Letter from the Chief Inspector of General Practice

We carried out an announced comprehensive inspection at Oak Street Medical Practice on 9 December 2015.

We have rated the practice overall as providing an outstanding service. Specifically we found the practice to be good for providing a safe, caring and effective service and outstanding for providing a responsive and well led service. It was also found to be providing good services across the patient population groups and vulnerable patients and mental health and people with dementia were rated as outstanding.

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

• Staff understood and fulfilled their responsibilities to raise concerns, and to report incidents and near misses. Information about safety was recorded, monitored, appropriately reviewed and addressed.
• Risks to patients were assessed and well managed.
• 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.
• 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.

There were some areas of outstanding practice:

• The practice looked at all admissions, and over time was able to evidence that their admissions rates were lower than local averages. We saw evidence from the previous and current year that emergency admissions, falls admissions and A&E attendance rates were significantly lower than the local CCG average via a chart supplied by Norwich CCG called Dashboards. The practice’s two week wait Cancer referrals conversion rate was within the accepted range of 9-14%.

• They worked closely with the City Reach programme (the service is provided for people who are homeless, or those at risk of being homeless, sex workers, prisoners and ex-offenders, people who substance misuse, travellers and asylum seekers). A Partner at the practice was the lead GP at City Reach and approximately 30 patients had successfully moved from the City Reach programme to the practice for their ongoing care. We spoke with two patients of Oak Street Medical Practice who were formerly from the City Reach Programme. The Patients now speak at conferences on their experiences and praised both City Reach and Oak Street Medical Practice for their assistance in their care.

• The practice supported Highwater House which is a 22 bed registered care home for people who have experienced homelessness and who have both mental health and substance abuse (alcohol and drugs) issues. The practice supported the Highwater House team to deliver care by providing routine GP primary care services and by a rapid medical response of advice and input, either in the surgery or the care home, within the hour, whenever a medical, mental health or behavioural crisis occurred. In the last two years three patients have moved on to independent living.

Professor Steve Field (CBE FRCP FFPH FRCGP) 

Chief Inspector of General Practice