Oaklands Surgery - Canvey Island

Updated 23 November 2016

Oaklands Surgery – Canvey Island is located in a purpose built primary care centre shared with several other primary care providers as well as a pharmacy. The centre is located in the centre of Canvey Island with ample parking facilities and good public transport links. At the time of our inspection the practice had a list size of 10,295 patients.

There are two male GP partners, two female GP partners and one male salaried GP and a female locum GP. There are two practice nurses and two nurse practitioners, three of the team are independent prescribers. There are three healthcare assistants and one associate practitioner. Non-clinical staff include a practice manager, a practice secretary and a large administrative and reception team.

The practice is open between 8.30am and 6.30pm Monday to Friday. In addition, weekend appointments were available through the local GP Alliance at an alternative location.

When the practice is closed, patients are directed to out of hours services by calling 111. These services are provided by IC24.

Updated 23 November 2016

Letter from the Chief Inspector of General Practice

We carried out an announced comprehensive inspection at Oaklands Surgery 22 April 2016. Overall the practice was rated as good but required improvement for providing safe services.

During our last inspection we required the provider to make the following improvements;

• Ensure there are robust systems in place for the safe storage of vaccines.
• Continue to monitor patient feedback and survey data to ensure that the improvements that have been made are being reviewed and maintained.

A requirement notice was issued and the practice put an action plan in place to address the areas requiring improvement an ensure they were resolved.

On 11 November 2016 we conducted a desk top review and found;

• The practice had spoken with their clinical team and conducted a comprehensive review of their management and storage of medicines. They had revised and replaced temperature recording devices to mitigate the risk of inaccurate fridge temperature readings. Their electronic temperature monitoring equipment was regularly downloaded to confirm adherence to their cold chain storage requirements.
• The practice had listened and responded to the findings of the January 2016 national GP patient survey and their three monthly patient feedback audits. They had recruited additional clinical staff (two nurses and a full time salaried GP). They had improved their responsiveness to patients during peak times with all available staff answering calls. The practice were also actively monitoring patient wait times with their telephone provider. The July 2016 national GP patient survey showed improvements in patient satisfaction levels with the service.

We were satisfied that the practice had made the required improvements.

Professor Steve Field (CBE FRCP FFPH FRCGP) 

Chief Inspector of General Practice

Updated 26 May 2016

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

• GPs and nursing staff had lead roles in chronic disease management. There were weekly GP led diabetes clinics with additional nurse led sessions as well as nurse led respiratory clinics.
• Patients at risk of hospital admission were identified as a priority; hospital admissions were monitored and followed up.
• There were good relationships with other organisations such as district nurses as they worked in the same primary care centre.
• National data showed the practice performance regarding diabetes indicators was below average; however following audits and other intervention we saw this data had improved but had not yet been verified.
• Longer appointments, telephone consultations and home visits were available when needed.
• 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 the most complex needs, there was a lead GP who worked with relevant health and care professionals on a regular basis to deliver a multidisciplinary package of care.

Updated 26 May 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. There were separate lead GPs for safeguarding adults and children and all staff were aware of this and their responsibilities regarding safeguarding.
• Immunisation rates were relatively high for all standard childhood immunisations.
• 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. Staff were aware of and understood Gillick competency.
• There was a mix of ages, races and gender throughout the clinical staff; we were told that this assisted in treating all patients in a caring, non-discriminatory and non-judgemental way.
• 86% of female patients aged 25 to 64 had a record of a cervical screening test performed in the last five years (01/04/2014 to 31/03/2015), this was above the national average of 82%. The practice had a dedicated staff member responsible for communicating with patients regarding cervical screening.
• Appointments were available outside of school hours and the premises were suitable for children and babies.
• We saw positive examples of joint working with district nurses, health visitors and school nurses who worked in the same primary care centre.

Updated 26 May 2016

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

• The practice had a large elderly population aged 60 years and over. They offered proactive, personalised care to meet the needs of these patients.
• The practice communicated with nursing homes where some of their patients lived and offered home visits and vaccination programmes as and when they were needed.
• The practice was responsive to the needs of older people, and offered home visits and urgent appointments for those with enhanced needs.
• All patients had a named GP and were made aware of this.
• A wide variety of information regarding services was made available to this patient group and their families.

Updated 26 May 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 including appointments, and a Web GP service allowing patients to ask for advice via the practice website. There were plans to further increase this use of technology by introducing Skype consultations.
• There was a full range of health promotion and screening that reflects the needs for this age group, including chlamydia and bowel cancer screening.
• A new pilot scheme was being offered to encourage patients to live healthier lifestyles.

Updated 26 May 2016

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

• 86% of patients diagnosed with dementia had their care reviewed in a face to face meeting in the last 12 months, which is comparable to the national average of 84%.
• Other data regarding mental health related indicators was below average and action had been taken to improve this data and we saw evidence of this working.
• The practice regularly worked with dementia liaison services and other organisations in the case management of patients experiencing poor mental health.
• The practice carried out advance care planning for patients with dementia.
• The practice had told patients experiencing poor mental health about how to access various support groups and voluntary organisations. Where necessary the practice referred patients to external organisations such as the community psychiatric team.
• The practice had a system in place to follow up all patients who had attended accident and emergency including those who may have been experiencing poor mental health.
• Staff had a good understanding of how to support patients with mental health needs and dementia and planned to share this knowledge by providing awareness training to staff in the local nursing homes.

Updated 26 May 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.
• There was a lead GP and a lead staff member for patients with a learning disability. These patients were offered longer appointments, health education and health assessments. These patients were always offered a chaperone. Information regarding patients was shared with the community learning disability team.
• The practice regularly worked with other health care professionals, including mental health services, social services and dementia liaison services, in the case management of vulnerable patients. Monthly multidisciplinary meetings were held to discuss patients with a lead GP and this information was shared with all clinical staff.
• 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.
• Staff had undertaken additional training regarding the awareness of female genital mutilation, domestic abuse and the care of rape victims.