Oak Vale Medical Centre Also known as Dr Michael Cranney & Partners

Updated 7 January 2016

Dr Moya F Duffy and Partners (known locally as Oak Vale Medical Centre) is registered with the Care Quality Commission to provide primary care services. It provides GP services for approximately 6388 patients living in the Childwall area of Liverpool. The practice is situated in a new building and covers two floors with lift access for patients. The practice has seven GP partners, both male and female. They also have a number of salaried GPs and they take GP trainees. The practice has a practice manager, office manager, administration staff and practice nursing team. Dr Moya F Duffy and Partners holds a General Medical Services (GMS) contract with NHS England.

The practice is open Monday – Friday 8am to 6.30pm with the phone lines opening for appointments starting at 8am. Extended hours are available on a Wednesday evening till 8pm. Patients can book appointments in person, via the telephone or online. The practice provides telephone consultations, pre-bookable consultations, urgent consultations and home visits. The practice treats patients of all ages and provides a range of primary medical services.

The practice does not provide out of hours services. When the surgery is closed patients are directed to the local out of hour’s service provider (Unplanned Care 24), local NHS walk in centres and NHS 111 for help.

Updated 7 January 2016

Letter from the Chief Inspector of General Practice

We carried out an announced comprehensive inspection at Dr Moya F Duffy and Partners, also known as Oak Vale Medical Centre, on 5 November 2015. Overall the practice is rated as good.

Please note that when referring to information throughout this report, for example any reference to the Quality and Outcomes Framework data, this relates to the most recent information available to the CQC at that time.

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

• Systems were in place to ensure incidents and significant events were identified, investigated and reported. All staff were aware of what constituted a significant event and they fulfilled their responsibilities to raise concerns and to report incidents. Information about safety was recorded, monitored, appropriately reviewed and addressed although action plans were not routinely used to monitor changes implemented.

• Patients’ needs were assessed and care was planned and delivered following best practice guidance. Staff had received training appropriate to their roles and any further training needs had been identified and planned.
• 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 readily available in document form for patients.
• The practice had recently introduced a new system for booking appointments with GPs known as ‘Doctor First’. The practice explained that patients were satisfied with these changes because they could have direct access to a doctor’s advice without the need for a face to face appointment.
• 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.

We saw areas of outstanding practice including:

• The practice routinely sends a birthday card to all patients each year reaching their 75th birthday. This was known as the ‘Forget-me-Not’ initiative. Within the card there was also a patient health questionnaire for them to complete and return. This initiative has helped to identify potential physical problems and mental health issues, such as dementia and mild cognitive impairment (MCI).

• Reception staff were identified as a ‘dementia buddy’ for patients and carers with this condition. Reception staff had put together a resource pack with useful information to support patients and families with dementia. Plans were in place to invite patients and carers into the practice to discuss the contents of the pack and to signpost them to agencies across the community that could support the families.

However, there were also areas of practice where the provider needs to make improvements.

The provider should:

• Review the records made of serious events and incidents to ensure that risks have been appropriately identified and actions plans have been put into place.

Professor Steve Field (CBE FRCP FFPH FRCGP) 

Chief Inspector of General Practice

Updated 7 January 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. Longer appointments and home visits were available when needed. All these patients had a named GP and a structured annual review to check that their health and medication needs were being met. For those people with the most complex needs, the named GP worked with relevant health and care professionals to deliver a multidisciplinary package of care. The practice takes a proactive approach towards flu and pneumonia, inviting patients on the telephone and by letter to attend a special walk-in clinic, some held on Saturdays, some evenings too and opportunistically when they come to surgery.

Updated 7 January 2016

The practice is rated as good for the care of families, children and young people. All patients were able to register for on-line access. They can download the app to book or cancel appointments. Other facilities were also available such as, ordering repeat medication, viewing allergies and vaccination history, all from patient’s computers, laptops, tablets and phones.

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. Patients told us that children and young people were treated in an age-appropriate way and were recognised as individuals, and we saw evidence to confirm this. 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, health visitors and school nurses.

The practice has spacious waiting areas and consultation rooms to accommodate prams and young children. There were reading and play areas for children. Breast feeding was encouraged and nappy changing facilities were available. Expectant mums can be seen each week for their antenatal care by the community midwife, which were based in the practice. Any problems or concerns that were identified by the midwife would be addressed by any of the doctors in the practice. At the time of the inspection the practice had just begun the baby and child immunisation and vaccination programme delivered by practice nurses. For teenagers and young people the practice offered sexual health advice and most forms of contraception.

Updated 7 January 2016

The practice is rated as outstanding for the care of older people. Nationally reported data showed that outcomes for patients were good for conditions commonly found in older people. The practice offered proactive, personalised care to meet the needs of the older people in its population and had a range of enhanced services, for example, in dementia and end of life care.

We heard the practice routinely sends a birthday card to all patients each year reaching their 75th birthday. This was known as the ‘Forget-me-Not’ initiative. They received a birthday card from the practice which included a health questionnaire for them to complete and return. This project has helped to pick up potential physical problems and mental health issues, such as dementia and mild cognitive impairment (MCI). All patients scoring 13 or more are followed up by a GP and referral to secondary care if required.

During the autumn and winter months of 2014/2015 the practice signed up for a local enhanced service, known as Community Geriatric Assessment (CGA’s). The practice exceeded the numbers identified with completing over 400 assessments and the CCG shared the work they had achieved with other practices across the area. These assessments enabled the practice to identify patients with early onset dementia, or MCI, which may well have gone undetected. All GPs attended training with the local Geriatric Consultant which included increasing their understanding of the importance of having Anticipatory Care Plans (ACP’s) in place for older patients identified at risk.

In addition to this work a number of reception staff were identified as a ‘dementia buddy’ for patients and carers with this condition. Reception staff had identified themselves that there was a lot of information available to support these families and they pulled this together a pack of useful resources and contacts. Plans were in place to invite patients and carers into the practice to discuss the contents of the pack.

Updated 7 January 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.

Updated 7 January 2016

The practice is rated as good for the care of people experiencing poor mental health (including people with dementia). The practice regularly worked with multi-disciplinary teams in the case management of people experiencing poor mental health, including those with dementia. It carried out advance care planning for patients with dementia. The lead GP regularly provided comprehensive home visits for patients with severe mental illness and hard to reach patients. 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. Staff had received training on how to care for people with mental health needs and dementia.

Updated 7 January 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 and had carried out annual health checks for people with a learning disability. They offered longer appointments for people with a learning disability. 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.