Windrush Medical Practice, Windrush Health Centre

Updated 17 June 2016

Windrush Medical Practice is located in a purpose built health centre that was opened in 2012. The practice occupies part of the grounds of Witney community hospital and is located over three storeys. The ground floor of the premises is sub-let to NHS property services where a range of health and social care services are located. These include podiatry and an urgent care ‘hub’ where patients from GP practices in West Oxfordshire can obtain a GP or nurse appointment when there are none available at their own practice. A commercial pharmacy is also located on the ground floor. The practice occupies the first and second floors of the centre. Treatment rooms and consulting rooms are on the first floor. Access to the practice is gained from either stairs or two lifts, one of which is large enough to accommodate an emergency trolley. There is parking available in the hospital grounds and a large public car park, offering free parking, is located to the rear of the practice. Bus routes run along the main road in front of the practice.

There are approximately 14,500 patients registered with the practice and the registered population is increasing. The practice is aware of the expansion of the local community and the premises are designed to accommodate further growth in the patient list. The age distribution of the registered patients is largely similar to the national averages. Although there is a slightly higher than average number of patients in the age group 65 to 79. National data does not show income deprivation to be a significant issue but the practice is aware of, and is able to identify, their patients with income deprivation issues. The practice serves two local traveller communities and a small group of Syrian refugees. Over 92% of the population are white British.

There are eight GP partners and three salaried GPs at the practice. Six of the GPs are male and five are female. There are 10 nurses (all female) at the practice who carry out various roles including medical research. Two of the nurses are qualified as independent prescribers and a third nurse is close to completion of their prescribing qualification. Four health care assistants and an assistant practitioner complete the nursing team.

The practice is a dispensing practice and the dispensary serves approximately 2,700 of the registered patients who live more than a mile from a pharmacy. The dispensary is staffed by a dispensary manager and a team of six dispensers and dispensing assistants. In addition there are two dispensary drivers who deliver prescriptions to patients who cannot attend the practice. The practice manager is supported by a large team of 32 administration and reception staff. Some of these staff are employed as cover for absence and holidays.

The practice offers both teaching of medical students and training for qualified doctors who wish to become GPs. Two trainee placements are available.

The practice is open for telephone calls from 8am every weekday morning and the doors open at 8.15am until 6.30pm from Monday to Friday. Appointments are available from 8.20am until 5.50pm each day. Extended hours clinics are held on a Friday morning from 7.30am until 8am and on Friday evening between 6.30pm and 7pm. In addition extended hours telephone consultations are offered on Monday, Wednesday and Thursday evenings from 6.30pm to 7pm

The practice has opted out of providing out of hours services to their patients. The out of hours service is provided by Oxford Health NHS Foundation Trust and is accessed by calling NHS 111. Advice on how to access the out of hours service is contained in the practice leaflet, on the patient website and on a recorded message when the practice was closed.

All services are provided from: Windrush Medical Practice, Welch Way, Witney, Oxfordshire, OX28 6JS.

The practice was subject to a CQC inspection in September 2014 when the CQC was testing new inspection methodologies and ratings were not applied. No concerns were identified at the inspection in 2014. This inspection was undertaken to check whether the practice was meeting regulations and to apply a rating to the service.

Updated 17 June 2016

Letter from the Chief Inspector of General Practice

We carried out an announced comprehensive inspection at Windrush Medical Practice on 5 May 2016. Overall the practice is rated as outstanding. Specifically it is rated outstanding for the provision of safe, effective and well led services and good for the provision of caring and responsive services.

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

• Staff understood and fulfilled their responsibilities to raise concerns and report incidents and near misses. All opportunities for learning from internal and external incidents were maximised.

• The practice used innovative and proactive methods to improve patient outcomes, working with other local providers to share best practice. For example, using e-mails and photographs to communicate with specialists at the local hospital to reduce the need for patients to travel to outpatient clinics.

• Feedback from patients about their care was consistently positive.

• The practice worked closely with other organisations and with the local community in planning how services were provided to ensure that they met patients’ needs. For example by providing a floor within the practice for visiting services such as audiology and orthopaedic clinics. They also hosted the ‘hub’ which provided an overflow facility for urgent GP and nurse appointments when practices in West Oxfordshire had filled their appointments.

• The practice implemented suggestions for improvements and made changes to the way it delivered services as a consequence of feedback from patients and from the patient participation group. For example a new telephone system had been installed and staff rosters amended to make more staff available to answer patient calls at peak times.
• The practice had modern and well maintained facilities and was well equipped to treat patients and meet their needs.
• The practice actively reviewed complaints and how they were managed and responded to, and made improvements as a result.
• The practice had a clear vision which had quality and safety as top priorities. The strategy to deliver this vision had been produced with stakeholders and was regularly reviewed and discussed with staff.
• The practice had strong and visible clinical and managerial leadership and governance arrangements.

• An innovative approach to training qualified doctors. This involved running a simulated clinic with case studies to prepare the doctors for their first clinics. GPs in training reported that this made them more prepared for their first clinics.

• Provision of a wide range of additional visiting services including sexual health clinics, podiatry, orthopaedic clinics, audiology clinics and counselling. This assisted patients to access services locally and avoid time consuming trips to the general hospital or other health services. An urgent care hub was also located on the premises for patients who needed to see a GP or nurse when appointments were not available at their own practice.

• The practice recognised the importance of providing services closer to the patient. When designing the medical centre additional space was provided to accommodate a growing population and additional local services.

• An innovative approach to training qualified doctors. This involved running a simulated clinic with case studies to prepare the doctors for their first clinics. GPs in training reported that this made them more prepared for their first clinics.

• Prompt and effective response to patient feedback. When feedback from the national patient survey identified difficulty in accessing the practice by phone the practice purchased a new telephone system, revised staff rosters to provide more staff to answer the phone and monitored call response time. Feedback from patients during inspection identified improvement in accessing the practice by phone.

We saw several areas of outstanding practice including:

• Operation of enhanced recall systems to ensure patients did not miss important tests or treatments. For example, GPs and nurses used information from hospital departments to remind patients who required a repeat test or scan at infrequent intervals. The risk of patients missing an important test was reduced.

• An improved and expanded prompt system to remind patients when they required tests and treatment. This was used to support patients with complex medical needs and long term medical conditions. For example, GPs were prompted to review whether a patient diagnosed with dementia required another person to act on their behalf in making decisions about care and treatment.

• Robust arrangements for use of technology to exchange information with hospital departments. Use of both e-mail and telemedicine with a range of hospital departments in a secure transfer system. This reduced the need for some patients to visit hospital outpatients and information returned from the hospital enabled prompt follow up for the patient with their named GP.

• Provision of a health information zone managed by the PPG. This included a computer terminal for patients to access information on local services and health promotion literature. The PPG members assessed useful information, often influenced by their discussions with other patients, to hold. They agreed what could be displayed with the practice. This information zone was for patients run by patients.Provision of services to 10 Syrian refugees and two local traveller communities. Feedback from these groups was positive. Particularly from members of the travelling community who benefitted from seeing their named GP for continuity of care. The practice record system alerted staff to book 30 minute appointments for members of the Syrian community and to book a translator who spoke the appropriate dialect.

Professor Steve Field (CBE FRCP FFPH FRCGP) 

Chief Inspector of General Practice

Updated 17 June 2016

The practice is rated as outstanding for the provision of safe, effective and well led services and was thus rated outstanding overall. This rating applies to all population groups.

• Nursing staff had lead roles in chronic disease management and patients at risk of hospital admission were identified as a priority.

• Diabetes care indicators showed that 88% of patients with diabetes were meeting target cholesterol levels compared to 84% average for the CCG and 80% national average. Data also showed that 96% of patients diagnosed with diabetes had received a foot examination compared to the CCG average of 90% and national average of 88%.

• 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 undertook additional tests and treatments for this group of patients and used a set of prompts in the patient records to enhance the care provided. For example, the system ensured new mothers who were diagnosed with diabetes received an additional blood test six weeks after giving birth.

• The practice used an expanded recall system to reduce the risk of patients with long term conditions missing follow up tests and treatments.

Updated 17 June 2016

The practice is rated as outstanding for the provision of safe, effective and well led services and was thus rated outstanding overall. This rating applies to all population groups.

• 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 patients 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 patients 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 80%, which was comparable to the CCG average of 83% and the national average of 82%.

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

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

• We saw examples of the practice making appropriate referrals to the local authority when GPs had concerns about child safety.

• A dedicated family planning clinic was available at the practice.

Updated 17 June 2016

The practice is rated as outstanding for the provision of safe, effective and well led services and was thus rated outstanding overall. This rating applies to all population groups.

• The practice offered proactive, personalised care to meet the needs of the older patients in its population.

• There were close links with the podiatry service to ensure that patients received additional support from their GP if the podiatrist had any concerns about other health matters.

• All patients aged over 75 had a named GP and were encouraged to see their named GP to facilitate continuity of care.

• The practice was responsive to the needs of older patients, and offered home visits and urgent appointments for those with enhanced needs.

• Care plans were in place for older patients with complex medical problems.

• The practice worked closely with the local community hospital to support older patients who needed short term care in hospital.

• The practice supported registered patients who moved into local care homes and wished to retain the services of their usual GP.

Updated 17 June 2016

The practice is rated as outstanding for the provision of safe, effective and well led services and was thus rated outstanding overall. This rating applies to all population groups.

• 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.

• Telephone appointments were available for patients who found it difficult to attend the practice and these extended beyond 6.30pm on three evenings every week.

• There were extended hours clinics held every Friday morning from 7.30am and Friday evening between 6.30pm and 7pm.

• The practice actively promoted smoking cessation and 189 patients had quit smoking in the last year.

• A range of health promotion opportunities were available and encouraged when appropriate. For example GPs referred patients for exercise classes.

Updated 17 June 2016

The practice is rated as outstanding for the provision of safe, effective and well led services and was thus rated outstanding overall. This rating applies to all population groups.

• 97% of patients diagnosed with a severe and enduring mental health problem had a care plan agreed with them compared to the CCG average of 86% 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 and included additional checks within the care plans. For example, the GPs checked whether the patient required a person to act as lasting power of attorney for decisions about care and treatment.

• The practice had told patients experiencing poor mental health about how to access various support groups and voluntary organisations. Counselling and talking therapy services were available at the practice.

• 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.

• All staff had received training in the Mental Capacity Act (2005) and understood the requirement to assess capacity of patients to make decisions about their care and treatment.

Updated 17 June 2016

The practice is rated as outstanding for the provision of safe, effective and well led services and was thus rated outstanding overall. This rating applies to all population groups.

• The practice held a register of patients living in vulnerable circumstances including homeless people, travellers and those with a learning disability.

• 81% of patients diagnosed with a learning disability had received an annual health check in the last year (58 patients out of 71).

• Feedback about practice services from members of the travelling community was positive. Members of this community had a named GP and were identified to ensure their need for prompt appointments was met.

• The practice regularly worked with other health care professionals in the case management of 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. 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. We saw records of safeguarding concerns being escalated to ensure the patient received relevant support.

• Translation facilities were available and actively promoted. When a patient required a translator their records were annotated to enable staff to book a translator in advance of an appointment. Some frequently used instructions and phrases were translated into a Syrian dialect and Polish because the practice was aware that members of these communities required additional support when attending for appointments.