Oak Tree Medical Centre

Letter from the Chief Inspector of General Practice

The previous inspection of this practice took place in November 2016. The overall rating for the practice at that time was requires improvement. At this time all key questions (are services safe, effective, caring, responsive and well-led) were rated requires improvement. Some of our concerns at this time related to the management of high-risk medicines at the practice, incomplete patient records and some members of the clinical team not having recent update training. Following the November 2016 inspection, we issued the practice regulation notices in respect of Regulations 12,17 and 18 of the Health and Social care Act (RA) Regulations 2014.

The key questions for this inspection report 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 inspection at Oak Tree Medical Centre on 8 November 2017. This inspection was carried out to review in detail the actions taken by the practice to improve the quality of care and to confirm that the practice was now meeting legal requirements following the November 2016 inspection.

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.
• Staff involved and treated patients with compassion, kindness, dignity and respect.
• There was a strong focus on continuous learning and improvement at all levels of the organisation.
• The practice had good facilities and was well equipped to treat patients and meet their needs.
• The practice was active in the community where it is based. Members of staff gave talks local schools and the practice was involved with a number of local projects including one which sought to ensure pathways to care were available for patients with a history of substance and alcohol misuse.
• Results from the National GP Patient Survey showed patients were treated with compassion, dignity and respect and were involved in their care and decisions about their treatment.
• The Quality Outcomes Framework (QOF) showed the patient outcomes at the practice were comparable with the Clinical Commissioning Group (CCG) and national averages.
• The practice ensured patients had good access to care by offering extended hours surgery, telephone and email consultations, as well as offering appointment booking on the practice website.

The areas where the provider should make improvements are:

• To reinstate the system for monitoring of the usage of prescription pads within the practice.
• Continue to review how patients with caring responsibilities are identified and recorded on the clinical system to ensure information, advice and support is available to them.
• Ensure that needle-stick posters are displayed in all clinical rooms.

Professor Steve Field (CBE FRCP FFPH FRCGP) 

Chief Inspector of General Practice

Letter from the Chief Inspector of General Practice

We carried out an announced comprehensive inspection at Oak Tree Medical Centre on 21 November 2016. Overall the practice is rated as Requires Improvement.

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

• Staff understood and fulfilled their responsibilities to raise concerns, and to report incidents and near misses. However, Medicines and Healthcare Regulatory Agency alerts were not always acted upon and the necessary patient checks were not completed.
• High risk medicines monitoring did not always take place and repeat prescriptions were issued without the relevant checks being undertaken.
• Not all clinical staff completed patient medical notes in full, therefore the practice could not ensure the correct information regarding patients’ consultations and treatment was accurately reflected in their notes.
• Risks to patients were assessed and well managed.
• Data showed patient involvement was low compared to the national average.
• The majority of patients said they were treated with compassion, dignity and respect. However, not all felt cared for, supported and listened to.
• Information about services was available.

The areas where the provider must make improvements are:

• Care and treatment must be provided in a safe way and the practice must take the relevant action following the receipt of MHRA alerts, doing all that is reasonably practicable to mitigate any risks.

• Ensure the proper and safe management of medicines in that there are processes in place for handling repeat prescriptions which include the review of high risk medicines before they are prescribed to patients.

• Maintain an accurate, complete and contemporaneous record in respect of each

  patient, including a record of the care and treatment provided and of decisions taken in relation to the care and treatment provided.

• Persons employed must receive appropriate clinical updates required for their role.

The areas where the provider should make improvement are:

• Improve the identification of carers to ensure their needs are known and can be met.

• Ensure the safe management of prescriptions.

• To provide children’s oxygen masks.

Professor Steve Field CBE FRCP FFPH FRCGP

Chief Inspector of General Practice