Archived: Bury Knowle Health Centre

Updated 9 November 2016

Bury Knowle Health Centre has a patient list of approximately 16,000 patients. It is located in Headington, Oxford with branch practices in Wood Farm and Barton. It serves an urban population with some areas of deprivation. There is a higher proportion of patients between 15 and 35 years old than the national average. The number of patients over 50 is significantly lower than the national average. Bury Knowle Health Centre is a purpose built practice with all services located on one floor. It is accessible for disabled patients and those with limited mobility. There was parking including designated disabled parking. There are good bus services enabling access between sites for patients.

The practice is registered to provide services from: Bury Knowle Health Centre, 207 London Road, Oxford, Oxfordshire, OX3 9JA. The practice also provides services from Barton Surgery Neighbourhood Centre, Underhill Circus, Headington, Oxford OX3 9LS and Leiden Road, Headington, Oxford, OX3 8RZ. We visited Bury Knowle Health centre only as part of this inspection.

There are three GP partners at the practice, eight salaried (non-ownership status) partners with an additional six salaried GPs. There are also two non-GP practice manager partners. There are four male and 15 female GPs. There are seven female practice nurses and a female healthcare assistant and phlebotomist. A number of administrative staff, a practice manager and a business manager support the clinical team. There are 10 whole time equivalent (WTE) GPs and 5 WTE nurses.

The practice was open between 8.30am and 6.00pm Monday to Friday and appointments were available during these times other than from 12.30 to 1.30pm on Wednesdays. From 8am to 8.30am and from 6pm to 6.30pm an external provider is available to take patient calls and provide assistance if necessary. There are extended hours appointments from 7.30am on Tuesdays and Fridays, 6.30pm to 7pm Wednesdays and from 8.15 to 11.15am on Saturday mornings. When the practice was closed patients could access out of hours GP services by calling 111. This was clearly displayed on the practice’s website.

Updated 9 November 2016

Letter from the Chief Inspector of General Practice

We carried out an announced comprehensive inspection at Bury Knowle Health Centre on 9 February 2016. Overall the practice is rated as good. However, there are improvements required in providing effective services.

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.
• Medicines were managed safely.
• 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.
• National data suggested patients received their care in line with national guidance. However, there were high levels of exception reporting compared to national and local averages and this had not been fully explored by the practice.
• 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.
• Patients said they found it easy to make an appointment with a GP and that 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.
• Governance arrangements were in place for non-clinical aspects of the service.
• The provider was aware of and complied with the requirements of the Duty of Candour.

We saw one area of outstanding practice:

• The practice led on a pilot project to improve holistic care for patients with complex conditions. A ‘social prescriber’ was employed by the practice as part of a practice initiative, supported by the local clinical commissioning group, to target high need and vulnerable populations in two deprived wards within the practice catchment area. This role supported patients who may need various support from the community. For example, staff were concerned about one elderly patient who had become insecure and disorientated in their own home. The social prescriber was able to speak with various support agencies and the patient had additional support which may not have been identified without the intervention, leading to greater independence and peace of mind for the patient. The practice provided nine case studies where the social prescriber had made an impact on patient care. A total of 62 patients had been identified and attended the service between July and December 2015.

The areas where the provider must make improvement are:

• Identify causes of exception reporting, ensure that patients are only exempted when appropriate and reduce exception reporting where possible.

The areas where the provider should make improvement are:

• Consider purchasing a hearing aid loop.
• Review the uptake of learning disability health checks to improve the low uptake.
• Ensure patients are made aware how they could access GP services during usual practice contracted hours when the practice is not open. Namely 8-8.30am and 6-6.30pm.
• Review and identify means of improving uptake of bowel cancer and breast screening, child immunisations and flu vaccination rates.

Professor Steve Field (CBE FRCP FFPH FRCGP) 

Chief Inspector of General Practice

Updated 31 March 2016

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

• The practice followed guidance in the management of chronic diseases.
• Patients at risk of hospital admission were identified and had care plans written where appropriate.
• The practice achieved 100% on its quality outcomes framework scores (QOF) in 2015. QOF is a quality system to measure the performance and quality of patient care and treatment. However, high numbers of patients were exempted from these figures. The practice could not account for whether exempted patients received care they required and whether those exemptions were appropriate.
• The care of long term conditions was audited to identify where improvements in the management of a specific condition could be made.
• Longer appointments and home visits were available when needed.
• There was a process to offer a periodic structured review to check patients’ health.
• There was monitoring of patients on long term medicines.
• 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.

Updated 31 March 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.
• Childhood immunisation rates for vaccinations given to under two year olds were 86% (regional average 90%) and for five year olds they were 91% (regional average 95%).
• Staff were aware of the circumstances and rights when gaining consent from patients under 16.
• Baby changing facilities were available.
• GPs worked with midwives and health visitors in the provision of care.

Updated 31 March 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 patients in its population.
• Care plans were available for patients deemed at high risk of unplanned admissions.
• Access for patients with limited mobility was good including for those with mobility scooters.
• There were named GPs for this group of patients.
• The practice provided screening for conditions which patients in this population group may be at risk of, such as dementia.

Updated 31 March 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 of this age group.
• There were extended hours appointments available.
• Patient feedback on the availability of appointments from the national survey and on the day of inspection was positive.
• Phone consultations were offered to patients.
• Online appointment booking was available.

Updated 31 March 2016

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

• Performance for mental health related indicators was 100% compared to the CCG average of 95% and national average of 93%. Exception reporting on national data for mental health indicators was 20% compared to the national average of 11%.
• In 2014/15 91% of patients eligible for a care plan had one completed.
• Patients on high risk medicines for mental health conditions received blood tests to ensure they were safe to continue taking these medicines. During 2014/2015, there were 77 patients assessed for dementia. The overall practice diagnosis rate was 84% of the predicted prevalence, based on the national averages and the patient list’s characteristics such as age profiles .
• The practice regularly worked with multi-disciplinary teams in the case management of patients experiencing poor mental health, including those with dementia.

Updated 31 March 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.
• Learning disability health check figures were low.
• The practice offered longer appointments for vulnerable patients.
• GPs regularly worked with multi-disciplinary teams in the case management of vulnerable patients. This was supported by the work of a social prescriber whose role was to improve joint working with external services to provide a more holistic package of care to 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.