Fort House Surgery

Updated 22 December 2016

Letter from the Chief Inspector of General Practice

We carried out an announced comprehensive inspection of Fort House surgery on 26 January 2016. Breaches of legal requirements were found during that inspection within the safe domain. The practice was rated as good overall, requires improvement in the safe domain and good in the effective, caring, responsive and well-led domains. After the comprehensive inspection, the practice sent to us an action plan detailing what they would do to meet the legal requirements. We undertook a focused inspection on 08 November 2016 to check that the provider had followed their action plan and to confirm that they now met legal requirements. The provider was now meeting all requirements and was rated as good overall and good under the safe domain. This report only covers our findings in relation to those requirements.

During the previous inspection on 26 January 2016 we found that the areas where the practice must make improvements were:

• To ensure all fire safety equipment is regularly serviced and that it is clarified to fire marshals what their responsibilities are. Ensure that all actions identified following fire risk assessments are implemented.

• To ensure that a Legionella risk assessment is carried out.

This report should be read in conjunction with the last report from 26 January 2016. The report from our last comprehensive inspection can be read by selecting the 'all reports' link on our website at www.cqc.org.uk.

During this inspection we found that:

• The practice had had all fire equipment checked by a specialist company. The fire marshals were clear about their roles. A further fire risk assessment had been carried out and the findings implemented.

• A Legionella risk assessment had been carried out and acted on.

Professor Steve Field (CBE FRCP FFPH FRCGP) 

Chief Inspector of General Practice

Updated 7 April 2016

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.

• Diabetes indicators were comparable to, or better than, the national average. For example the percentage of patients on the diabetes register, who had a foot examination and risk classification recorded within the preceding 12 months was 94.6% (national average 88.3%).

• Longer appointments and home visits were available when needed.

• All these patients had a named GP and a structured annual review to check their health and medicines needs were being met. For those patients with the most complex needs, the named GP worked with relevant health and care professionals to deliver a multi-disciplinary package of care.

• Care plans were developed for the two per cent of patients identified as at risk from unplanned admissions. The care plans were available, with the patient’s consent, to the ambulance service and out of hours provider.

• The practice had regular multi-disciplinary team meetings and palliative care meetings.

Updated 7 April 2016

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 A&E attendances. Immunisation rates were relatively high for all standard childhood immunisations.

• The percentage of patients with asthma, on the register, who had an asthma review in the preceding 12 months that included an assessment of asthma control was 75.7% (national average 75.3%)

• 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.

• On the day appointments were released at 5am online, three hours before the phone lines opened.

• The percentage of women aged 25-64 whose notes record that they had had a cervical screening test performed in the preceding five years was 85.6% (national average 81.8%)

• Appointments were available outside of school hours and the premises were suitable for children and babies.

• We saw positive examples of joint working with health visitors who attended monthly multi-disciplinary team meetings.

Updated 7 April 2016

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 patients, and offered home visits and urgent appointments for those with enhanced needs.

• The practice engaged with Locality Hubs. By working with the local commissioner the practice had been supporting the development of a local hub (of community services) to support older people with frailty to live at home healthily, safely and happily for as long as possible.

• The practice applied the Edmonton Frailty Scale screening and management tool to their two per cent most ‘at risk’ patients during 2014/15 to assist with identifying the services required in the Locality Hub.

• The practice had a dedicated phone line for care homes, hospitals and ambulance staff.

• The practice had participated in a CCG initiated Nursing Home Project and ensured that the designated GP worked closely with the Community Matron and Pharmacist in order to provide continuity of care and reduce A&E / hospital admissions.

Updated 7 April 2016

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 including an email service and blood test booking service as well as a full range of health promotion and screening that reflects the needs for this age group.

• Sexual health and contraception clinics were available and there was a GP sexual health lead.

• There was a text message reminder and cancellation service available.

• Electronic prescribing was available allowing patients to pick up prescriptions closer to their place of work.

• Telephone consultations were available.

• Patients could book some referrals to secondary care online.

• Travel clinics were available.

Updated 7 April 2016

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

• The percentage of patients with schizophrenia, bipolar affective disorder and other psychoses who have a comprehensive, agreed care plan documented in the record, in the preceding 12 months was 96.5% (national average 88.5%).

• The practice regularly worked with multi-disciplinary teams in the case management of patients 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 undertaken a data analysis at the request of the local CCG to help improve the rate of early diagnosis of dementia.

Updated 7 April 2016

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

• The practice held a register of patients with a learning disability and a carer’s register.

• Homeless patients could register at the practice and use the practice address.

• The practice offered longer appointments for patients with a learning disability.

• The practice regularly worked with multi-disciplinary teams in the case management of vulnerable patients.

• The practice informed vulnerable patients about how to access various support groups and voluntary organisations including a drug and alcohol network.

• 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.