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Inspection Summary


Overall summary & rating

Good

Updated 28 April 2016

Letter from the Chief Inspector of General Practice

We carried out an announced comprehensive inspection at Forum Family Practice on 23 February 2016. Overall, the practice is rated as good.

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

  • Staff understood and fulfilled their responsibilities to raise concerns and report incidents and near misses. Lessons were learned when incidents and near misses occurred.

  • 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.

  • Staff were highly motivated and inspired to offer care that was kind and promoted peoples dignity. Patient's individual preferences and needs were always reflected in how care was delivered.

  • Information about services and how to complain was available and easy to understand.

  • Patients said they were able to get an appointment with a GP when they needed one.

  • Extended hours appointments with a GP were available each Saturday morning from 8:30am to 11:30am.

  • Urgent appointments were available on the day they were requested.

  • The uptake of the online services provided by the practice was high, one third of patients were registered to access the online services.

  • 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 one area of outstanding practice:

  • Feedback from people who use the service and those close to them was continually positive about the way staff treat people. Patients rated the practice higher than others for almost all aspects of care according to the latest National GP Patient Survey results. For example, 97% of respondents said they would recommend this surgery to someone new to the area (CCG average 81%, national average 78%). In addition, 95% of respondents said the last GP they saw or spoke to was good at involving then in decisions about their care (CCG average 86%, national average 82%).

    T

    he practice had identified 262 of their patients as being a carer (4.3% of the practice patient population).

Professor Steve Field (CBE FRCP FFPH FRCGP) 

Chief Inspector of General Practice

Inspection areas

Safe

Good

Updated 28 April 2016

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 there were unintended or unexpected safety incidents, patients received reasonable support, truthful information, a verbal and written apology. They were told about any actions to improve processes and prevent the same thing happening again. For example, following a significant event the practice had updated their process for issuing controlled drugs.

  • The practice had clearly defined and embedded systems, processes and practices in place to keep patients safe and safeguarded from abuse. For example, there was an effective safety alert system, safeguarding leads were in place and appropriate recruitment checks had been undertaken prior to employing staff.

  • Risks to patients were assessed and well managed. However, when we inspected the practice, they did not have full medical indemnity cover for their practice nurses. We discussed this with the practice and they reviewed their medical indemnity arrangements and sought this cover for their nursing staff promptly.

Effective

Good

Updated 28 April 2016

The practice is rated as good for providing effective services.

  • We found that systems were in place to ensure that all clinicians were up to date with both National Institute for Health and Care Excellence (NICE) guidelines and other locally agreed guidelines.
  • Data showed patient outcomes were at or above average for the locality. The practice used the Quality and Outcomes Framework (QOF) as one method of monitoring their effectiveness; they had achieved 98% of the points available in 2014/15. This was 0.2% above the local average and 3.1% above the national average. For 14 of the 19 clinical domains within QOF the practice had achieved 100% of the points available.

  • Clinical audits demonstrated quality improvement. Audit was clearly linked to guidelines and best practice.

  • 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 people’s needs.

Caring

Outstanding

Updated 28 April 2016

The practice is rated as outstanding for providing caring services.

  • Data showed that patients rated the practice higher than others for almost all aspects of care. For example, results from the National GP Patient Survey showed that 98% of respondents had confidence and trust in their GP, compared to 95% nationally. 99% of respondents said that they GP had confidence or trust in the last nurse they saw or spoke to, compared to the national average of 97%.
  • Feedback from patients about their care and treatment was consistently and strongly positive. We saw a strong patient-centred culture.
  • Patients said they were treated with compassion, dignity and respect and they were involved in decisions about their care and treatment.
  • Staff were motivated and inspired to offer kind and compassionate care and worked to overcome obstacles to achieving this.
  • We observed a strong patient-centred culture. We also saw that staff treated patients with kindness and respect.
  • Information for patients about the services offered by the practice was available. For example, they provided this information on the practices’ website, patient leaflet and in the waiting areas. The practice had identified 262 of their patients as being a carer (4.3% of the practice patient population).

Responsive

Good

Updated 28 April 2016

The practice is rated as good for providing responsive services.

  • The practice worked closely with other organisations and with the local community in planning how services were provided to ensure that they met patients’ needs. For example, the practice provided a minor injuries services.
  • 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.
  • Patients could access appointments and services in a way and at a time that suited them. Data from the National GP Patient Survey published in January 2016 showed that patients rated the practice highly for accessibility. For example, 99% said the last appointment they got was convenient (CCG average of 93%, national average of 92%) and 91% were able to get an appointment to see or speak to someone the last time they tried (CCG average 86%, national average 85%).
  • 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 the practice responded quickly when issues were raised.
  • The practice promoted the use of online services for ordering repeat prescriptions. Over 2000 patients were registered for this service; this is over 30% of the practice population. Patients were able to use the online service to book an appointment with a GP.

Well-led

Good

Updated 28 April 2016

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

  • The practice had a clear vision with quality and safety as their top priority. 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.
  • The provider was aware of and complied with the requirements of the Duty of Candour. The partners 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.
  • 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 practice had a business plan, which was regularly reviewed.
Checks on specific services

People with long term conditions

Good

Updated 28 April 2016

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

  • Patients at risk of hospital admission were identified as a priority for care and support by the practice, comprehensive care plans were in place and regularly reviewed.
  • Nationally reported data showed the practice had achieved good outcomes in relation to most of the conditions commonly associated with this population group. For example, the practice had achieved 100% of the QOF points available for providing the recommended care and treatment for patients with hypertension. This was 0.3% above the local CCG average and 2.2% above the national average. The practice had achieved 89% of the QOF points available for providing the recommended care and treatment for patients with diabetes. This was 6.5% below the local CCG average and 0.7% below the national average. The practice had undertaken work to improve their performance for diabetes related indicators. While performance for the diabetes related indicators was below average this was an improvement on the results for 2013/2014 when the practice had achieved 84% (CCG average of 95%, national average of 90%).
  • Longer appointments and home visits were available when needed.
  • All patients with a long-term condition had a named GP and were offered 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 multidisciplinary package of care.

Families, children and young people

Good

Updated 28 April 2016

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

  • There were processes in place for the regular assessment of children’s development. This included the early identification of problems and the timely follow up of these. Systems were in place for identifying and following-up children who were considered to be at-risk of harm or neglect. For example, the needs of all at-risk children were regularly reviewed at practice multidisciplinary meetings involving child care professionals such as health visitors.
  • Appointments were available outside of school hours and the premises were suitable for children and babies.
  • There were arrangements for new babies to receive the immunisations they needed. Childhood immunisation rates for the vaccinations given to under two year olds ranged from 97% to 100% (CCG average 95% to 98%) and for five year olds ranged from 93% to 100% (CCG average 95% to 99%).
  • Urgent appointments for children were available on the same day.
  • 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.
  • Pregnant women were able to access an antenatal clinic provided by healthcare staff attached to the practice.
  • Nationally reported data showed that outcomes for patients with asthma were good. The practice had achieved 100% of the QOF points available for providing the recommended care and treatment for patients with asthma. This was 0.7% above the local CCG average and 2.6% above the national average.
  • The practice provided a full range of contraceptive services

Older people

Good

Updated 28 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 their population.
  • All patients over the age of 75 had a named GP and patients over the age of 75 were offered an annual health check.
  • The practice was responsive to the needs of older people; they offered home visits and urgent appointments for those with enhanced needs.
  • Nationally reported data showed that outcomes for patients with conditions commonly found in older people were good. For example, the practice had achieved 100% of the Quality and Outcomes Framework (QOF) points available for providing the recommended care and treatment for patients with heart failure. This was 1.1% above the local clinical commissioning group (CCG) average and 2.1% above the national average.
  • The practice maintained a palliative care register and offered immunisations for pneumonia and shingles to older people.

Working age people (including those recently retired and students)

Good

Updated 28 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.
  • Extended hours appointments with a GP were available each Saturday morning from 8:30am to 11:30am
  • Patients could order repeat prescriptions and book GP appointments online. Over one third of patients were registered for these services.
  • Telephone appointments were available each weekday.
  • The practice offered a full range of health promotion and screening which reflected the needs for this age group.
  • The practice’s uptake for cervical screening was 86%, which was 2.1% above the local CCG average and 3.8% above and national average.
  • Additional services such as new patient health checks, travel vaccinations and minor surgery were provided.
  • The practice website provided a wide range of health promotion advice and information.

People experiencing poor mental health (including people with dementia)

Good

Updated 28 April 2016

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

  • The practice held a register for patients experiencing poor mental health.
  • Nationally reported data showed that outcomes for patients with mental health conditions were above average. The practice had achieved 100% of the QOF points available for providing the recommended care and treatment for patients with mental health conditions. This was 3.5% above the local CCG average and 7.2% above the national average.
  • Nationally reported data showed that outcomes for patients with dementia were good. The practice had achieved 100% of the QOF points available for providing the recommended care and treatment for patients with dementia. This was 0.9% above the local CCG average and 5.5% above the national average. 91% of patients diagnosed with dementia had their care reviewed in a face-to-face meeting in the last 12 months, which is above the national average of 84%.
  • 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.

People whose circumstances may make them vulnerable

Good

Updated 28 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 living in vulnerable circumstances including those with a learning disability. Patients with learning disabilities were invited to attend the practice for an annual health check.
  • Nationally reported data showed that outcomes for patients with a learning disability were good. The practice had achieved 100% of the QOF points available for providing the recommended care and treatment for patients with a learning disability. This was the same as the local CCG average and 0.2% above the national average.
  • The practice offered longer appointments for patients with a learning disability if required.
  • The practice regularly worked with multi-disciplinary teams (MDT) in the case management of vulnerable people.
  • The practice informed vulnerable patients about how to access various support groups and voluntary organisations.
  • 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.
  • Good arrangements were in place to support patients who were carers.