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Inspection Summary


Overall summary & rating

Good

Updated 11 July 2016

Letter from the Chief Inspector of General Practice

We carried out an announced comprehensive inspection at Forest Practice on 11 April 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.
  • The practice offered extra in-house services and home visits for people living in vulnerable circumstances. This included people requiring support with substance misuse, drug and alcohol addictions, refugees and people with learning disabilities. Patients benefited from receiving care and treatment that was closer or within their homes. This also reduced the burden on hospital services.

  • Feedback from patients showed they were treated with dignity and respect, and they felt involved in decisions about their care and treatment.

  • 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.
  • The practice responded to complaints that were raised and learning was shared with staff.

  • The practice had a clear vision which had quality and safety as its top priority. The strategy to deliver this vision was reviewed and discussed with staff.

  • The practice had a leadership structure in place, with clear delegation of tasks and responsibilities for both clinical and non-clinical staff. Staff we spoke with felt valued and supported by management.

  • The practice proactively sought feedback from staff and patients, which it acted on. However, the practice did not have a patient participation group in place despite several attempts to set up one.

We saw one area of outstanding practice:

The practice was proactive in identifying and providing services for people whose circumstances may make them vulnerable closer to home. For example:

  • The practice delivered the second largest weekly substance misuse management clinic in Nottingham and this was accessible to registered and non-registered patients. Patients benefited from integrated care as this clinic was delivered with input from a specialist substance misuse worker. Practice staff had received extra training to ensure patients were able to receive more complex treatment at the practice.

  • The practice provided primary medical services to patients enrolled in a rehabilitation programme to address their drug and alcohol addictions. In addition to removing barriers for these patients to access services at the practice, they undertook home visits. This service was provided at no extra funding and had improved outcomes for patients.

The areas where the provider should make improvement are:

  • Continue to make attempts to set up a patient participation group within the practice.

  • Ensure carers are proactively identified and offered services that improve their care.

Professor Steve Field (CBE FRCP FFPH FRCGP) 

Chief Inspector of General Practice

Inspection areas

Safe

Good

Updated 11 July 2016

The practice is rated as good for providing safe services.

  • There was an effective system in place for reporting and recording significant events.

  • We found staff used every opportunity to learn from significant events and patient safety alerts, to support improvement.

  • Learning was also shared with external providers to promote wider learning and share best practice. This included the clinical commissioning group and the crimes and drug prevention death review group.

  • The safeguarding of vulnerable adults and children was a priority within the practice and suitable arrangements were in place to keep patients safe and safeguarded from abuse.

  • Risks to patients were assessed and well managed. This included recruitment checks, medicines management, infection control and medical emergencies.

  • Staffing arrangements had been reviewed and the practice was actively recruiting for a GP and a receptionist to ensure sufficient staffing levels were maintained.

Effective

Good

Updated 11 July 2016

The practice is rated as good for providing effective services.

  • Data from the Quality and Outcomes Framework (QOF) showed most patient outcomes for long term conditions were at or above average compared to the local and national averages.

  • However, clinical outcomes for people with mental health and dementia were better than the CCG and national averages.

  • The practice proactively reached out to the community and worked with other multi-disciplinary professionals to improve the outcomes of people whose circumstances might make them vulnerable. For example, weekly substance misuse clinics were run from the practice along with a specialist substance misuse worker to ensure integrated care for patients. In addition, the practice had assessed the health needs of refugees that had settled within the area and made referrals to mental health services were appropriate.

  • Staff assessed patients’ needs and delivered care in line with current evidence based guidance.

  • Clinical audits were carried out and these resulted in improved outcomes for patients.

  • Staff had the skills, knowledge and experience to deliver effective care and treatment.

  • There was evidence of appraisals and personal development plans for staff.

  • Staff worked with other health care professionals to understand and meet the range and complexity of patients’ needs.

Caring

Good

Updated 11 July 2016

The practice is rated as good for providing caring services.

  • Feedback from patients about their care and treatment was consistently and strongly positive. Patients said they were treated with compassion, dignity and respect and they were involved in decisions about their care and treatment.

  • We observed staff treating patients in a dignified and respectful way.

  • The January 2016 national GP patient survey results showed patients rated the practice higher than others for several aspects of care. For example, 96% of patients said the last GP they saw or spoke to was good at listening to them compared to a local average of 87% and national average of 89%.

  • Care planning arrangements were in place to ensure patients were involved in their care and treatment. This included people with learning disabilities and complex long term conditions.

  • Information about health services and support organisations was accessible to patients and carers.

Responsive

Good

Updated 11 July 2016

The practice is rated as good for providing responsive services.

  • An outstanding feature of the practice included the additional in-house services offered for people living in vulnerable circumstances. This included people requiring support with substance misuse, drug and alcohol addictions, refugees and people with learning disabilities. Patients benefited from receiving care and treatment closer or within their homes; which also reduced the burden on hospital 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. This was reflected in the national GP patient survey results. For example, 86% of patients described their experience of making an appointment as good compared to the CCG average of 74% and the national average of 73%.

  • 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.

Well-led

Good

Updated 11 July 2016

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

  • The practice had a clear vision to deliver high quality care and promote good outcomes for patients. Staff were clear about the vision and their responsibilities in relation to it.

  • There was a clear leadership structure and staff felt supported by management.

  • There was an overarching governance framework and a number of policies in place which supported the delivery of good quality care.

  • The practice proactively sought feedback from staff and patients which it acted on. However, the practice did not have an active patient participation group in place.

  • There was a strong focus on continuous learning and improvement at all levels.

Checks on specific services

People with long term conditions

Good

Updated 11 July 2016

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

  • All staff had individual responsibilities for monitoring patient outcomes and / or managing long-term conditions. For example, nursing staff had lead roles in chronic disease management and patients at risk of hospital admission were identified as a priority.

  • 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 multidisciplinary package of care.

  • Nationally reported data showed clinical indicators for long term conditions such as asthma, were all higher than the local and national averages with low exception reporting.

  • Longer appointments and home visits were available when needed.

  • The community diabetes nurse specialist facilitated a monthly clinic to review patients with diabetes.

Families, children and young people

Good

Updated 11 July 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.

  • 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.

  • Children who required urgent care were given priority including same day GP appointments. Appointments were also available outside of school hours and the premises were suitable for children and babies.

  • We saw positive examples of joint working with midwives and health visitors.

  • Immunisation rates were high for all standard childhood immunisations and above the local average. For example, vaccination rates for children under two years old ranged from 95.1% to 100% compared to a CCG average ranging from 91.1% to 96.3%.

Older people

Good

Updated 11 July 2016

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

  • The practice offered proactive and personalised care to meet the needs of the older people in its population. For example, monthly multi-disciplinary meetings were held to review patients at risk of hospital admission and to plan and deliver care appropriate to their needs.

  • The practice was responsive to the needs of older people, and offered home visits and urgent appointments for those with enhanced needs.

  • A total of 70% of people aged 65 and over had received the flu vaccination.

  • Nationally reported data showed outcomes for patients for conditions commonly found in older people were mostly above the local and national averages; with the exception of osteoporosis.

Working age people (including those recently retired and students)

Good

Updated 11 July 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 as well as a full range of health promotion and screening that reflects the needs for this age group. However, the practice did not routinely offer NHS annual health checks.

  • Patients had access to a text messaging service for confirming an appointment, informing of missed appointment and cancelling booked appointment.

People experiencing poor mental health (including people with dementia)

Good

Updated 11 July 2016

Data reviewed showed outcomes for people with mental health and dementia were above CCG and national averages. For example:

  • Performance for mental health related indicators was 100% which was above the CCG average of 87% and national average of 92.8%. In addition, 95.1% of patients with a mental health condition had a documented care plan in the last 12 months which was above the CCG average of 84% and the national average of 88.3%. 

  • 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.

People whose circumstances may make them vulnerable

Good

Updated 11 July 2016

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

The practice was proactive in identifying and providing services for this population group and this was an outstanding feature. For example:

  • The practice delivered the second largest substance misuse management clinic in Nottingham and 55 people (registered and non-registered patients) accessed this service at the time of our inspection. Staff had received extra training to ensure patients were able to receive more complex treatment at the practice.
  • The practice had 82 patients with a learning disability living in a care home and all these patients had received an annual health check and a care plan was in place. The practice had a designated GP lead who undertook the reviews every third Thursday of the month or when needed. The practice also had 30 patients with learning disabilities living in the community.
  • The practice provided primary medical services to 19 patients enrolled in a rehabilitation programme to address their drug and alcohol addictions. This service was provided at no extra funding and had improved outcomes for patients.

  • The practice offered longer appointments and regularly worked with other health care professionals in the case management of vulnerable patients.
  • 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.