We carried out an announced comprehensive inspection at Oaklands Health Centre on 16 March 2018. This practice is rated as requires improvement overall. (At our previous inspection on 14 January 2015 this practice was rated as good overall and outstanding in well- led).

The key questions are rated as:

Are services safe? – Requires improvement

Are services effective? – Requires improvement

Are services caring? – Good

Are services responsive? – Good

Are services well-led? - Requires improvement

As part of our inspection process, we also look at the quality of care for specific population groups. The population groups are rated as:

Older People – Requires improvement

People with long-term conditions – Requires improvement

Families, children and young people – Requires improvement

Working age people (including those recently retired and students – Requires improvement

People whose circumstances may make them vulnerable – Requires improvement

People experiencing poor mental health (including people with dementia) - Requires improvement

We carried out an announced comprehensive/focused inspection at Oaklands Health Centre as part of our inspection programme.

At this inspection we found:

• The practice did not have a systematic approach for identifying and managing risk so that safety incidents were less likely to happen.
• When incidents did happen, the practice learned from them and improved their processes.
• There was evidence of audit activity and quality improvement. Clinical staff told us they delivered care according to evidence- based guidelines. However, we did not see comprehensive clinical protocols to support this, nor did the practice have a systematic approach for recording quality improvement activity.
• Staff involved and treated patients with compassion, kindness, dignity and respect.
• The practice had introduced a new ‘book on the day’ appointment system and patients told us that they experienced difficulties accessing services by telephone during the implementation of this new system.
• Patients had the additional option of accessing services online through E-consults.
• There was a strong focus on continuous learning and improvement at all levels of the organisation. The practice was a training practice for GPs and had plans to become a training practice for nurses.
• The practice was forward thinking and their three year forward plan included developing staff skills and mix including using advanced nurse practitioners to meet the challenge of recruiting more GPs and bringing new services to the local health economy.

The areas where the provider must make improvements as they are in breach of regulations are:

• Ensure care and treatment is provided in a safe way to patients.
• Establish effective systems and processes to ensure good governance in accordance with the fundamental standards of care.
• Ensure recruitment procedures are established and operated effectively to ensure only fit and proper persons are employed.
• Ensure persons employed in the provision of the regulated activity receive the appropriate support, training, professional development, supervision and appraisal necessary to enable them to carry out the duties.

The areas where the provider should make improvements are:

• Review the process for recording and adopting new clinical pathways in line with national guidance.
• Continue to review patient satisfaction with the new appointment system including utilising the patient participation group to gain patients views and review changes.
• Develop systems and processes for clinical and service audit to gain a practice wide approach.

Professor Steve Field (CBE FRCP FFPH FRCGP) 

Chief Inspector of General Practice

We carried out an announced comprehensive inspection at Oaklands Health Centre on 9 April 2019 under Section 60 of the Health and Social Care Act 2008, as part of our regulatory functions.

At this inspection we followed up on breaches of regulations identified at a previous inspection on 16 March 2018.

At the last inspection in March 2018 we rated the practice as requires improvement overall because we had found that arrangements were ineffective for:

•Staff checks for recruitment.

•safeguarding and safety training

•general staff training

•formal locum GP induction.

•implementing new guidance

At this inspection most of these had been addressed.

We based our judgement of the quality of care at this service on a combination of:

•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 have rated this practice as requires improvement overall. The factors causing the practice to be rated as requires improvement impacted all the population groups and so we have rated all population groups as requires improvement.

We have rated this practice as requires improvement for providing safe services because:

•The practice did not have effective arrangements for the monitoring and actioning medicines safety alerts.

We have rated this practice as requires improvement for providing effective services because:

•The follow up system to improve quality outcomes for patients with diabetes was not effective.

•Patient outcomes could not always be identified as not all audits were used to promote quality improvement.

•Patient consent was not always recorded correctly.

We have rated this practice as requires improvement for providing well-led services because:

•Staff had clear roles and responsibilities, however there were failings in the governance systems and processes at the practice.

We have rated this practice as good for providing caring and responsive services because:

•Staff treated patients with compassion, kindness, dignity and respect.

•Patients could access care and treatment from the practice within an acceptable timescale for their needs.

•The practice organised and delivered services to meet patients’ needs. Patients could access care and treatment in a timely way.

The areas where the provider must make improvements are:

•Ensure that care and treatment is provided in a safe way for service users.

•Establish effective systems and processes to ensure good governance in accordance with the fundamental standards of care.

The areas where the provider should make improvements are:

•Improve the identification of carers to enable this group of patients to access the care and support they need.

Dr Rosie Benneyworth BM BS BMedSci MRCGP

Chief Inspector of Primary Medical Services and Integrated Care

Please refer to the detailed report and the evidence tables for further information

We carried out an announced comprehensive inspection at Oaklands Health Centre on 14 January 2015. Overall the practice is rated as good.

Specifically, we found the practice to be good for providing safe, effective, caring and responsive services. It was outstanding for well led.

It was also good for providing services for the care of older people, the care of patients with long-term conditions, the care to working-age people (including those recently retired and students), the care of families, children and young people, the care of patients whose circumstances may make them vulnerable and the care of patients experiencing poor mental health (including people 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.
• 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. It was available in a wide variety of languages.
• 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. Staff and patients were actively involved in the decision making about how the practice could improve.

We saw several areas of outstanding practice:

• There were protected “slots” in the appointments system to ensure that end of life and palliative care patients would be seen when they called for an appointment.
• The practice participated in a national scheme to help identify the types of viral infection prevalent across the country at a particular time.
• The practice had set up a “dressing station” within the surgery building where community nurses could manage the care of patients, usually elderly, with pressure sores and such like.
• An integrated family support officer from a local agency attended relevant meetings where patients who needed multi-disciplinary care were discussed.

• Nursing homes had an allocated GP to manage care of residents and there was a ward round each week.
• Reception staff routinely called patients who had memory problems to remind them of their appointments.
• The practice held a “super flu” Saturday event, at this about 2500 patients were vaccinated this meant a wide coverage early on in the flu season to ensure maximum patient care.
• Communication with staff was excellent. There was a weekly meeting which took place during the lunch break so there were no distractions. Staff were involved in the decision making about improvements to the way the practice was run.

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

Importantly the provider should:

• Review the manner in which patient group directions were filed so as to avoid any confusion to staff using them.
• Review its auditing activity to ensure its effectiveness and to more closely reflect the population it served.

Professor Steve Field (CBE FRCP FFPH FRCGP) 

Chief Inspector of General Practice