Archived: North Bicester Surgery

Updated 4 July 2016

North Bicester Surgery is located in a purpose built medical centre within a modern housing estate. It serves a population of approximately 4,500 patients. There are a larger than average number of patients in the age groups 0 to 14 and 30 to 54 years. The practice is in an area of little or no income deprivation. There are two male GPs and one female GP. Two practice nurses and one health care assistant make up the nursing team.

The practice is open between 08:30 and 18:00 Monday to Friday. Appointments are from 08:30 to 11:00 every morning and 15:00 to 18:00 daily. Extended hours surgeries are offered at the following times on a Monday between 18:30 and 19:30 and Wednesday 18:30 to 19:15.

The practice had been inspected in January 2014, under regulations that have been superseded. At that time we found the practice had breached two regulations relating to staff support and quality monitoring. We issued the practice with compliance actions and they provided CQC with an action plan. The inspection in August 2015 was the first inspection under the new CQC comprehensive inspection approach and covered the full scope of regulations included in the Health and Social Care Act 2008 (Regulated Activities) Regulations 2014. There were further breaches of regulation identified relating to governance arrangements, quality monitoring, cleaning standards and appointments. The practice submitted another action plan to address these issues. During the focussed inspection in May 2016 we followed up on the issues identified from the inspection carried out in August 2015.

Services are provided from a single location at:

3 Barberry Place, Bure Park, Bicester, Oxfordshire, OX26 3HA

The practice has opted out of providing out of hours services to their patients. Out of hours services are provided by Oxfordshire Foundation NHS Trust via NHS 111. There are arrangements in place for services to be provided when the surgery is closed and these are displayed at the practice, in the practice information leaflet and on the patient website.

Updated 4 July 2016

Letter from the Chief Inspector of General Practice

We carried out an announced comprehensive inspection at North Bicester Surgery in August 2015. Breaches of the legal requirements were found relating to good governance. Following the comprehensive inspection, the practice wrote to us to tell us what they would do to meet the legal requirements in relation to these breaches.

We undertook this focussed inspection on 5 May 2016, to check that the practice had followed their plan and to confirm that they now met the legal requirements. This report only covers our findings in relation to those requirements. You can read the report from our last comprehensive inspection by selecting the ‘all reports’ link for North Bicester Surgery on our website at www.cqc.org.uk.

We carried out a focussed follow up inspection of North Bicester Surgery on 5 May 2016 to ensure these changes had been implemented and that the service was meeting regulations. The ratings for the practice have been reviewed in relation to our findings.

At the inspection in May 2016, we found the practice had not made many improvements since our last inspection on August 2015 and were still in breach of the regulation relating to good governance.

Specifically the practice:

• Carried out clinical audits in April and May 2016, but did not have an ongoing programme of audit.
• Had not made sufficient changes to improve the feedback received from patients relating to appointments and waiting times.
• Policies had been updated in April 2016 to reflect current legislation and guidance.
• Were not effectively monitoring cleaning standards and were missing risk assessment information for cleaning products.
• Had reviewed the complaints process to encourage development and learning, but did not share learning or outcomes with the whole practice or the PPG.
• Did not hold regular PPG meetings to gather feedback or discuss current trends, despite this being a concern raised in August 2015.

We have considered and reviewed the ratings for this practice to reflect these findings. The practice is rated as requires improvement for the provision of effective and responsive care and inadequate for well led services.

The areas where the provider must make improvements are:

• Ensure policies and procedures relating to the management of the service and health and safety are reviewed at intervals determined by a risk assessment of their relevance to the day to day running of the practice.

• Ensure general cleaning standards are monitored effectively to confirm that appropriate cleaning standards are achieved.

• Introduce a quality improvement plan, which includes the implementation of an audit plan and carry out completed audits that identify, assess and manage improvements in patient care in a timely manner. Implement and improve a system of operational audit cycles to ensure effective monitoring and assessment of the quality of the service.

• Ensure effective and sustainable actions are taken to respond to patient feedback in regard to waiting times for appointments and accessibility to appointments.

• Ensure learning from complaints are communicated consistently and effectively to all staff to reduce the risk of recurrence of similar events.

Where a service is rated as inadequate for one of the five key questions or one of the six population groups or overall, it will be re-inspected within six months after the report is published. If, after re-inspection, the service has failed to make sufficient improvement, and is still rated as inadequate for any key question or population group or overall, we will place the service into special measures. Being placed into special measures represents a decision by CQC that a service has to improve within six months to avoid CQC taking steps to cancel the provider’s registration.

Professor Steve Field (CBE FRCP FFPH FRCGP) 

Chief Inspector of General Practice

Updated 22 October 2015

The practice is rated as requires improvement for the care of patients with long term conditions. This is because we found the practice required improvement in the delivery of effective, responsive and well led services which applies to all population groups. However, GPs and nursing staff had lead roles in chronic disease management and patients at risk of hospital admission were identified as a priority. Longer appointments and home visits were available when needed. All these patients had a structured annual review to check that their health and medication 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.

Updated 22 October 2015

The practice is rated as requires improvement for the care of families, children and young people. This is because we found the practice required improvement in the delivery of effective, responsive and well led services which applies to all population groups. However, there were systems in place to identify and follow up children who may be at risk for varying reasons. Immunisation rates were high for all standard childhood immunisations. Appointments were available outside of school hours and the premises were suitable for children and babies. We saw good examples of joint working with midwives and health visitors.

Updated 22 October 2015

The practice is rated as requires improvement for the care of older people. This is because we found the practice required improvement in the delivery of effective, responsive and well led services which applies to all population groups. However, nationally reported data showed that outcomes for patients were good for conditions commonly found in older people. The practice offered personalised care to meet the needs of the older people in its population and had a range of enhanced services in dementia end of life care. It was responsive to the needs of older people, and offered home visits and a service to a local care home.

Updated 22 October 2015

The practice is rated as requires improvement for the care of Working age people (including those recently retired and students). This is because we found the practice required improvement in the delivery of effective, responsive and well led services which applies to all population groups. Patient feedback referred to difficulties in obtaining appointments and long waiting times when attending for appointments. However, telephone consultations are available, appointments can be booked on line and there are two evening clinics a week. A full range of health promotion and screening facilities are on offer that reflect the needs for this age group.

Updated 22 October 2015

The practice is rated as requires improvement for the care of people experiencing poor mental health (including people with dementia). This is because we found the practice required improvement in the delivery of effective, responsive and well led services which applies to all population groups. However, 91% of people experiencing severe mental health issues had a care plan. The practice regularly worked with multi-disciplinary teams in the case management of people experiencing poor mental health, including those with dementia.

The practice had told patients experiencing poor mental health about how to access various support groups and voluntary organisations. It had a system in place to follow up patients who had attended accident and emergency (A&E) where they may have been experiencing poor mental health.

Updated 22 October 2015

The practice is rated as requires improvement for the care of people whose circumstances may make them vulnerable. This is because we found the practice required improvement in the delivery of effective, responsive and well led services which applies to all population groups. The practice held a register of patients with a learning disability but had carried out annual health checks for less than half this group. However, the practice regularly worked with multi-disciplinary teams in the case management of vulnerable people. It had told 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.