Oakenhurst Medical Practice

Updated 25 November 2016

Oakenhurst Medical Practice is situated in the Barbara Castle Way Health Centre on Simmons Street in Blackburn at BB2 1AX. The practice serves a mainly urban population. The building is a large purpose-built health centre with several floors. The practice is situated on the third level accessed by a lift or stairs and provides level access for patients to the building with disabled facilities available. A minor surgery service for patients is also offered on a lower level within the same building. The practice shares the building with two other doctors’ practices and many other patient health services. The practice also has a branch surgery in the more rural area of Mellor at St Mary’s Gardens in Mellor at BB2 7JW. We did not visit the branch site as part of this inspection.

There is parking provided for patients in the underground car park of the building at a charge of 50 pence and the practice is close to public transport.

The practice is part of the Blackburn with Darwen Clinical Commissioning Group (CCG) and services are provided under a General Medical Services Contract (GMS) with NHS England.

There are four male and two female GP partners and one male and one female salaried GPs assisted by three practice nurses and two healthcare assistants. A practice manager, reception manager and 10 additional administrative and reception staff also support the practice. The practice is a teaching practice for GPs in training and medical students and also conducts research.

The main practice site is open from Monday to Friday 8am to 6.30pm and extended hours are offered on Wednesday until 8.30pm. The practice also offers early morning appointments from 730am to 8.30am about once a month. The practice branch site is open on Monday and Wednesday from 8am to 5.30pm and on Thursday and Friday from 8am to 4.30pm. The practice is part of a federation of GP practices and patients are also able to attend appointments at a local GP hub practice on Saturday and Sunday from 9am to 12noon. Appointments are offered at the Health Centre from 8.30am to 11.25am, from 12.30pm to 1.30pm and from 3pm to 6pm every weekday except Wednesday, when appointments are from 9.30am to 12.15pm, from 12.30pm to 1.30pm and from 3pm to 8.30pm. When the practice is closed, patients are able to access out of hours services offered locally by the provider East Lancashire Medical Services by telephoning 111.

The practice provides services to 9,761 patients. There are higher numbers of patients aged over 65 years of age (20%) than the national average (17%) and fewer numbers of patients aged under 18 years of age (21%) than the local average (25%).

Information published by Public Health England rates the level of deprivation within the practice population group as four on a scale of one to ten. Level one represents the highest levels of deprivation and level ten the lowest. Both male and female life expectancy is lower than the national average, 82 years for females compared to 83 years nationally and 77 years for males compared to 79 years nationally.

The practice has a higher proportion of patients experiencing a long-standing health condition than average practices (60% compared to the national average of 54%). The proportion of patients who are in paid work or full time education is lower (54%) than the local average of 57% and national average of 62% and the proportion of patients with an employment status of unemployed is 2% which is lower than the local average of 7% and the national average of 5%.

Updated 25 November 2016

Letter from the Chief Inspector of General Practice

We carried out an announced comprehensive inspection at Oakenhurst Medical Practice on 18 October 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 a system in place for reporting and recording significant events. There was evidence of shared learning from events and actions put in place although there was no formal documentation of actions taken and review of those actions. The practice sent us evidence following inspection to show that a comprehensive system had been put in place for future reporting and review.
• 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.
• The practice had developed a decision aid for consent for influenza vaccinations for patients where decisions needed to take account of the requirements of the Mental Capacity Act and Deprivation of Liberty Standards.
• Patients said they were treated with compassion, dignity and respect and they were involved in their care and decisions about their treatment.
• The practice had run a “Boo to Flu!” event for children to encourage uptake of the nasal ‘flu vaccination.
• 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 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 one area of outstanding practice:

• One of the practice GPs had won a Professionals Macmillan Excellence Award in November 2015 for a “Think Cancer” project. As a result of the project, all GP practices in the CCG had appointed Cancer Champions which had improved the diagnosis, care and treatment for patients suffering from cancer. The GP was also the lead GP for the CCG which won a National Patient Safety Award in 2016 that aimed to improve services, treatment and care at all stages of the cancer journey for patients.

The areas where the provider should make improvement are:

• Follow the procedure defined by the practice significant event analysis tool to allow for all actions taken as a result of analysis to be recorded and reviewed.
• Improve the identification of carers within the practice population.

Professor Steve Field (CBE FRCP FFPH FRCGP) 

Chief Inspector of General Practice

Updated 25 November 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.
• The practice’s performance was above the average of the clinical commissioning group (CCG) and the England average for the diabetes indicators outlined in the Quality and Outcomes Framework (QOF) for 2014/15.
• 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.
• All patients with asthma who had an emergency admission to hospital were telephoned after discharge and offered a face-to-face review at the practice.

Updated 25 November 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.
• The practice’s uptake for the cervical screening programme was 82%, which was comparable to the clinical commissioning group average of 80% and the national average of 82%.
• Appointments were available outside of school hours and the premises were suitable for children and babies. Same day appointments were available for children.
• We saw positive examples of joint working with midwives, health visitors and school nurses and a midwife visited the practice weekly.
• The practice had run a “Boo to Flu!” event recently. They had invited children eligible to receive nasal vaccinations against influenza into the practice on one evening and given out balloons. In this way they hoped to increase the uptake of vaccinations for children.

Updated 25 November 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.

• The practice had taken part in a project with a national charitable organisation to identify patients with significant frailty in order to provide support and exercise to maintain and improve mobility.
• The practice had 22 residential nursing and care homes in the practice area with approximately 70 patients in them and had appointed a named GP for each home. The GP was then responsible for providing care for those patients whenever possible and this provided continuity of care.
• The practice had changed the way that patients were encouraged to participate in the bowel screening programme and they had increased uptake from 59% in 2013 to 69% in 2016.
• Patients at risk of unplanned admission to hospital had an agreed recorded care plan in place to support them and their carers to take appropriate action when the patient’s health needs deteriorated.

Updated 25 November 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 a ‘Commuter’s Clinic’ on a Wednesday evening until 8.30pm for working patients who could not attend during normal opening hours. There were also appointments available on a Saturday and Sunday morning at the practice federation hub practice.
• There were telephone appointments available for patients.
• 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.

• Patients could order their repeat prescriptions in person at the practice, through local pharmacies, online and also by telephoning the practice.
• The practice offered a ’flu vaccination clinic on a Saturday.

Updated 25 November 2016

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

• 97% of patients diagnosed with dementia had their care reviewed in a face to face meeting in the last 12 months, which was higher than the local average of 88% and the national average of 84%.
• 94% of people experiencing poor mental health had a comprehensive, agreed care plan documented in the record compared to the local average of 92% and national average of 88%.
• The practice regularly worked with multi-disciplinary teams in the case management of patients experiencing poor mental health, including those with dementia.
• 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.
• 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. The practice had a high number of older patients with dementia and had appointed two staff members as dementia champions to aid communication with these patients.
• The practice had developed a decision aid for consent for ‘flu vaccinations for patients where decisions needed to take account of the requirements of the Mental Capacity Act and Deprivation of Liberty Standards.

Updated 25 November 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 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. They held meetings with health and social care services representatives to agree the best way to care for 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 offered a weekly clinic for patients suffering from substance misuse. One of the GPs ran this clinic with a key worker from the community substance misuse team.
• Other services visiting the practice as needed included members of the local patient eating disorders team and a specialist counsellor for patients experiencing post-traumatic stress disorder.
• The practice had identified approximately 10% of the patient population as non-English speaking and had added alerts to the electronic health record for these patients. Longer appointments could then be offered.