Archived: Deer Park

Updated 21 November 2016

We undertook an inspection of this practice on 27 September 2016. The practice provided services from Deer Park Medical Centre, Witney, Oxfordshire, OX28 5YT. The service provider is Virgin Care.

Deer Park has a purpose built location with good accessibility to all its consultation rooms. The practice serves 4,410 patients from the surrounding area. The practice demographics show that the population has a lower proportion of patients over 65 compared to the national average, but cares for patients in local care and nursing homes. There was a higher prevalence of patients under 18 years old and patients in their 40s. The practice had a low proportion of patients from ethnic minority backgrounds. A traveller community resided locally and the practice care for some of the patients who were part of this community. There is minimal social deprivation according to national data.

There were local and provider level governance structures supporting the delivery of services. Staff were supported by clinical leads within the practice and at provider level. There were meetings provided for staff but also at the provider level as part of the system of clinical governance.

The provider’s contract is due to end in March 2017 and the patient list will be dispersed among the practices in the local area.

• There is a clinical lead working at the practice supported by clinical expertise employed by the provider. There are two male and one female GP working at the practice, two locum nurses and a healthcare assistant. A number of administrative staff and a practice manager support the clinical team.
• There are 2.7 whole time equivalent (WTE) GPs, the nursing hours varied per week. This was usually two days of nursing support, providing immunisations and some long term condition reviews.

• Deer Park is open between 8.00am and 6.30pm Monday to Friday. There are no extended hours appointments available. A walk-in service is available Mondays and Fridays.
• Out of hours GP services were available when the practice was closed by phoning 111 and this was advertised on the practice website.
• The practice had an Alternative Provider Medical Services (APMS) contract. APMS contracts enable local commissioners to provide tailored primary medical services within their area airmed at meeting requirements they deem to be necessary based on local needs.

The practice was not registered for the regulated activity of Diagnostic and Screening Procedures. It is a requirement of the Health and Social Care Act 2008 that providers must register with the commission to provide any activities which fall under the scope of regulation. We are in discussion with the provider to determine whether they are registered appropriately.

Updated 21 November 2016

Letter from the Chief Inspector of General Practice

We carried out an announced comprehensive inspection at Deer Park on 27 September 2016. Overall the practice is rated as good. However, improvements were required in providing effective services. Our key findings were as follows:

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

• The practice’s patients and staff had recently been informed that the practice was closing in March 2017. The patient list was to be dispersed among the local population.
• There was a system in place for reporting and recording significant events and for learning to be circulated to staff and changes implemented where required. Reviews of complaints, incidents and other learning events were thorough.
• Risks to patients were assessed and well managed.
• Staff assessed patients’ ongoing needs and when they delivered care to patients it was in line with current evidence based guidance.
• The practice was performing well on most clinical outcomes in terms of national data. However, national data suggested patients did not always access reviews of their conditions or meet standards of managing their care in line with national guidance as in some clinical areas there were significantly higher instances of patients not being included in national data outcomes.
• Reviews of patients on repeat medicines were not always recorded properly to ensure this system was monitored properly and this had not been identified as an area for improvement or further monitoring.
• The practice planned its services based on the needs and demographic of its patient population.
• There were well developed processes to ensure the continuity of care, particularly for patients with the most complex health needs.
• Staff were trained in order to provide them with the skills, knowledge and experience to deliver effective care and treatment.
• 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. Improvements were made to the quality of care as a result of complaints and concerns.
• Patient feedback in the CQC comment cards suggested patients felt staff were caring, committed and considerate.
• The practice had good facilities and was well equipped to treat patients and meet their needs.
• The provider was aware of and complied with the requirements of the duty of candour.
• There was an ethos of continuous learning and improvement.

Areas the provider must make improvements are:

• Identify, mitigate and improve the monitoring of patient care to ensure patients receive effective care and treatment. Specifically improve the recording and monitoring of medicine reviews and identify means of improving take up of health checks for patients with long term conditions.

Areas the provider should make improvements are:

• Ensure that where tasks are required and identified (such as those identified through risk assessments) that these are completed. Specifically, ensure that water temperatures are tested in line with the legionella assessment and that deep cleaning required in the infection control audit is undertaken.
• Review and assess the provision of Hepatitis B immunisation to reception staff.

Professor Steve Field (CBE FRCP FFPH FRCGP) 

Chief Inspector of General Practice

Updated 21 November 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 had appropriate training.
• Patients at risk of hospital admission were identified as a priority.
• The most recent published results showed that overall the practice was performing well compared to national averages. However, there was higher than average numbers of patients not included in national data in specific clinical areas.
• All these patients were offered 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.

Updated 21 November 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 people who had a high number of A&E attendances.
• Immunisation rates were similar to average for all standard childhood immunisations.
• Staff explained how they treated children and young people in an age-appropriate way including recognition of their rights to access treatment.
• We saw positive examples of joint working with midwives and health visitors.
• Joint working with external organisations took place in the management of children at risk of abuse.
• The practice provided staff with training on female genital mutilation and how to report and respond to any instances or risks of this occurring.

Updated 21 November 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 high proportion of older people in its population.
• GPs offered personalised care to patients in care and nursing homes.
• The premises were accessible for patients with limited mobility.
• A hearing loop was available for patients with hearing difficulties.
• Patients over 75 had a named GP to maintain continuity of care.
• Care planning was provided for patients with dementia.
• There was support provided for carers where necessary through referrals to external services and charities.
• GPs regularly visited nursing and care homes to enable them to provide the necessary care and treatment to these patients.

Updated 21 November 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 considered and the practice had adjusted the services it offered enable continuity of care.
• Patients’ feedback on the appointment was very positive.
• A walk in service supported the working age population to see a GP or nurse at short notice.
• The appointment system was monitored to identify improvements where possible.
• 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.
• Travel vaccinations were available.
• There were no extended hours appointments available.

Updated 21 November 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 100% compared to the national average 92% and regional average of 95%.
• The proportion of patients on mental health register with an up to date care plan was 81%.
• The practice regularly worked with multi-disciplinary teams in the case management of patients experiencing poor mental health, including those with dementia.
• We saw dementia care planning included comprehensive information regarding relevant medical history, patient preferences, changes to medicine, regular reviews and significant others in patients’ lives.
• The practice carried out advanced 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.

Updated 21 November 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 including homeless people, travellers and those with a learning disability.
• The practice offered longer appointments for vulnerable patients.
• A temporary registration process was available to patients who may be in the area for a short period of time and who needed to see a GP.
• 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.
• Joint working with external organisations took place in the management of patients at risk of abuse or harm.