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Archived: Fieldway Medical Centre Good

Inspection Summary


Overall summary & rating

Good

Updated 24 February 2017

Letter from the Chief Inspector of General Practice

We carried out an announced comprehensive inspection at Fieldway Medical centre on 4 August 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.
  • Risks to patients were assessed and well managed.
  • 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 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 two areas of outstanding practice:

  • The practice had on screen alerts set up for prescribing broad spectrum antibiotics; this made the prescriber aware that they can only prescribe medicines in the formulary and they must record their justification for prescribing these medicines which was linked to the patients’ notes. For example the practice had an automated template for acute tonsillitis which made clinicians complete a centor score (predicts the likelihood of bacterial infection) to justify use of antibiotics. Following the implementation of this system monthly antibiotic prescribing audits showed a decrease in prescribing rates from 772 to 573 in a four month period. The practice looked at the antibiotic prescribing of individual GPs as part of this monthly audit.
  • The practice offered frontline telephone clinic between 9:00am and 1:00pm everyday where patients could speak to a GP who provided telephone advice or offered face to face appointments where appropriate. On average GPs were able to deal with 35 patients each day compared to 17 face to face appointments in a traditional setting. Following the implementation of this clinic the practice’s DNA rate (number of patients who did not attend their appointment) had reduced by 5%.

There were areas of practice where the provider should make improvements:

  • Review practice procedures to ensure that there is a system in place for monitoring the use of blank prescriptions.
  • Review systems in place to ensure that patients with a learning disability are regularly reviewed.
  • Review the feedback from national GP patient survey to identify and act on areas that can be improved.

Professor Steve Field CBE FRCP FFPH FRCGP

Chief Inspector of General Practice

Inspection areas

Safe

Good

Updated 24 February 2017

The practice is rated as good for providing safe services.

  • There was an effective system in place for reporting and recording significant events.
  • Lessons were shared to make sure action was taken to improve safety in the practice.
  • When things went wrong patients received reasonable support, truthful information, and a written apology. They were told about any actions to improve processes to prevent the same thing happening again.
  • The practice had clearly defined and embedded systems, processes and practices in place to keep patients safe and safeguarded from abuse.
  • Risks to patients were assessed and well managed.

Effective

Good

Updated 24 February 2017

The practice is rated as good for providing effective services.

  • Data from the Quality and Outcomes Framework showed patient outcomes were at or above average for the locality and compared to the national average.
  • Staff assessed needs and delivered care in line with current evidence based guidance.
  • Clinical audits demonstrated quality improvement.
  • Staff had the skills, knowledge and experience to deliver effective care and treatment.
  • There was evidence of appraisals and personal development plans for all staff.
  • Staff worked with multidisciplinary teams to understand and meet the range and complexity of patients’ needs.

Caring

Good

Updated 24 February 2017

The practice is rated as good for providing caring services.

  • Data from the national GP Patient Survey showed patients rated the practice at or below average for many aspects of care.
  • Patients said they were treated with compassion, dignity and respect and they were involved in decisions about their care and treatment.
  • Information for patients about the services available was easy to understand and accessible.
  • We saw staff treated patients with kindness and respect, and maintained patient and information confidentiality.
  • The practice worked with the local community development pilot project and referred isolated patients, vulnerable patients, carers and single parent families to a health connector to join local groups.

Responsive

Good

Updated 24 February 2017

The practice is rated as good for providing responsive services.

  • Practice staff reviewed the needs of its local population and engaged with the NHS England Area Team and Clinical Commissioning Group to secure improvements to services where these were identified.
  • Patients said they found it easy to make an appointment with a named GP and 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.
  • Information about how to complain was available and easy to understand and evidence showed the practice responded quickly to issues raised. Learning from complaints was shared with staff and other stakeholders.
  • The practice provided a phlebotomy service at the practice which suited older patients who may have difficulty in getting to the hospital and the service also improved monitoring of patients with long term conditions.
  • The practice worked with a social enterprise to tackle health and social issues affecting Muslim communities, especially around mental health. They co-produced a short film ‘Talking from the heart’ exploring mental health diagnosis and therapy by combining medical and faith advice.
  • The practice worked with the local community development pilot project and referred isolated patients, vulnerable patients, carers and single parent families to a health connector to join local groups. Health connectors were employed by the local council who coordinated care between social services, health charities, carer organisation and any relevant asset. The New Addington Group of practices was the only local pilot.
  • The practice had an in-house pharmacist who ran regular medicines review clinics for patients with long term conditions, reviewed protocols for prescribing, reviewed abnormal pathology results, performed medicines reconciliation and optimisation and also reviewed medicines for patients who had unplanned admissions to ensure safe prescribing. 

Well-led

Good

Updated 24 February 2017

The practice is rated as good for being well-led.

  • The practice had a clear vision and strategy to deliver high quality care and promote good outcomes for patients. Staff were clear about the vision and their responsibilities in relation to this.
  • There was a clear leadership structure and staff felt supported by management. The practice had a number of policies and procedures to govern activity and held regular governance meetings.
  • There was an overarching governance framework which supported the delivery of the strategy and good quality care. This included arrangements to monitor and improve quality and identify risk.
  • The provider was aware of and complied with the requirements of the Duty of Candour. The GPs encouraged a culture of openness and honesty. The practice had systems in place for knowing about notifiable safety incidents and ensured this information was shared with staff to ensure appropriate action was taken.
  • The practice proactively sought feedback from staff and patients, which it acted on. The Patient Participation Group was active.
  • There was a strong focus on continuous learning and improvement at all levels.
Checks on specific services

People with long term conditions

Good

Updated 24 February 2017

The practice is rated as good for the care of people with long-term conditions.

  • Nursing staff had lead roles in chronic disease management and patients at risk of hospital admission were identified as a priority.
  • The national Quality and Outcomes Framework (QOF) data showed that 84% of patients had well-controlled diabetes, indicated by specific blood test results, compared to the Clinical Commissioning Group (CCG) average of 72% and the national average of 78%. The number of patients who had received an annual review for diabetes was 96% which was above the CCG average of 86% and in line with the national average of 88%.
  • The national QOF data showed that 85% of patients with asthma in the register had an annual review, compared to the CCG average of 75% and the national average of 75%.
  • Longer appointments and home visits were available for people with complex long term conditions when needed.
  • The local respiratory team visited the practice on a fortnightly basis to screen pre Chronic Obstructive Pulmonary Disease (COPD) patients.
  • The practice had a central recalling system to monitor patients with chronic diseases; this improved their monitoring of these patients.
  • All these patients had a structured annual review to check their health and medicines needs were being met. For those patients with the most complex needs, the GPs worked with relevant health and care professionals to deliver a multidisciplinary package of care.
  • The practice provided a phlebotomy service, electrocardiography and spirometry to improve monitoring of patients with long term conditions.
  • The practice used a risk stratification tool that analysed medicine interactions and blood result anomalies on a weekly basis; this was monitored and actioned by the in-house pharmacist.

Families, children and young people

Good

Updated 24 February 2017

The practice is rated as good for the care of families, children and young people.

  • There were systems in place to identify and follow up children living in disadvantaged circumstances and who were at risk, for example, children and young people who had a high number of urgent care and Accident and Emergency (A&E) attendances.
  • Immunisation rates were relatively high for all standard childhood immunisations.
  • Patients told us that children and young people were treated in an age-appropriate way and were recognised as individuals, and we saw evidence to confirm this.
  • The practice’s uptake for the cervical screening programme was 80%, which was in line with the Clinical Commissioning Group (CCG) average of 82% and the national average of 82%.
  • Appointments were available outside of school hours and the premises were suitable for children and babies.

Older people

Good

Updated 24 February 2017

The practice is rated as good for the care of older people.

  • The practice offered proactive, personalised care to meet the needs of the older people in its population.
  • The practice was responsive to the needs of older people, and offered home visits and urgent appointments for those with enhanced needs.
  • The patients over 75 years of age had a named GP and were given priority access.
  • The practice worked with the local community development pilot project and referred isolated patients, vulnerable patients, carers and single parent families to a health connector to join local groups.

Working age people (including those recently retired and students)

Good

Updated 24 February 2017

The practice is rated as good for the care of working-age people (including those recently retired and students).

  • The needs of the working age population, those recently retired and students had been identified and the practice had adjusted the services it offered to ensure these were accessible, flexible and offered continuity of care.
  • The practice was proactive in offering online services as well as a full range of health promotion and screening that reflects the needs for this age group.
  • Patients can send a message to their GP through the practice’s website for advice and guidance.
  • The practice provided self-referral forms and information on the website for antenatal care, weight management, children’s health, drug and alcohol services, eye conditions, lifestyle and healthy food projects and mental health. 

People experiencing poor mental health (including people with dementia)

Good

Updated 24 February 2017

The practice is rated as good for the care of people experiencing poor mental health (including people with dementia).

  • The number of patients with dementia who had received annual reviews was 75% which was below the Clinical Commissioning Group (CCG) average of 85% and national average of 84%.
  • 96% of 23 patients with severe mental health conditions had a comprehensive agreed care plan in the last 12 months which was above the CCG average 85% and national average of 88%.
  • The practice regularly worked with multi-disciplinary teams in the case management of people experiencing poor mental health, including those with dementia.
  • The practice carried out advance care planning for patients with dementia.
  • The practice had told patients experiencing poor mental health about how to access various support groups and voluntary organisations.
  • The practice had a system in place to follow up patients who had attended accident and emergency where they may have been experiencing poor mental health.
  • Staff had a good understanding of how to support patients with mental health needs and dementia.
  • The practice had access to a counsellor who provided bi-weekly clinics which made it easier for local patients to attend.
  • The practice worked with a social enterprise to tackle health and social issues affecting Muslim communities, especially around mental health. They co-produced a short film ‘Talking from the heart’ exploring mental health diagnosis and therapy by combining medical and faith advice.   

People whose circumstances may make them vulnerable

Good

Updated 24 February 2017

The practice is rated as good for the care of people whose circumstances may make them vulnerable.

  • The practice held a register of patients living in vulnerable circumstances including homeless people, carers, travellers and those with a learning disability.
  • The practice offered longer appointments and extended annual reviews for patients with a learning disability; only 9% (5 patients) out of 54 patients with learning disability had received a health check in the last year. The practice GPs provided care for a learning disability/autistic adults home supporting the needs of eight residents.
  • The practice regularly worked with multi-disciplinary teams in the case management of vulnerable people.
  • The practice informed vulnerable patients about how to access various support groups and voluntary organisations.
  • The provider ran a monthly substance misuse clinic at Headley Drive Surgery which is one of the three practices in New Addington Group.
  • Staff knew how to recognise signs of abuse in vulnerable adults and children. Staff were aware of their responsibilities regarding information sharing, documentation of safeguarding concerns and how to contact relevant agencies in normal working hours and out of hours.