Oakley Health Group

Updated 20 March 2017

Oakley Health Group is a GP partnership located in Camberley, Surrey. The practice is also known locally as Hartley Corner Surgery. The practice has a branch which is known locally as Yately Medical Centre. The practice premises includes nine consulting rooms and three treatment rooms at Hartley Corner Surgery and, 11 consulting rooms and one treatment room at Yately Medical Centre. At the time of our inspection, the branch was undergoing major refurbishment and development work which once completed, would create a hub for the integrated care team, a large meeting room, three additional consulting rooms and one additional treatment room. We visited both sites as part of this inspection.

The practice partnership includes 10 GP partners and six salaried GPs which is equivalent to approximately 13.5 whole time equivalent GPs. Six are male and 10 are female. The clinical team includes one advanced nurse practitioner, eight practice nurses and five health care assistants. The practice management team includes a business manager, a practice manager and a range of administration and reception staff. The practice is approved for training qualified doctors who wish to become GPs.

The practice provides its service to approximately 22,300 patients under a General Medical Services (GMS) contract. (A GMS contract is a contract between NHS England and general practices for delivering general medical services and is the commonest form of GP contract). The practice delivers its services from the following locations:

Hartley Corner Surgery

51 Frogmore Road,

Blackwater,

Camberley,

Surrey,

GU17 0DD.

And,

Yately Medical Centre

Oaklands,

Yately,

GU46 7LS.

The practice population has a higher proportion of patients aged between 60 and 75 compared to local and national averages. The general Index of Multiple Deprivation (IMD) population profile for the geographic area of the practice is in the least deprivation decile. (An area itself is not deprived: it is the circumstances and lifestyles of the people living there that affect its deprivation score. Not everyone living in a deprived area is deprived and that not all deprived people live in deprived areas). Average male and female life expectancy for the practice is 82 and 85 years, which is above the national average of 79 and 83 years respectively.

The practice is open from 8am to 6.30pm Monday to Friday. Extended hours are on Monday evenings between 6.30pm to 7.30pm, Wednesday mornings from 7.30am to 8am and Saturday mornings from 8.30am to 11.30am. Saturday opening varies between the practice’s main site and its branch and details of these are available on the practice’s website.

The practice has opted out of providing out of hours services to its patients. Patients can access the out of hours services provided by North Hampshire Urgent Care via the NHS 111 service.

This inspection is part of the CQC comprehensive inspection programme and is the first inspection of Oakley Health Group.

Updated 20 March 2017

Letter from the Chief Inspector of General Practice

We carried out an announced comprehensive inspection at Oakley Health Group on 18 January 2017. 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.
• Risks to patients were assessed and 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.
• 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. 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 a named GP and 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.

The areas where the provider should make improvement are:

• Ensure the temperature of the fridge is monitored consistently.

Professor Steve Field (CBE FRCP FFPH FRCGP) 

Chief Inspector of General Practice

Updated 20 March 2017

The practice is rated as good for the care of patients 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 percentage of patients on the diabetes register, with a record of a foot examination and risk classification within the preceding 12 months (04/2015 to 03/2016) was 92% which was above both the clinical commissioning group and national average of 89%.
• The practice held a daily International Normalised Ratio (INR) clinic for patients who were on blood thinning medicines and required regular monitoring.
• Saturday appointments were available where patients could have a review of their long term conditions or receive a cervical screening test.
• 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.

Updated 20 March 2017

The practice is rated as good for the care of families, children and young patients.

• There were systems 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 sent letters to young patients on their 16th birthday to introduce them to the practice and inform them of the services that are available.
• The practice’s uptake for women aged 25-64 whose notes record that a cervical screening test has been performed in the preceding five years was 80% which was comparable to the clinical commissioning group average of 82% and national average of 81%.
• Children and young patients who required counselling could be referred to Hampshire Youth Access who offered advice, information and counselling to children and young people aged from five to 17.
• 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.

Updated 20 March 2017

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

• 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.
• The practice offered 20 minutes appointments for all patients over the age of 85 and those with complex needs.
• The practice hosted a weekly clinic held by a palliative care nurse specialist from the local hospice.
• There was a paramedic practitioner attached to the practice who could carry out urgent home visits in the morning where appropriate. They also followed up on patients who had recently been discharged from hospital or those who have attended A&E.

Updated 20 March 2017

The practice is rated as good for the care of working-age patients (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 on Mondays from 6.30pm to 7.30pm, Wednesdays from 7.30am to 8am and Saturdays from 8.30am to 11.30am. Saturday opening varied between the practice’s main site and its branch and details of these were available on the practice’s website.
• Saturday appointments were available with a GP, nurse or health care assistant.

Updated 20 March 2017

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

• 85% of patients diagnosed with dementia had their care reviewed in a face to face meeting in the last 12 months (04/2015 to 03/2016), which was comparable to the clinical commissioning group (CCG) average of 86% and the national average of 84%.
• The percentage of patients with severe mental health problems who had a comprehensive, agreed care plan documented in their record, in the preceding 12 months (04/2015 to 03/2016) was 94% compared to the CCG average of 91% and national average of 89%.
• 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. For example, patients with Alzheimers and their families were signposted to Alzheimer Café which was a local group providing dementia education in a friendly, café like setting.

• 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 20 March 2017

The practice is rated as good for the care of patients 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 had engaged with Hampshire County Council on a project to test “health passports” and develop a website for patients who were travellers.
• The practice offered 20 minutes appointments for patients with a learning disability. There was a dedicated nurse who undertook annual health checks for patients with a learning disability and we were told that consistency of care had increased uptake for blood tests and cervical screening.

• The practice was able to refer patients at risks of social isolation to a social prescribing organisation which was single hub for assessment as to which alternative service might be of most benefit.

• 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.