Archived: The Practice Osler House

Updated 22 January 2015

The Practice Osler House is located; Potter Street, Harlow, Essex, CM17 9BG. The practice provides a range of primary medical services to around 3140 patients.

The practice is managed and owned by a primary care company. The company holds a PMS contract to provide their services.  The company employs one full-time male salaried GP and regular part-time locum GPs. The GPs at the practice are supported by a practice manager, a practice nurse prescriber, a healthcare assistant, and a team of reception and clerical staff.

The practice has opted out of providing out-of-hours services to patients. These services are provided by a local out-of hour’s provider and details of how to access these services are available in the practice, in the practice leaflet, and on their website.

Updated 22 January 2015

Letter from the Chief Inspector of General Practice

Overall we found the practice provided patients a good service with two areas that required some improvement. The areas where improvement was needed were; there was scope to better embed learning from incidents through more formal dissemination of information to staff and improved recording of this learning. There was also scope to formally document staff meetings in order to provide formal records of internal communication within the practice.

Our key findings were as follows:

• Patients were pleased with the improvements to the service provision over the previous 18 months.
• The Practice had worked with local care homes, healthcare professionals and schools to improve communication around patients’ health needs?

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

The provider should:

• Ensure that learning from incidents and complaints is formally disseminated to all staff and that this learning is formally documented.
• Formal notes should be taken during staff meetings to provide a record of internal communication.

Professor Steve Field CBE FRCP FFPH FRCGP

Updated 22 January 2015

The practice identified those people with long term conditions at the practice with a long term conditions and placed them on a clinical register to oversee and maintain their care. Where appropriate, patients had been appointed a clinical lead to co-ordinate and oversee their care, this included assistance and support to self-manage their conditions. We found patients had been advised with regards to specialist services they could access to meet their individual needs and had been signposted to additional support networks to assist them.

We found records of regular multidisciplinary meetings, these were held monthly and detailed discussions, and any actions that were assigned to staff members were then reviewed at subsequent meetings. These discussions included reviewing all unplanned admissions or readmissions of patients with long-term conditions.                                                                                                                                           

We found regular patient care reviews were conducted by the GP and the nursing team for those patients identified with a long term condition. These were in consultation with patients and carers where appropriate to ensure the information was accurate and they were involved in their care. We found patients had been referred appropriately to specialists and in an appropriate and timely way.

Updated 22 January 2015

We looked at arrangements the practice had in place for families, children and young people. We saw that consideration had been given to the appointment system and availability for children outside the school open hours to ensure their access to health provision. This availability was managed by offering early opening at 8:00am four days a week and one morning at 7:30am and extended evening opening hours on two days a week until 7.30pm one evening and 8:00pm on another.

The practice accommodated the midwifery service every Monday morning to provide local antenatal care. This meant only those mothers at the practice that needed consultant led antenatal care needed to attend the hospital to meet their antenatal needs. Expectant mothers’ needs were assessed individually and their care plans reflected this, for example, receiving general information on healthy lifestyle choices and how to access community services and support networks.

The practice told us there was a good up-take rate for pregnant mothers receiving the flu vaccine this year.

We found that clinical and administrative staff had received safeguarding training to recognise and respond to safeguarding concerns. We saw there was a system in place for the timely identification and management of children where safeguarding concerns within a family were identified.

The practice had five children with complex health needs; these children required a multidisciplinary approach to the management of their health conditions. Staff told us how they had detailed care plans in place and the practice supported their carer's.

The practice conducted regular assessments of children’s development and monitored the up-take of primary and pre-school immunisation to identify children at potential risk. Where concerns were identified with regard to physical and/or mental health of a child, appropriate and timely referrals to partner agencies were made and documented.

The practice told us they had attended meetings with the local primary school and nurseries to discuss ways they could help to support children’s health in the community.

Updated 22 January 2015

The practice had systems in place to identify people aged over 75; each person had a named accountable GP in line with the recent GP 2014 to 2015 contract changes.

We found the practice provided care to meet older people’s individual needs. They accomplished this by surveying and, talking with patients to understand their needs and support their choices. The practice identified patients with caring responsibilities or those that needed additional support; this was recorded in their records. By identifying those with caring responsibilities this enabled staff to consider these responsibilities when discussing care and arranging appointments to ensure they were suitable for patients.

The practice showed us they had a good uptake of flu vaccinations for patients 75 years and over. They had also encouraged the uptake for shingles vaccination; at least half the patients eligible for treatment had already received it.

We found that although staff had not received detailed training to understand the needs of older people, we saw that staff were polite, patient and helpful with older people whilst trying to book appointments and assist them with their enquiries. Staff told us they recognised patient’s individual needs such as limited mobility or difficulties reading or writing and tried to support them.

Practice staff told us they monitored emergency admissions to hospital and reviewed all unplanned admissions or readmissions for patients over 75years of age. These reviews involved a medication review within 72 hours of their discharge from hospital to ensure that patients were not readmitted to hospital where this was avoidable and appropriate.

Updated 22 January 2015

We asked staff how they made sure the appointment system was accessible for working age people to attend and contact the practice. We were told the practice offered extended opening hours, telephone consultations; ring backs, and priority appointments. The practice had also introduced online booking and a text reminder system for those patients who had signed up for it. The practice opened at 8:00am four days a week and one morning at 7:30am and extended evening opening hours on two days a week until 7.30pm one evening and 8:00pm on another.

The practice had monitored their accident and emergency (A&E) admissions and identified that there was no increased correlation between working people attending A&E outside normal practice hours registered at the practice.

When patients required referral to specialist services they were offered a choice of services, locations and dates. Patients were also informed by staff of pharmacy opening times ahead of bank holidays so patients could obtain their medicines.

The practice provided screening clinics and signposting for this population group. These included family planning, contraception and follow-up, cervical smears, health advice regarding lifestyle, diet, smoking and alcohol intake, new patient health checks and chlamydia screening.

Updated 22 January 2015

We asked the practice how they met the needs of people experiencing poor mental health. They told us there was an appointed lead clinician responsible to oversee the care provided to people experiencing poor mental health. The clinical staff told us about wider community health services that patients can access and showed us their care pathways to access mental health services for children and adolescents.

In addition, we found the practice monitored the mental health needs of patients to ensure they could access services and were supported throughout their care.

We asked staff what training and support they were given to enable them to recognise and respond appropriately to patients experiencing mental illness. Staff had received no specific training but the practice manager explained that the staff knew patients well and were sensitive in addressing patient’s individual needs. Staff had also been taught to recognise and escalate health concerns to the clinical team by the appointed lead clinician responsible for this population group at the practice.

The practice monitored the A&E admissions of patients experiencing poor mental health or had attended due to self-harm. The practice told us they were not currently involved in any mental health assessments, guardianship orders, or deprivation of liberty orders.

The practice monitored their prescribing of anti-psychotic medication and this was seen to be low.

Other universal support services such as advice and counselling services were available to patients via community services such as Mind (a mental health charity).

Updated 22 January 2015

We were told that staff had received training in identifying vulnerable adults and children. They currently had no patients on treatment programmes for addictions at the practice. However, where appropriate patients were encouraged to attend regular health screenings including HIV testing and to participate in vaccination programmes.

Staff told us about the care they provided care for patients who had been identified as vulnerable due to their diagnosis of a learning disability. The practice worked closely with local services for example adult social care, community health services, and financial support services to access specialist equipment and to promote patients independence. The practice also works with the department of work and pensions to provide evidence to support claims, and continuity of care to enable patient’s access to services. They conducted annual health checks to ensure that patients’ needs were identified and that they could access the care they required.

The practice showed us how they monitored the needs of their vulnerable patients via their risk register. They explained they had responsive support care plans in place to ensure patients felt able to access timely and appropriate care. They also identified alerts from the Clinical Commissioning Groups regarding patients who potentially abuse substances or were missing locally.

We asked staff what training and support they were given to enable them to recognise and respond appropriately to vulnerable patients. Staff said they felt comfortable supporting patients who may experience difficulty communicating, have mobility issues or present differently from others due to their lifestyle choices. 

The practice told us they had a register of patients who may be considered vulnerable due to a number of factors including deprivation and rural isolation The practice had no known patients who had no fixed abode or who were nomadic. W here concerns had been raised regarding the living standards of a person the practice had worked with the person and social care to access the care and support they needed.

We spoke with a local care home that provided care to patients with learning disabilities and dementia. They told us the practice always treated the patients they bought to the practice well and with respect and dignity. They spoke to each person before the carer and explained treatment. The home told us the staff were very helpful and were responsive to the needs of the patient at the home. No problems had been experienced by the home with regards to the practice provision of prescriptions, secondary care referrals, or test results. We were also told the practice manager came to meet with the home manager regularly to maintain good level of communication.