Dr Matthews & Partner

Updated 16 December 2016

Letter from the Chief Inspector of General Practice

We carried out an announced comprehensive inspection at Dr Uden & Partners on March 16, 2016. Overall the practice is rated as good.

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.
• However, cleaning was not up to standard in all clinical areas, the spill kit was out of date, staff were not receiving infection control training at induction, and some non-clinical staff were occasionally acting as chaperones without appropriate training or confirmed DBS checks.
• Staff assessed patients’ needs and delivered care in line with current evidence based guidance. Staff had 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 and easy to understand.
• Patients said they found it easy to make an appointment with a named GP and that there was continuity of care, with urgent appointments available the same day.
• 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.

We saw one area of outstanding practice:

The practice offered a holistic approach to end of life care and for those with complex needs through individual care plans and multi-agency liaison along with close involvement with patients’ families and nursing home staff. This included recording care and resuscitation wishes for all patients with dementia at the local nursing home; GPs providing mobile phone numbers and attending out-of-hours home visits in the final days of life. The practice had also worked with the parish council to ensure that the needs of elderly and vulnerable patients could be met in the event of an emergency incident. The practice’s work in care planning for older patients had reduced its unplanned hospital admissions rate for this population group, and had been noted by the Oxfordshire CCG as an example of good practice.

The areas where the provider must make improvements are:

• Ensure that infection control audits are thorough to ensure the identification and addressing of concerns, including cleaning of clinical areas, infection control training at induction, and that equipment is in-date.

• Ensure that any staff acting as chaperones are trained, risk assessed and DBS checked.

In addition the provider should:

• Ensure that emergency equipment is calibrated regularly within the appropriate time periods

• Undertake work to identify more patients as carers, and review its carers’ list regularly.

• Ensure that all members of the nursing team receive an annual appraisal.

Professor Steve Field (CBE FRCP FFPH FRCGP) 

Chief Inspector of General Practice

Updated 26 May 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.

• Data available demonstrated that the monitoring and management of patients with diabetes was comparable to CCG and national averages.

• 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.

• GPs had specialist training in diabetes and cardiology

• Practice nurses were trained in leg ulcer dressing to avoid hospital attendance, and liaised with podiatry for shared diabetic foot care.

• The entire nursing team were trained smoking cessation counsellors, and undertook cardiac risk assessments by invitation.

Updated 26 May 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 accident and emergency attendances. Regular multi-agency primary health care team meetings attended by the local health visitor allowed discussion about children at risk of harm, and maintained awareness within the practice of any domestic violence concerns and children in foster care.

• Immunisation rates were relatively high for all standard childhood immunisations.

• 72% of patients diagnosed with asthma had their condition reviewed in the last 12 months, in line with CCG and national averages.

• 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.

• 82% of female patients aged 25-64 had attended for a cervical screening test in the last five years, in line with CCG and national averages.

• 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, health visitors and school nurses.

• Siblings were often seen opportunistically during appointments made initially for other family members,

• A dedicated paediatric nurse undertook all child immunisations, and occasionally arranged home vaccinations for serial defaults.

• The female GP was trained in IUCD fitting and implants, and emergency contraception was available daily via the telephone triage system.

Updated 26 May 2016

The practice is rated as good for the care of older people.

• The practice offered proactive, personalised care to meet the needs of older patients with complex needs or residing in the village nursing home, through individual care plans and multi-agency liaison and primary healthcare team meetings. This work has reduced unplanned hospital admissions rates for older patients, and has been noted by the Oxford CCG as an example of good practice.

• The practice offered proactive, personalised palliative care to meet the needs of patients nearing the end of life through individual care plans and multi-agency liaison, along with close involvement with the patients’ families, providing GPs’ personal mobile phone numbers and arranging out of hours visits when appropriate. It ensured that these care plans were immediately accessible to other emergency and out of hours medical services when required.

• The practice had an excellent working relationship with the local nursing home, with daily GP visits.

• The practice had been actively involved with the parish council’s emergency planning to ensure that the needs of elderly and vulnerable patients identified by the practice could be met in the event of an emergency incident, such as the flooding which impacted on the village a few years ago.

Updated 26 May 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. These including early morning appointments and late evening appointments one day a week

• GP appointments and nurse appointments were available to encourage attendance for smoking cessation advice, cervical screening, to support chronic conditions, and for travel advice and vaccinations.

• 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.

• Appointment reminders were sent via email and text.

• Cardiovascular risk assessments were offered by invitation to working age patients who may not otherwise be regularly attending the practice.

• Clinical staff had recently attended training to improve the practice’s uptake of chlamydia screening by patients aged under 25.

Updated 26 May 2016

The practice is rated as good for the care of people experiencing poor mental health (including people with dementia).

• 93% of patients with schizophrenia, bipolar affective disorder and other psychoses had a comprehensive care plan drawn up in the last 12 months, which is above the national average. The practice worked to achieve this number by recalling for review all those who were not seen routinely or who were not under the care of the Community Mental Health Team.

• The practice regularly worked with multi-disciplinary teams in the case management of patients experiencing poor mental health, including those with dementia.

• Regular appointments with a familiar practice nurse for patients receiving depot medicines had established a good rapport, and assisted with early alert of relapse or medicine default.

• A counsellor held regular sessions at the practice, and referral were also made to Talking therapies.

• The practice carried out advance care planning for patients with dementia, including those in the local nursing home, including recording care wishes and resuscitation status to make staff and out-of-hours healthcare providers aware, and involving relatives when appropriate.

• Identification of dementia cases had improved in the last year, and those caring for dementia patients and those experiencing poor mental health were encouraged to register with the practice as carers to improve their access to local support services and respite

• 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.

Updated 26 May 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 patients, travellers and those with a learning disability.

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

• The practice regularly worked with multi-disciplinary teams in the case management of vulnerable patients, including Primary Healthcare Team meetings attended by the local health visitor to update on safeguarding concerns and disability issues.

• 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.

• The practice held a register of patients with learning disabilities, and these were invited to have an annual health assessment to review their needs. In the last year, 30% of those invited had attended a review.

• The practice held a register of carers, to identify their needs, offer signposting and offer respite. There were 188 carers on this register, which represented 1% of the patient list.

• Patients with a hearing impairment were identified, and alternative ways of contact were arranged, including use of email for making appointments, and sign language support on attendance.

• The practice held a list of vulnerable adults alongside the parish council’s emergency plan, to ensure that they received appropriate intervention in the event of severe weather or flooding.