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• However, cleaning was not up to standard in all clinical areas, the spill kit was out of date, staff were not receiving infection control training at induction, and some non-clinical staff were occasionally acting as chaperones without appropriate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

Letter from the Chief Inspector of General Practice

During our comprehensive inspection of Dr Uden & Partners in March 2016 we found concerns relating to the provision of safe services, which included issues with cleaning standards, training and security checks for chaperones and infection control. These concerns resulted in the practice being rated as requires improvement for the delivery of safe services.

The practice sent us an action plan describing how they planned to make changes to address the issues that led to our concerns.

We carried out a desk top review on 2 December 2016 to ensure these changes had been implemented and that the service was meeting regulations. The rating for the practice has been updated to reflect our findings. We found the practice had made improvements in the provision of safe services since our last inspection on 16 March 2016 and they were meeting the requirements of the regulation.

Specifically the practice had:

• Improved cleaning standards and were performing audits with the cleaning team.

• Replaced the out of date spill kits.

• Included infection control and handwashing training on the new staff induction checklist.

• Reviewed their chaperone and Disclosure and Barring Service checks policies to ensure appropriately trained and security checked personnel were being offered as chaperones.

In addition to the above, we saw evidence that emergency equipment had been calibrated and all nurses had received, or had a date booked to receive, an appraisal. The practice list of identified carers remained at 1% and we saw evidence of information available to carers. In addition, all carers were routinely offered an annual flu vaccination.

We have updated the ratings for this practice to reflect these changes. The practice is now rated as good for the provision of safe services.

Professor Steve Field (CBE FRCP FFPH FRCGP) 

Chief Inspector of General Practice