The Oaks Medical Centre

Updated 24 March 2016

The Oaks Medical Centre provides primary medical services to approximately 8480 patients through a General Medical Services (GMS) contract. Services are provided to patients from a single site which occupies purpose built premises in Beeston. The patient list is increasing and has grown 17% since 2011.

The level of deprivation within the practice population is less than the national average. Income deprivation affecting children and older people is also below the national average.

The clinical team comprises four GP partners (2 female and 2 male), two female salaried GPs, three nurses and two healthcare assistants. The clinical team is supported by a practice manager, and a team of administrative and reception staff.

The practice is open from 8am to 6.30pm on Monday to Friday. The consultation times for morning GP appointments start at 8.20am to 11am. Afternoon appointments are offered from 2pm until 5.30pm. The practice offers extended hours on a Wednesday and Thursday mornings from 7am. In addition to these bookable sessions, walk in patients are seen at the end of clinics which patients do not have to book appointments for and all patients who attend are seen.

The practice has opted out of providing out-of-hours services to its own patients. This service is provided by Nottingham Emergency Medical Services (NEMS) through the 111 system.

Updated 24 March 2016

Letter from the Chief Inspector of General Practice

We carried out an announced comprehensive inspection at The Oaks Medical Centre on 17 November 2015. Overall the practice is rated as outstanding.

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

• There was an open and transparent approach to safety and an effective system in place for reporting and recording significant events.

• The practice reviewed significant events every six months to ensure improvements were implemented in a timely manner and full staff meetings were used to discuss learning outcomes and within the local CCG.

• Information about safety was highly valued and used to promote learning and improvement. Risk management was comprehensive, well embedded and recognised as the responsibility of all staff.
• Staff assessed patients’ needs and delivered care in line with current evidence based guidance. Staff had the skills, knowledge and experience to deliver effective care and treatment.
• Data from the GP survey was consistently high, this included access to appointments and confidence in care provided by GPs, where 100% of patients surveyed agreed they had confidence and trust in the last GP they saw or spoke to.
• Patients said they were treated with compassion, dignity and respect and they were involved in their care and decisions about their treatment.
• Patients said they found it easy to make an appointment with a named GP and there was continuity of care, with urgent appointments available the same day.
• There was a clear leadership structure and staff felt supported by management. The practice proactively sought feedback from staff and patients, which it acted on.

We saw areas of outstanding practice:

• The practice assessed appointments several times a day and when demand was high additional appointments were assigned for patients, reception staff were empowered to be patient advocates and accommodated patients’ needs. In practice this meant the vast majority of patients had access to an appointment on the same day.

• Patients whose circumstances may make them vulnerable were able to see a GP or nurse without an appointment as this was found to improve attendance and accommodate their often chaotic lifestyles.The practice also allowed patients to use the practice address for post, allowing other agencies to engage and support patients where appropriate.

• The practice staff had highlighted risks in administering adrenalin in an emergency. To mitigate this, a visual guide had been produced for quick reference to ensure the correct dose was administered to the patient.

• The practice were routinely updating policies and procedures to reduce future reoccurrence of risks highlighted from significant events and complaints.Significant event analysis was comprehensively reviewed to ensure updates were effective.

Professor Steve Field (CBE FRCP FFPH FRCGP) 

Chief Inspector of General Practice

Updated 24 March 2016

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

• The practice had put in place dedicated clinics for the support of patients with long term conditions such as diabetes and breathing problems, and operated a recall system to ensure patients were receiving appropriate care. The results for patients with a long term condition were in line with national averages. For example:

  • The percentage of patients with COPD who had a review undertaken including an assessment of breathlessness in the preceding 12 months was 94% compared to a national average of 90%

• GPs and nursing staff had lead roles in chronic disease management and patients at risk of hospital admission were identified as a priority. Care plans were in place for the patients identified as being at risk of admission.

• Longer appointments and home visits were available when needed.

The practice worked with community specialist nurses who ran clinics at the practice for conditions such as heart failure and diabetes.  The practice computer system was connected to the community team’s system to provide up to date clinical notes and seamless transfer of information.

Updated 24 March 2016

The practice is rated as outstanding for the care of families, children and young people.

• Immunisation rates were in line with national averages for all standard childhood immunisations.

• Following feedback from staff and patients the immunisation clinics were run by two nurses to ensure safety and so vaccines could be administered at the same time instead of one after another, reducing the stress caused to the patient.

• 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 recognised once children were removed from the at risk register could still be at risk, so developed a ‘vulnerable child in the family’ code to alert clinicians that additional support might be required. This code was regularly reviewed by the safeguarding lead, health visitor and school nurse.

• Appointments were available outside of school hours and the premises were suitable for children and babies. Urgent appointments were always available on the day.

Updated 24 March 2016

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

• The practice offered proactive, personalised care to meet the needs of older people in its population.

• It was responsive to the needs of older people, and offered home visits and urgent appointments for those with enhanced needs. Home visits were co-ordinated with relatives, carers and district nurses, with the patient’s consent, which allowed additional support and planning to be undertaken during the appointment.

• They worked effectively with multi-disciplinary teams to identify patients at risk of admission to hospital and to ensure their needs were met. For example the practice held a weekly meeting with the district nursing team to coordinate care.

• The percentage of people aged 65 or over who received a seasonal flu vaccination was 80% which was above the national average of 73%.

The practice had patients living in eleven local care homes which a designated GP visited each week undertaking urgent and routine appointments and health checks.  We spoke with staff at a care home who said the care the practice provided was compassionate and caring. The practice produced an updated patient summary every six months which assisted community health and social care teams, out of hours visits and ambulance crews gain a current medical history and provide effective care for the patient when the practice was closed.

Updated 24 March 2016

The practice is rated as outstanding 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. This included access to telephone appointments, text reminders and the availability of early morning appointments.

• The practice offered online services such as electronic prescriptions, and GP appointments were offered through the online booking system.

• Health promotion and screening was provided that reflected the needs for this age group.

Updated 24 March 2016

The practice is rated as outstanding 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 people experiencing poor mental health, including those with dementia.

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

• Clinicians had moved to a more sensitive dementia diagnostic tool (the Montreal Cognitive Assessment Tool) which the Partners found more accurate in the early diagnosis of dementia, despite the additional time it took to perform.

• There was 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 people with mental health needs and dementia.

Updated 24 March 2016

The practice is rated as outstanding for the care of people whose circumstances may make them vulnerable.

• The practice had an increasing Eastern European and Middle Eastern population and frequently made full use of interpreters to ensure effective communication.

• Homeless patients were encouraged to become full time patients so they could access healthcare and support when required. With the patients’ consent the practice would use its address for registration, which allowed post received at the practice to be collected by the patient, this assisted in referrals to other healthcare teams and support workers.

• The practice identified that appointments for this group often ended in missed or late attendance. To improve this, the practice encouraged patients to present at reception without an appointment whenever they felt in need of care or in crisis. An appointment would be found for them within 30 minutes of arrival and the patient seen by a nurse or GP as required. This has proved more acceptable to the patients in this group and has shown a marked increase in the attendance rate of homeless people as well as people with drug or alcohol problems.

• The practice offered learning disability checks and sent out invites to attend this annually, however found performing at least some of this review during regular appointments had a positive impact on the patients’ health even if the full review was not completed.

• The practice offered longer appointments for people who would benefit from one.

• The practice regularly worked with multi-disciplinary teams in the case management of vulnerable people.

• Staff knew how to recognise signs of abuse in vulnerable adults and children. For example all staff, including the reception team had completed training to recognise signs of domestic violence. 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.