This practice is rated as Good overall. (Previous rating December 2015 – Good)

The key questions at this inspection are rated as:

Are services safe? – Good

Are services effective? – Good

Are services caring? – Good

Are services responsive? – Good

Are services well-led? - Good

We carried out an announced comprehensive inspection at Oak Tree Partnership (Oak Tree Health Centre) on 12 June 2018. This inspection was part of our inspection programme.

At this inspection we found:

• The practice had a system to manage risk so that safety incidents were less likely to happen. When incidents did happen, the practice learned from them and improved their processes. However, within one day of the inspection the practice made further improvements to their incident reporting processes.
• The practice routinely reviewed the effectiveness and appropriateness of the care it provided. It ensured that care and treatment was delivered according to evidence-based guidelines.
• The practice regularly reviewed the composition of the clinical team to meet the needs of patients. For example, a paramedic practitioner and a practice nurse trained to deal with minor illnesses had recently been appointed.
• Staff involved and treated patients with compassion, kindness, dignity and respect.
• There was a strong focus on continuous learning and improvement at all levels of the organisation.
• Patients offered mixed feedback about the practice appointment system. Particularly when accessing the practice by telephone. The practice was aware of this and was installing an updated telephone system. However, patients reported that they were able to access care when they needed it.
• The practice performance in meeting indicators of care for patients with long term conditions had improved in 2017/18.

The areas where the provider should make improvements are:

• Review the implementation and sustainability of the revised processes introduced on the day of inspection.
• Follow up patients due cervical cytology screening who have not attended after being invited for this screening under the national recall system.

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 of Oak Tree Partnership at Oak Tree Health Centre on 8 September 2015.

This was the first inspection using the CQC comprehensive inspection programme. Overall the practice is rated as good. We found the practice good for the delivery of safe, caring, responsive and well led services. They were also good for delivery of services to the population groups of working age people (including those recently retired and students), families children and young people and people whose circumstances may make them vulnerable. However, the practice was found to require improvement in delivering effective services and for the care of people with long term conditions and people experiencing poor mental health (including those with dementia).

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, with the exception of those relating to annual checks for patients with long term conditions.
• Data showed patient outcomes were below average for the locality. Although some audits had been carried out, we saw limited evidence that audits were driving improvement in performance to improve patient outcomes.
• 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.

• The majority of appointments were available on the day the patient called the practice. The practice operated a system whereby GPs contacted all patients requesting an appointment on the day of their incoming phone call. Appointments were then undertaken by phone or by calling the patient in for a same day face to face consultation.
• The practice had a wide range of policies and procedures to govern activity. These were all reviewed on a regular basis and staff knew how to access these to support their day to day duties.
• Staff were appropriately trained to carry out their duties and received support through appraisals and supervision.
• The practice had a vision and strategy underpinned by a business plan which recognised challenges and opportunities in the future.
• 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 areas of practice where the provider needs to make improvements.

Importantly, the provider must:

• Ensure performance in undertaking annual checks and reviews for patients with long term conditions is improved and the outcomes of the checks appropriately and accurately recorded.

• Ensure the care and treatment of patients experiencing poor mental health follows national guidelines and is accurately and appropriately recorded.

• Improve the identification of the smoking status of patients and increase the advice given on the benefits of stopping smoking. Data showed the practice was achieving much lower rates of identification and advice compared to the CCG average.

In addition the provider should:

• Ensure cleaning standards are effectively monitored to achieve consistent appropriate standards of general cleanliness in all clinical rooms.

• Continue to improve the patient experience from the survey feedback improvement plan.

Professor Steve Field (CBE FRCP FFPH FRCGP) 

Chief Inspector of General Practice

During our visit to Oak Tree partnership we met with the registered manager who was a GP partner and with the practice manager. We spoke with five patients and with four members of staff.

Patients were involved in their treatment. One of the patients we spoke with said "my GP always goes through the options very well". A patient record showed that when a patient had declined health promotion advice their wishes were respected.

Patients received treatment appropriate to their needs. A patient we spoke with told us "they [the doctors] treat the patient properly and give the patient time to talk". We saw records confirming good clinical practice guidance was being followed.

The practice was not following all current guidance to reduce the risk and spread of infection. Checks to see whether measures to reduce the risk of infection were effective had not been carried out and staff had not had recent control of infection training.

Staff received training appropriate to their role. We saw that staff had attended courses relevant to the job they carried out. For example, one member of staff had taken training to become a Nurse prescriber.

There were effective systems in place to seek and act on patients views. We saw that patient satisfaction surveys had been carried out. When patients commented on raising the profile of the practice we saw that the practice responded, For example, by promoting their flu vaccination campaign in the local newspapers.

Letter from the Chief Inspector of General Practice

On 8 September 2015 we carried out a comprehensive inspection of Oak Tree Partnership and found concerns relating to the review of care and treatment for patients with long term medical conditions. The practice performance against national indicators was lower than average and offering patients identified as smokers advice on smoking cessation was lower than average. Following the inspection the provider sent us an action plan detailing how they would make the required improvements.

We carried out a desktop review of Oak Tree Partnership on 17 May 2016 to ensure these changes had been implemented and that the service was meeting regulations. Our previous inspection in September 2015 had found a breach of regulations relating to the delivery of safe care and treatment. The rating for the provision of effective services has been updated to reflect our findings. Based on the information received we have also updated the ratings for the population groups of Older People, People with Long-term conditions and People experiencing poor mental health (including people with dementia).

We found the practice had made significant improvements since our last inspection on 8 September 2015 and they were now meeting the regulation, relating to identifying and assessing risk of not completing annual health reviews and taking action to address identified risks.

Specifically the practice had:

• Significantly improved the number of annual health assessments and reviews that took place.

• Improved performance in the national indicators for care of patients with long term conditions.

• The practice had increased the number of patients with a smoking status recorded and had offered an increased number of these patients advice on smoking cessation.

The practice also sent us evidence to confirm they had implemented revised cleaning regimes and staff reported an improvement in standards. The most recent friends and family recommendation results showed that patients who gave a positive response to whether they would recommend the practice was 81%. Those who did not give a negative or positive response were excluded from the calculation of satisfaction.

We have changed the rating for this practice to reflect these improvements. The practice is now rated good for the provision of safe, effective, caring, responsive and well led services.

Professor Steve Field (CBE FRCP FFPH FRCGP) 

Chief Inspector of General Practice