The Abingdon Surgery

Updated 21 July 2016

The Abingdon Surgery is located in the centre of Abingdon in two converted buildings. The first practice on the site had opened in 1902 since when many different practices had delivered services from the site.

The current practice delivers services to patients from ground floor consulting and treatment rooms with level access from the practice car park. There are bus services running close by the practice and a car park for patients is available to the rear of the practice.

Seven GPs currently work at the practice and an eighth has been appointed to start in August 2016. Six of the GPs are partners. One is a salaried GP working towards partnership. The new GP due to start in August will commence in a salaried role and will work towards joining the partnership. Three of the GPs are male and four are female. There are three practice nurses and two health care assistants in the practice nursing team. All are female. The practice manager is supported in the day to day management of the practice by a team of 15 administration and reception staff. The practice employs a full time care navigator. A clinical pharmacist has been appointed and will join the practice in July 2016.

The practice is accredited to provide training to qualified doctors who are seeking to become GPs. Placements are also offered to medical students.

The practice is open between 8am and 6.30pm every weekday. Appointments are from 8.30am to12pm every morning and 2.30pm to 5.30pm daily. Patients requiring urgent appointments are seen or receive a telephone consultation after 5.30pm. Extended hours appointments are offered on Monday and Thursday evenings between 6.30pm and 8.30pm and every Saturday between 8am and 11.30am.

There are approximately 13,700 patients registered at the practice and the practice population has grown by around 3000 since 2010. The age profile of the registered patients shows a slightly higher than average number of patients aged under 5 and between the ages of 25 and 39. Sixteen per cent of the registered patients are over the age of 65. Nationally reported data shows that income deprivation was low amongst the practice population. The income deprivation score was nine on a scale of 10 (lower scores indicate a higher level of deprivation). The majority of the registered patients are white British with English as a first language.

All services are provided from:

The Abingdon Surgery, 65 Stert Street, Abingdon, Oxfordshire, OX14 3LB

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.

This is the first inspection of The Abingdon Surgery using the CQC comprehensive inspection methodology under regulations that came into force after April 2014. The practice was inspected in March 2014 using a previous inspection process. At that time the practice was found to be compliant with the regulations that were in force.

Updated 21 July 2016

Letter from the Chief Inspector of General Practice

We carried out an announced comprehensive inspection at The Abingdon Surgery on 16 June 2016. Overall the practice is rated as good. Specifically it is rated as outstanding for the provision of responsive services and good for provision of safe, effective, caring and well led 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. Staff demonstrated a commitment to reporting any incidents and near misses and described the practice as having a no blame culture.
• Risks to patients were assessed and were generally well managed.
• Staff assessed patients’ needs and delivered care in line with current evidence based guidance. Staff had been trained to provide them with the skills, knowledge and experience to deliver effective care and treatment.
• The practice registered patients with mental health problems who resided at a local hostel. This facility provided five places for people who required short term following discharge from hospital. Staff supported these patients for all their physical and social needs to assist them in settling into the community.
• Feedback from patients was consistently positive in regard to being treated with compassion, dignity and respect. Patients told us they benefitted from continuity of care arising from the GPs operating a personal list system. Patients commented that their care often exceeded their expectations.
• Feedback from patients was strong in regard to their involvement in their care and decisions about their treatment.
• Information about services and how to complain was available and easy to understand. Improvements were made to the quality of care as a result of complaints and concerns.
• Patients said they found it easy to make an appointment with their named GP and there was continuity of care. Routine appointments were available within two days and urgent appointments available the same day. Patient feedback was consistently positive in regard to accessing the practice and obtaining appointments with GPs and nurses on days and times that suited their needs.

• 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.
• The provider was aware of and complied with the requirements of the duty of candour.
• The practice worked closely with the local clinical commissioning group (CCG) (A CCG is a group of general practices that work together to plan and design local health services in England. They do this by 'commissioning' or buying health and care services). For example they had obtained funding to appoint a clinical pharmacist to expand the range of services offered at the practice.

• The practice used innovative and proactive methods to improve responsive patient outcomes. It worked with other local providers to reduce the number of visits patients made to hospital clinics. For example, using e-mails and photographs to communicate and consult with specialists at the local hospital.

• The practice also used e-mail for some consultations with patients. We saw examples of this service benefitting patients.

We saw areas of outstanding responsive practice:

• The practice employed their own care navigator to assist patients with complex needs in accessing appropriate services and support organisations.

• The practice appointment system, coupled with a firm commitment to patients seeing their named GP, enabled patients to obtain routine appointments within two working days.

• A variety of extended hours clinics were available to assist patients who were unable to attend during normal surgery opening hours. Clinics ran until 8.30pm on two evenings each week and every Saturday morning from 8am to 11.30am.

The areas where the provider should make improvement are:

• Review the role of the PPG to ensure it meets the needs of the registered patients and the practice.

• Review the annual health checks for patients with a learning disability to increase the uptake and increase the number of care plans for this group of patients.

• Maintain records of the discussions at the practice nurse team meetings.

Professor Steve Field (CBE FRCP FFPH FRCGP) 

Chief Inspector of General Practice

Updated 21 July 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.

• The practice achieved 100% of the indicators for care of patients diagnosed with diabetes compared to the CCG average of 93% and national average of 89%.

• 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 reviews of patients with more than one long term condition was co-ordinated to reduce the number of visits they made to the practice.

Updated 21 July 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 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 performance for the cervical screening programme was 82%, 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.

Updated 21 July 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.

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

• Older patients who required support in accessing benefits and resources were supported by the practice’s care navigator.

• Continuity of care was provided to older patients who moved into any one of four local care homes.

• 100% of patients aged over 75 with a fragility fracture had been treated with the appropriate medicine. Compared to 82% CCG average and 80% national average. The practice achieved this without exempting any patients from the target.

Updated 21 July 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.

• The practice offered extended hours clinics until 8.30pm on two weekdays and a Saturday morning clinic every week between 8am and 11.30am.

• E-mail consultations were available for patients who found it difficult to attend the practice during opening hours.

• The practice employed e-mail and telemedicine consultations with hospital clinics to assist patients in avoiding time consuming trips to hospital clinics.

Updated 21 July 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 patients experiencing poor mental health, including those with dementia.

• The practice carried out advance care planning for patients with dementia.

• The practice had told patients experiencing poor mental health about how to access various support groups and voluntary organisations.

• 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.

• The practice had completed care plans for 86% of patients diagnosed with a severe and enduring mental health problem. This was better than the CCG average of 78% and national average of 77%. This was achieved with a low 6% exception rate compared to the CCG average exception rate of 12% and national average of 13%.

• The practice supported patients with a mental health problem who were residing temporarily in a local rehabilitation home after discharge from hospital.

However,

• 70% of patients diagnosed with dementia had their care reviewed in a face to face meeting in the year April 2014 to March 2015, which was below the CCG average of 79% and national average of 77%.

Updated 21 July 2016

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

• There were 60 patients on the practice register with a learning disability. Of these 28 had received an annual physical health check (47%). Thirty of these patients had a care plan in place.

However, there were examples of good practice:

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

• The practice offered longer appointments for patients with a learning disability.

• 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 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.