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Inspection Summary


Overall summary & rating

Good

Updated 16 February 2017

Letter from the Chief Inspector of General Practice

We carried out an announced comprehensive inspection at Fairfax Group Practice on 8 March 2016. The overall rating for the practice was requires improvement. The practice had not ensured Disclosing and Barring Scheme checks were carried out for staff who act as chaperones and staff were not provided with an appraisal of their work. Information about patients was not stored securely and prescriptions were not well managed. Within an agreed timescales the practice submitted an action plan which demonstrated they are now meeting the requirement notices from this inspection. The full comprehensive report on the 8 March 2016 inspection can be found by selecting the ‘all reports’ link for Fairfax Group Practice on our website at www.cqc.org.uk.

We carried out this announced comprehensive inspection at Fairfax Group Practice on 17 January 2017. Overall the practice is now 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, although they were not reviewed annually to identify any themes.

  • Risks to patients were assessed and well managed.

  • Staff assessed patients’ needs and delivered care in line with current evidence based guidance. Staff had been trained to provide them with 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. Improvements were made to the quality of care as a result of complaints and concerns.

  • 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.

  • 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.

The areas where the provider should make improvement are:

  • The safeguarding policy needs to be updated to reflect current guidance.
  • Staff should ensure READ coding is completed accurately.

Professor Steve Field (CBE FRCP FFPH FRCGP) 

Chief Inspector of General Practice

Inspection areas

Safe

Good

Updated 16 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, although they were not reviewed annually to identify any themes.
  • 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. The safeguarding policy needed to be updated to reflect current guidance.
  • Risks to patients were assessed and well managed.
  • The arrangements for managing medicines, including emergency medicines and vaccines, in the practice kept patients safe.

Effective

Good

Updated 16 February 2017

The practice is rated as good for providing effective services.

  • Data from the Quality and Outcomes Framework (QOF) showed patient outcomes were at or above average 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 other health care professionals to understand and meet the range and complexity of patients’ needs.
  • Patients had access to health assessments and checks including NHS health checks.  Patients were signposted to the relevant services and provided with information about how to maintain a healthy lifestyle.  

Caring

Good

Updated 16 February 2017

The practice is rated as good for providing caring services.

  • Data from the national GP patient survey showed patients rated the practice the same as and higher than others for several 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.
  • Patients told us they felt involved in decision making about the care and treatment they received. They also told us they felt listened to and supported by staff and had sufficient time during consultations to make an informed decision about the choice of treatment available to them.

Responsive

Good

Updated 16 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.
  • The practice had received the Pride in Practice award from the Lesbian, Gay, Bisexual and Transgender (LGBT) Foundation for its services provided to LGBT patients.
  • 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.

Well-led

Good

Updated 16 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 it.
  • 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 partners encouraged a culture of openness and honesty. The practice had systems in place for 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.
  • There was a strong focus on continuous learning and improvement at all levels.
  • The practice team was forward thinking and had developed a practice improvement plan for 2017. The improvement plan addressed a range of issues to ensure the ongoing effective and efficient running of the business and the ongoing improvement to the service.
Checks on specific services

People with long term conditions

Good

Updated 16 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.
  • 90% of patients on the diabetes register had a record of having had a foot examination and risk classification within the preceding 12 months compared to the CCG average of 91% and the national average of 88%.
  • 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 multidisciplinary package of care.
  • Personalised care plans were offered to patients with long term conditions and in particular those identified as being at high risk of hospital admission.
  • Personal action plans were developed for patients with respiratory problems (COPD, asthma)
  • Referrals were made to Bury Exercise and Therapy Scheme.
  • The practice participated in a new pilot scheme called ‘A Better Life For You’ to support patients back to work.
  • The lead GP for cancer care monitored patients with cancer and identified those patients who needed palliative/end of life care. Quarterly palliative care meetings were arranged and attended by a multidisciplinary health care team.
  • GPs analysed cancer diagnoses outside of the 2 week wait pathway to improve early detection.

Families, children and young people

Good

Updated 16 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 accident and emergency attendances.
  • Immunisation rates were relatively high for all standard childhood immunisations.
  • 91% of women aged between 25 and 64 had their notes recorded as having a cervical screening test performed in the preceding five years which was above the CCG and national average of 82%.
  • Appointments were available outside of school hours and the premises were suitable for children and babies.
  • We saw positive examples of joint working with midwives, health visitors and school nurses.
  • Acutely ill children under the age of 12 years were always directed to the on-call doctor or offered an appointment at any time during normal working hours.
  • Flexible appointments with clinicians were available from 7.30 am until 6.30 pm (7.00 pm 2 days per week).
  • The extended working hour’s service run by the Bury Federated GP’s was run from the practice.
  • Female health clinics were available, which included the fitting of contraceptive implants and coils.
  • Baby clinics and health visiting services were available on site once a week. There were coordinated clinics for baby assessments, immunisations and health visitor clinics to avoid multiple trips to the surgery.
  • There were consistently high childhood immunisation rates.
  • Safeguard training was provided to all staff with regular updates when appropriate.
  • The pharmacist and practice nurses ran childhood asthma clinics with appointments available out of school hours and during school holidays.

Older people

Good

Updated 16 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 patients in its population including providing advanced care planning.
  • The practice employed a pharmacist who worked with a pharmacy technician to ensure safe and evidence based prescribing. The pharmacist and practice nurses also ran childhood asthma clinics.
  • The practice was responsive to the needs of older patients and offered home visits and urgent appointments for those with enhanced needs.
  • GPs worked in line with the Gold Standards Framework for end of life care, including patient choice to receive end of life care at home.
  • The patients listed on the palliative care register were discussed regularly.
  • All patients over the age of 75 years had a named GP.
  • 80% of patients aged 65 years and over had received an influenza vaccination.
  • Combined flu, pneumonia and shingles campaigns were carried out and other routine health checks took place when patients attended for their vaccination.
  • Patients who attended accident and emergency had their care reviewed.
  • A significant event analysis took place following hospital discharge for patients living in care homes.
  • Staff participated in the ‘Friendly Faces’ scheme which was run by a local group set up to tackle loneliness and social isolation among older people.
  • The building was accessible to patients with mobility problems.

Working age people (including those recently retired and students)

Good

Updated 16 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 reflected the needs for this age group.
  • Flexible appointments were available with the nursing team for cervical smears, travel health and blood tests from 7.30 am until 6.30 pm (7.00 pm 2 days per week).
  • The extended working hour’s service run by Bury Federated GP’s was run from the practice.
  • Pre-bookable appointments were available up to one month in advance.
  • Same day appointments, face to face and telephone appointments, and a telephone triage service were available Monday to Friday.
  • On-line appointments and on-line repeat prescription requests were available.
  • Patients were encouraged to attend for NHS Health Checks.
  • Appointments for blood tests were offered throughout the day.
  • There was a virtual Patient Participation Group so patients had an opportunity to contribute to the development of the practice.
  • Patients were encouraged to use the practice website as a source of information.
  • The practice had a twitter account to inform patients of practice developments.

People experiencing poor mental health (including people with dementia)

Good

Updated 16 February 2017

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

  • 85% of patients diagnosed with dementia had their care reviewed in a face to face meeting in the last 12 months, which was comparable to the CCG and national average.
  • 93% of patients with schizophrenia, bipolar affective disorder and other psychoses had a comprehensive, agreed care plan documented in their record in the preceding 12 months compared to the CCG average of 91% and the national average of 88%.
  • The practice regularly worked with multi-disciplinary teams in the case management of patients experiencing poor mental health, including those with dementia. Annual reviews were held for all patients with complex mental health issues.
  • The practice had told patients experiencing poor mental health how to access various support groups and voluntary organisations.
  • There was a system 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 carried out advanced care planning for patients with dementia.
  • Care plans/individual management plans were initiated for these patients where appropriate.
  • A member of staff was the nominated Dementia Champion for the practice and was supported by a GP lead in dementia care
  • There were systems for the investigation and diagnosis of uncomplicated dementia.
  • Dementia awareness training was planned for staff.
  • Following a bereavement a condolence letter and bereavement support was offered to next of kin.
  • There was a Section 12 approved GP in the practice. This is a medically qualified doctor who has been recognised under section 12(2) of the UK’s Mental Health Act 1983 who has specific expertise in mental disorders and has received training in the application of the Act.

People whose circumstances may make them vulnerable

Good

Updated 16 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 with a learning disability.
  • The practice offered home visits and longer appointments for patients with a learning disability.
  • The practice 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.

All patients with learning disabilities, dementia and poor mental health were invited for 

  • annual health checks.
  • The GP lead for drug misuse worked closely with the drugs liaison worker.
  • There was a lead GP for sexual health/HIV.
  • The practice was the first in Bury to be awarded the Gold Pride in Practice Award. The practice had close working relationship with the LGBT (Lesbian, Gay, Bisexual and Transgender) Foundation.
  • The practice was participating in a pilot scheme with Bury Carer’s team in order to support all carers with appropriate help and advice. Two members of staff were nominated Carer’s Champions.
  • An interpreting service was used when required and leaflets were available in other languages when necessary.
  • A hearing aid loop was available.
  • The practice was part of a local scheme which acted as a drop off point for food parcels for vulnerable patients.