average of 89%.
• Patients with pre-diabetes were seen annually. There was also information in the waiting area for patients with pre-diabetes. The practice had held a meeting to discuss the increase in patients with diabetes and to develop strategies to support these patients.
• Longer appointments and home visits were available when needed.
• For those patients with the most complex needs, the named GP worked with relevant health and care professionals to deliver a multidisciplinary package of care.
• There were leaflets in the waiting area providing information about a range of conditions including cancer and diabetes.

Updated 8 April 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.
• Childhood immunisation rates for the vaccinations given were comparable to CCG averages. For example, childhood immunisation rates for the vaccinations given to under two year olds ranged from 92% to 100% (CCG average 6% to 97%) and five year olds from 94% to 100% (CCG average 92% to 98%).
• 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 85%, which was high compared to the national average of 82%.
• Appointments were available outside of school hours and the premises were suitable for children and babies. There was a children’s area in the waiting room and baby changing facilities.

Updated 8 April 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.
• The practice was responsive to the needs of older people, and offered home visits and urgent appointments for those with enhanced needs.
• 59% of patients over 60 years had bowel cancer screening.
• Health checks were provided to older people.
• The entrance, waiting area, and treatment and consultation rooms were accessible for people who may have mobility difficulties.

Updated 8 April 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, 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 reflects the needs for this age group.
• The practice offered appointments early in the morning and in the late afternoon / early evening to meet the needs of employed patients unable to attend during working hours.

Updated 8 April 2016

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

• 100% of patients with mental health difficulties have had a care plan and alcohol screen in the past 12 months which is better than the national averages of 88% and 90% respectively.
• The practice regularly worked with multi-disciplinary teams in the case management of people experiencing poor mental health, including those with dementia. Staff had a good understanding of how to support patients with mental health needs and dementia.
• The waiting area contained information about a range of sources of support for people, including those with dementia and people experiencing mental health difficulties.
• An audit was conducted in collaboration with the Clinical Commissioning Group (CCG) to identify any missed diagnosis of dementia and to ensure diagnoses were correctly recorded.

Updated 8 April 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. Annual health checks had been completed for five of the six patients at the practice on the register for people with learning disabilities at the time of the inspection.
• The practice offered longer appointments for patients with a learning disability if needed.
• The practice regularly worked with multi-disciplinary teams in the case management of vulnerable people.
• The practice informed vulnerable patients about how to access various support groups and voluntary organisations.
• 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.