Dr H Tattersfield & Mr M Lenzi Also known as Oakview Family Practice

Updated 3 March 2017

Letter from the Chief Inspector of General Practice

We carried out an announced comprehensive inspection of the practice on 8 March 2016. Breaches of the requirements of the Health and Social Care Act 2008 (Regulated Activities) Regulations 2014 were found and the practice was rated as Requires Improvement for Safety. After the comprehensive inspection, the practice wrote to us to say what they would do to address the breaches of regulation. We undertook this focussed inspection on 28 November 2016 to check that they had followed their plan and to confirm that they now met the legal requirements. This report covers our findings in relation to those requirements and also where other improvements have been made following the initial inspection. You can read the report from our last comprehensive inspection by selecting the ‘all reports’ link for Dr H Tattersfield & Mr M Lenzi on our website at www.cqc.org.uk. Overall the practice is rated as Good. Specifically, following the focussed inspection we found the practice to now be good for providing safe services.

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

• Risks to patients were assessed and well-managed, including those related infection prevention and control, fire and electrical safety and equipment for dealing with medical emergencies.

Professor Steve Field CBE FRCP FFPH FRCGP

Chief Inspector of General Practice

Updated 22 June 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 ran a specific diabetic clinic. The practice nurse was trained to initiate insulin, meaning that patients did not have to travel to hospital if they needed to start taking insulin to manage their diabetes.

• A dietician visited the practice once a month to advise patients.

• Three members of staff were trained to provide intensive one-to-one advice to help patients stop smoking.

• 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 developed the knowledge of its staff as the needs of the patients changed. For example, when staff identified a number of children with sickle cell anaemia, the practice asked a specialist sickle cell anaemia nurse to come to provide training.

Updated 22 June 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.

• The practice sent all new parents a congratulations card with an invitation to the baby clinic and details of local baby groups.

• The weekly baby clinic was run by a GP, a practice nurse and a health visitor.This allowed families in need of extra support to be identified and appropriately directed. We heard examples of vulnerable families receiving support when they needed it.

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

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

• The practice established a nutrition programme (that became Downham Nutrition Partnership) encouraged healthy eating, education in cooking and growing food particularly for those with young children.

Updated 22 June 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.

• For specific frail or vulnerable patients (flagged on the computer system) the practice accepted telephone requests for repeat prescriptions.

• The practice had links with local community groups, and referred older people to social groups, community exercise programmes and volunteer visiting schemes, to provide holistic person-centred care.

Updated 22 June 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 as well as a full range of health promotion and screening that reflects the needs for this age group.

• The practice invested in a system that sends appointment reminders and allows patients to cancel and re-book appointments without needing to call. Where appropriate, test results are sent by text message.

• The practice offered minor surgery and joint injections, saving patients a visit to hospital for these procedures.

Updated 22 June 2016

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

• The percentage of patients with schizophrenia, bipolar affective disorder and other psychoses whose alcohol consumption was recorded in the preceding 12 months was 94%, compared to 90% nationally.

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

• Staff had a good understanding of how to support patients with mental health needs and dementia.

Updated 22 June 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 multi-disciplinary teams in the case management of vulnerable people.

• 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.