The Leys Health Centre

Updated 18 January 2017

The Leys Health Centre has a patient list of approximately 10700 patients. It is located in Blackbird Leys, Oxford. The patient list had a much higher proportion of young children than average and lower numbers of older patients. The local area was socially and economically deprived, ranked as in the third most deprived according national deprivation rankings (10 least deprived 1 most deprived). The practice is registered to provide services from: The Leys Health Centre, Dunnock Way, Oxford, Oxfordshire OX4 7EX.

There are seven GP partners at the practice and one salaried GP. There are seven female and 1 male GP. There are five female practice nurses and two healthcare assistants, plus phlebotomists. A number of administrative staff and a practice manager support the clinical team.

At the time of our last comprehensive inspection there were 6.1 whole time equivalent (WTE) GPs and three WTE nurses.

The practice was open between 8.30am and 6.00pm Monday to Friday and appointments were available during these times. During 8am to 8.30am and 6pm to 6.30pm an external provider covered the phones to provide patients with access to a clinician if required. However, this was not made clear on the practice website to inform patients of how they could access GP services during these times. Extended surgery hours were provided from 6.30pm to 8pm on Mondays and 8.30 to 10.30pm 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.

This is a training practice.

Updated 18 January 2017

Letter from the Chief Inspector of General Practice

We carried out an announced comprehensive inspection at The Leys Health Centre on 24 February 2016. Overall the practice is rated as good, improvements are required in providing responsive 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.
• 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 difficult to make an appointment with a GP.
• 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 found one area of outstanding practice:

• The practice considered and went beyond its contractual obligations in providing support to some its most vulnerable patients. For example:
  • The practice had led on a scheme to provide mentoring to young patients (16-24) who were encountering social or personal problems, potentially at risk of developing mental health issues. The practice referred patients onto the project during the initial pilot in 2015 and this has been extended due to the feedback from those involved. Patients provided feedback and we were shown case studies where patients reflected positively on the scheme. Outcomes included better social contact, long term planning to meet needs and greater independence in tackling problems.
  • Staff worked with patients who they were aware had problems associated with poor housing conditions, including working with external organisations to try and improve these patients physical and mental wellbeing.
  • Staff identified that some patients did not find leaflets on their care and treatment easy to use. Therefore nurses developed pictorial guides along with written guidance on the practice leaflets for diabetes and asthma care.

The areas the provider must make improvements are:

• Ensure the appointment system and appointment availability enable patients to book appointments in a reasonable timeframe.

Areas the provider should make improvements:

• Ensure nurses are aware of the principles and requirements of the Mental Capacity Act 2005
• Review means to increase in the uptake of learning disability health checks.
• Identify how to promote better awareness of the bowel cancer screening to help increase uptake on the screening programme.

Professor Steve Field (CBE FRCP FFPH FRCGP) 

Chief Inspector of General Practice

Updated 6 May 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 97% 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.
• 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 6 May 2016

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

• The practice had led on a scheme to provide mentoring to young patients (16-24) who were encountering social or personal problems, potentially at risk of developing mental health issues. The practice referred patients onto the project during the initial pilot in 2015 and this has been extended due to the feedback from those involved.
• Local schemes which the practice participated in had reduced teenage pregnancy rates in the local area.
• Childhood immunisation rates for the vaccinations given were comparable to CCG averages. Vaccinations given to under two year olds were 90% (regional average 90%) and for five year olds they were 85% (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 6 May 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.
• Screening for conditions which patients in this population group may be at risk of was provided, such as dementia

Updated 6 May 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.
• Extended hours appointments were available including on Saturday mornings. The practice was proactive in offering online services as well as a full range of health promotion and screening that reflected the needs for this age group.

• Patient feedback on the availability of appointments from the national survey and on the day of inspection was poor.
• Phone consultations were offered to patients.
• Online appointment booking was available.

Updated 6 May 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 96% compared to the CCG average of 95% and national average of 93%.
• 93% of patients eligible for a care plan had one in place and reviewed in 2015/16.
• During 2014/2015, there were 231 patients assessed for dementia with 14 diagnoses.
• 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 led on a scheme to provide mentoring to young patients (16-24) who were encountering social or personal problems, potentially at risk of developing mental health issues. The practice referred patients onto the project during the initial pilot in 2015 and this has been extended due to the feedback from those involved.

Updated 6 May 2016

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

• Learning disability health check figures were low.
• The practice held a register of patients living in vulnerable circumstances including those with a learning disability.
• The practice offered longer appointments for vulnerable patients.
• GPs regularly worked with multi-disciplinary teams in the case management of vulnerable patients.
• A mentoring scheme offered young people with social, emotional or potential mental health problems with support.
• 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.
• Staff worked with patients who they were aware had problems associated with poor housing conditions, including working with external organisations to try and improve these patients physical and mental wellbeing.
• Staff identified that some patients did not find leaflets on their care and treatment easy to use. Therefore nurses developed pictorial guides along with written guidance on the practice leaflets for diabetes and asthma care.