We undertook an announced comprehensive inspection on 16 April 2019.

We have rated this practice as requires improvement overall and for all population groups.

We based our rating on:

• what we found when we inspected
• information from our ongoing monitoring of data about services and
• information from the provider, patients, the public and other organisations.

We carried out an announced comprehensive inspection at Banbury Road Medical Centre on 2 October 2018 as part of our inspection programme. We found risks to patients and took enforcement action against the provider. We undertook a focussed inspection in November 2018 and found improvements to clinical care.

At this inspection we found:

• The practice had made improvements to identification and investigation of incidents. However, the practice did not always have processes to assess and manage risks to patients.
• The practice had improved the monitoring of care tasks including patients on high risk medicines.
• There was some quality assurance in terms of audit to ensure the care provided was appropriate, but this was minimal.
• National clinical data indicators showed there was high performance in terms of managing long term conditions. However, there was high exception reporting in some areas which had not been identified and assessed to ensure it was always appropriate.
• Staff involved and treated patients with compassion, kindness, dignity and respect.
• Patients found the appointment system easy to use and reported that they could access care when they needed it.
• Training was not always delivered to staff
• The practice understood the diverse needs of its patient population and adapted services for its population.

The areas where the provider must make improvements are:

• Establish effective systems and processes to ensure good governance in accordance with the fundamental standards of care.
• Ensure patients receive safe care and treatment.

(Please see the specific details on action required at the end of this report).

The areas where the provider should make improvements are:

• Review the processes by which carers are identified as requiring additional support and identified to staff so that they can consider their needs.
• Review the maintenance concerns within the practice.
• Identify potential means of improving child immunisations rates.
• Consider means of improving patient participation in the running of the practice.

Details of our findings and the evidence supporting our ratings are set out in the evidence tables.

Dr Rosie Benneyworth BM BS BMedSci MRCGP

Chief Inspector of Primary Medical Services and Integrated Care

We carried out an announced comprehensive inspection at Banbury Road Medical Centre on 2 October 2018 as part of our inspection programme. This practice was rated as requires improvement overall and we took action against the provider.

This was a focussed follow up inspection to identify if action required in response to significant risks identified at our previous comprehensive inspection had been taken. This inspection did not result in a rating of the key question we inspected:

Are services safe?

At this inspection we found:

• There had been improvements to the monitoring of medicines including high risk medicines.

• The practice had assessed and was in the process of mitigating risks including those related to fire and the storage of medical records.

• Patients with learning disabilities were being reviewed to determine their needs.

We found an area where the provider should make improvements:

• Continue to improve the systems for reviewing patients on high risk medicines.

Professor Steve Field CBE FRCP FFPH FRCGP
Chief Inspector of General Practice

This practice is rated as requires improvement overall. (Previous inspection February 2015 – Good)

The key questions are rated as:

Are services safe? – Inadequate

Are services effective? – Requires improvement

Are services caring? – Good

Are services responsive? – Good

Are services well-led? - Requires improvement

We carried out an announced comprehensive inspection at Banbury Road Medical Centre on 2 October 2018 as part of our inspection programme. We found risks to patients and have taken action against the provider.

At this inspection we found:

• The practice did not always have processes to assess and manage risks to patients. When incidents occurred, the practice did not always ensure reviews were undertaken or that learning was identified.
• The practice did not consistently monitor the effectiveness and appropriateness of the care it provided to ensure treatment was always appropriate. Prescribing was not always monitored to ensure patient outcomes were optimal and that medicines were safe to be taken.
• National clinical data indicators showed there was high performance in terms of managing long term conditions. However, there was poor recording of some patient care on the record system.
• Staff involved and treated patients with compassion, kindness, dignity and respect.
• Patients found the appointment system easy to use and reported that they could access care when they needed it.
• Governance systems were not fully functional and we identified areas of service provision and risks where there was no governance process to ensure appropriate measures were in place. For example, governance of the health and safety of premises and prescribing of medicines was poor.
• The practice understood the diverse needs of its patient population and adapted services for its population.

The areas where the provider must make improvements are:

• Improve the monitoring and governance of services and processes to identify where quality and safety improvements are necessary.
• Ensure patients receive safe care and treatment.

Additionally the provider should:

• Review the processes by which vulnerable patients are identified as requiring additional support and identified to staff so that they can consider their needs.
• Review means of improving cervical screening uptake.

Professor Steve Field CBE FRCP FFPH FRCGP
Chief Inspector of General Practice

Letter from the Chief Inspector of General Practice

We carried out an announced comprehensive inspection at Banbury Road Medical Centre on 18 February 2015. Overall the practice is rated as good.

We found the practice to be good for providing safe, effective, caring and responsive services and for being well led. It was also good for providing services for the all of the six population groups we assessed. During this inspection we followed up on concerns regarding infection control systems, training, appraisals, and development for staff, health and safety systems and the complaint system, which had been identified during our previous inspection in July 2014. Following the inspection in July 2014 an action plan was sent to us by the practice, detailing how they would meet compliance. We found the practice had addressed the concerns we identified

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

• Patients’ needs were assessed and care was planned and delivered following best practice guidance. Staff had received training appropriate to their roles and any further training needs had been identified and planned.
• 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.

Importantly, the provider should:

• Explore and develop an effective Patient Participation Group (PPG).

Professor Steve Field (CBE FRCP FFPH FRCGP)

Chief Inspector of General Practice

Banbury Road Medical Centre is a GP practice located in Summertown, Oxford. The practice provides medical services to several colleges with the University of Oxford and to local schools. The practice has over 7600 registered patients. The practice team consists of four GP partners, a salaried GP, practice nurse, district nurses, midwives, a practice manager and a reception and administration team. This was the first inspection since registration.

The patients we spoke with were complimentary of the services they received from the practice. The feedback received through patient comment cards was also positive.

The practice provided services which were not safe. The administrative and reception staff members were not aware of safeguarding procedures and had not received safeguarding training. Health and Safety procedures were not in place and appropriate risk assessments had not been undertaken. Patients were not protected from the potential risk of infection. Appropriate standards of cleanliness and hygiene were not maintained in relation to the practice. Checks relevant to individual roles had been performed by the practice. However, we found no assessments had been carried out for the potential risks involved in using staff without a Disclosure and Barring Service (DBS) check.

The practice provided services that were mostly effective. GPs meetings took place on monthly basis, where significant events and relevant changes to professional guidelines where discussed. The practice had close working relations with other services and promoted a multi-disciplinary approach which had benefited patients. An induction programme for new staff was not in place. Training and professional development for staff was not provided. The practice did not have any formal systems to disseminate learning and training to staff.

Staff were caring, kind and treated patients with respect and dignity. GPs and staff demonstrated a caring approach. Patients we spoke with were positive about the care they received. Patients were satisfied with the system for both urgent and routine appointments.

The practice was responsive to meeting patient’s needs. The appointment system enabled patients to access care and treatment when required. The practice understood the different needs of the population it served and acted on these to ensure the service provided offered appropriate support. A comprehensive complaints procedure was in place. There were systems to review complaints received by the practice and a response was provided in timely manner.

The practice staff were focussed in providing person centred care to patients. Feedback was primarily sought via the suggestion box kept in the waiting area. The practice did not have a patient participation group (PPG). A PPG is a group set up to gain patients' views and involve them in the practice and service development. Practice, administrative team and reception meetings did not take place. Administrative and reception staff did not have regular appraisals and did not have opportunities to discuss plans for any formal training or qualifications. They were also not engaged in relation to how the practice could improve patient experience and the quality of service. The practice had not taken all measures to identify, assess and manage risk.

The practice had systems to support specific population groups. All patients who were 75 years of age and over had a named GP. Home visits were arranged for frail and elderly patients living in nursing and residential homes. Older patients were able to make appointments for immunisations required. Self-management plans for conditions such as diabetes were provided by the practice nurse during their appointments. The practice had an electronic system which had flagging mechanisms. This system was used to remind staff to carry out health checks which helped these patients to manage their conditions and symptoms.

The practice also provided support to local boarding schools. The GPs ran day surgeries at the University of Oxford premises, and students were able to sign up for appointments in advance. The practice also provided a range of appointment between 8:30am to 6:30pm. The practice supported patients who were not able to attend due to work commitments, by offering Saturday pre-bookable appointments. Interpreters were used for patients who were not able to understand English. The practice website provided fact sheets in different languages to explain the role of a GP, how to register and how to access emergency services. Patients with mental health care needs had regular appointments with the practice nurse for tests to manage their medicines.

Please note that when referring to information throughout this report, for example any reference to the Quality and Outcomes Framework data, this relates to the most recent information available to the CQC at that time.

We found that the practice was not meeting four of the Regulations to monitor quality and safety. These were in relation to safeguarding patients who use services from abuse, cleanliness and infection control, supporting workers and assessing and monitoring the quality of service provision.

The practice provides services from:

Banbury Road Medical Centre

172 Banbury Road

Oxford