Goring & Woodcote Medical Practice

Updated 3 October 2016

Goring & Woodcote Medical practice provides GP services from two surgeries to just over 9,600 patients in a large rural area of South Oxfordshire. The practice serves an area with very low levels of deprivation. Ethnicity based on demographics collected in the 2011 census shows the population of the surrounding area is predominantly White British. It has more patients aged between 10 and 19 and aged 40 and above than the national average, and fewer aged between 20 and 39. Just over 54% are in paid employment or full time education compared to the national average of 62%.

The practice’s patient population has a longer life expectancy than the national average, and it has a high number of elderly patients, with 157 aged 90 or above, and five aged over 100. In total, 64% of its patients have a long standing health condition, compared to the national average of 54%. The practice covers four care homes, with GPs undertaking weekly visits, as well as an assistant living complex. It is also the main practice for a local boarding school and a large farming estate.

The practice has six GP partners, four male and two female, and three salaried GPs, two female and one male, equivalent in total to 6.25 whole time GPs. There are five practice nurses, equivalent to just over two whole time, two healthcare assistants and a phlebotomist. It also provides office space for the local district nursing and health visitor teams.

The practice is a training practice, and currently has four GP Registrars. GP Registrars are qualified doctors who are undertaking additional training to gain experience and higher qualifications in general practice and family medicine. It also recently supported a GP returner to re-qualify after a number of years away from the profession, and is accredited to train practice nurses.

The practice had a dispensary at both the surgeries in Goring and Woodcote, which can provide pharmaceutical services to patients who live more than one mile (1.6km) from their nearest pharmacy premises. Five dispensers, including the dispensary manager, work at the Woodcote surgery, and two work in the Goring surgery.

The practice is open from 8am to 6.30pm Monday to Friday at both surgeries, with extended hours openings on one weekday a week until 8pm, alternating between the two surgeries, and from 8.30am until midday every other Saturday, again alternating between the surgeries. Both GP and nurse appointments are available during the extended hours surgeries. The out of hours service is provided by Oxford Health and is accessed by calling NHS 111. Advice on how to access the out of hours service is contained in the practice leaflet, on the patient website, on television screens in both waiting rooms, and on a recorded message when the practice is closed.

Services are delivered from:

Goring Surgery

Red Cross Road

Goring

RG8 9HG

And

Woodcote Surgery

Wayside Green

Woodcote RG8 0QL.

We visited both surgeries as part of this inspection. The practice has not been previously inspected by the CQC.

Updated 3 October 2016

Letter from the Chief Inspector of General Practice

We carried out an announced comprehensive inspection at Goring & Woodcote Medical Practice on 27 July 2016. Overall the practice is rated as good.

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.
• Risks to patients were assessed and well managed.
• Staff assessed patients’ needs and delivered care in line with current evidence based guidance. Staff had been trained to provide them with the skills, knowledge and experience to deliver effective care and treatment.
• Patients said they were treated with compassion, dignity and respect and they were involved in their care and decisions about their treatment.
• Information about services and how to complain was available and easy to understand. Improvements were made to the quality of care as a result of complaints and concerns.
• 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.
• The practice had good facilities and was well equipped to treat patients and meet their needs.
• 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.
• The provider was aware of and complied with the requirements of the duty of candour.

We saw areas of outstanding practice:

• The practice had identified 550 patients as carers (6% of the practice list) through a sustained campaign to raise awareness among patients and staff, including at the annual flu clinics and as a regular agenda items at practice meetings. The practice supported the monthly meetings of the local carers’ group, which were advertised in the waiting rooms on dedicated carers’ noticeboards and the information screens. Members of the practice team attended these meetings to speak on a variety of subjects, and a member of the carers; group was a representative on the practice's patient participation group. One of the reception team had been identified as the practice’s carers’ champion, and one of the GP partners led on carer issues. Both were due to attend a carers' rights conference in Oxford later this year, to keep abreast of current issues and share their learning with the practice.

• The practice had been running on site memory clinics for patients with possible dementia, to reduce the need for hospital referral, and had been feeding back on these to the Clinical Commissioning Group (CCG). A survey of patients using this service had been undertaken in March 2016, and had received positive feedback. Through dementia diagnosis, the practice had achieved 100% for the expected prevalence of the condition among its practice population, leading the 10 other GP practices in the South East Oxfordshire locality.

The area where the provider should make improvement is:

• Ensure that decisions to except patients from national targets for receiving treatment or attending clinical reviews for long term conditions continue to be effectively monitored and reviewed.

Professor Steve Field (CBE FRCP FFPH FRCGP) 

Chief Inspector of General Practice

Updated 3 October 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 above the national average. The percentage of patients with diabetes whose last test showed long-term blood glucose control at or below the recommended level, was 88% compared to a CCG average of 79% and a national average of 78%.

• The practice had run a programme to pro-actively identify patients indicating a higher risk of developing diabetes. These patients were provided with support and advice, with the aim of reducing their likelihood of developing diabetes in the future.

• Longer appointments 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, the named GP worked with relevant health and care professionals to deliver a multidisciplinary package of care.

• The practice had home monitoring equipment available for loan, such as blood pressure machines.

Updated 3 October 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. 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.

• 81% of female patients aged 25 to 64 had received a cervical screening test within the target period, compared to a CCG and national average of 74%.

• Appointments were available outside of school hours and the premises were suitable for children and babies.

• We saw positive examples of joint working with midwives, health visitors and school nurses.

• The practice installed child-friendly soap dispensers in the patient toilets to encourage hand washing.

• The practice had designed a template to aid the prompt diagnosis of sepsis, a serious blood condition, following a significant event. The template was developed and implemented before the recent release of new NICE guidelines on sepsis.

• The practice had pulse oximeters designed to check the oxygen levels of babies and young children.

• There was a young persons’ representative on the practice’s patient participation group to focus on their needs and requirements when service provision was being considered.

Updated 3 October 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 when clinically appropriate.

• The practice had a named GP for each of the four care homes it provided GP services for, who undertook a weekly visit.

• The practice had designed patient self-care leaflets for minor ailments, and these were available in large print for patients who required them.

Updated 3 October 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 offered Saturday morning and weekday evening clinics for working patients who could not attend during normal opening hours.

• 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 had achieved the joint highest rate of attendance in Oxfordshire for patients aged 40 to 65 invited for NHS health checks with health care assisants.

• The practice had hosted the local mobile breast screening facility in its car park.

• A weight loss clinic was run by one of the practice’s health care assistants.

Updated 3 October 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.

•  The practice had been running on site memory clinics for patients with possible dementia, to reduce the need for hospital referral, and had been feeding back on these to the Clinical Commissioning Group (CCG). A survey of patients using this service had been undertaken in March 2016, and had received positive feedback.

• Through dementia diagnosis, the practice had achieved 100% for the expected prevalence of the condition among its practice population, leading the 10 other GP practices in the South East Oxfordshire locality.

• Advance care planning was carried out for patients with dementia.

• Patients experiencing poor mental health were told about how to access various support groups and voluntary organisations.

• A counsellor visited the practice weekly, to support patients with depression and low mood.

• The practice had 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 patients with mental health needs and dementia.

Updated 3 October 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 homeless people, travellers and those with a learning disability.

• The practice offered longer appointments for patients with a learning disability.

• The practice regularly worked with other health care professionals in the case management of vulnerable patients.

• 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.

• The practice had identified 6% of its patient list as carers. It actively supported the local carers group, and a receptionist was the carers’ champion and a GP partner was carers' lead. There was a representative of the carers’ group on the practice’s patient participation group. 

• An addictions counsellor visited the practice weekly, and the practice made referrals to the local drug and alcohol service when required.

• All patients were allocated a “usual” GP, and would be given appointments to see that GP, their “buddy” or the registrar they were training whenever possible, to ensure continuity of care. Vulnerable patients were prioritised for this service.

• The practice’s triage policy was patients who contacted the practice requesting urgent same day medical help or advice would be able to speak to a GP within the target period of one hour.

• There was a representative from the local mobility issues group on the patient participation group, to consider the needs of patients with physical disabilities.