Archived: Dr Fenske and Partners

Updated 23 June 2016

Dr Fenske & Partners is also known as the Goldington Medical Practice and provides a range of primary medical services, including minor surgical procedures from its location on Goldington Road in Bedford, located on the periphery of the town centre. The practice has a branch surgery, known as the Church Lane Surgery on Church Lane in Bedford.

The practice serves a population of approximately 13,007 patients with higher than average populations of males aged 10 to 19 years and lower than average populations of females for the same age group. The practice population is largely White British with an increasing population of Eastern Europeans. National data indicates the area served is one of average deprivation in comparison to England as a whole.

The clinical staff team consists of one male and two female GP partners, one male salaried GP, a long term GP locum, one minor illness nurse, four practice nurses and one health care assistant. Additional GP locums are also employed by the practice to ensure adequate availability of GP appointments. The team is supported by a practice manager and a team of administrative staff. The practice holds a General Medical Services (GMS) contract for providing services, which is a nationally agreed contract between general practices and NHS England for delivering general medical services to local communities.

The practice has recently experienced some staffing difficulties. In the 12 months prior to our inspection the practice saw the departure of five out of seven GP partners, primarily due to retirement and relocation. In addition to this, the long standing practice manager partner, lead nurse and health care assistant also retired. The practice has struggled to recruit and retain new staff, in particular GP partners. The remaining two partners continued to provide services with the support of locums and the return of a GP partner as a long term locum. They have successfully recruited one new GP partner and are continuing efforts to stabilise their clinical team. As a result of the clinical capacity issues, the practice has closed its patient list and was not accepting new patient registrations as of January 2016.

Dr Fenske & Partners is open between 8am and 6.30pm Mondays to Fridays, at both the main and branch surgeries. Pre-bookable appointments are available at both surgeries from 6.30pm to 7.30pm on Tuesdays. The main surgery on Goldington Road is open from 9am to 12pm on Saturdays. The out of hours service is provided by Bedfordshire Doctors on Call (BEDOC) and can be accessed via the NHS 111 service. Information about this is available in the practice and on the practice website.

At the time of our inspection, the registration of Dr Fenske & Partners with CQC to provide regulated activities was not accurate and we had not been notified of changes made to the partners and the registered manager at the practice, as required under the CQC (Registration) Regulations 2009. The practice has now taken steps to complete the necessary application to ensure their registration with us is accurate.

Updated 23 June 2016

Letter from the Chief Inspector of General Practice

We carried out an announced comprehensive inspection at Dr Fenske & Partners on 17 May 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 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 were able to make an appointment with a named GP, 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 area where the provider should make improvement is:

• Develop systems to identify and support more carers in their patient population.

Professor Steve Field (CBE FRCP FFPH FRCGP) 

Chief Inspector of General Practice

Updated 23 June 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.
• Performance for diabetes related indicators was comparable to the national average. For example, the percentage of patients with diabetes, on the register, in whom the last blood glucose reading showed good control in the preceding 12 months was 74%, where the CCG average was 76% and the national average was 78%.
• Longer appointments and home visits were available when needed.
• All these patients had a named GP and a structured six monthly or 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.

Updated 23 June 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 practice had a system to alert clinicians to children at risk, including those that have a child protection plan in place.
• 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 comparable to the CCG average of 83% and the 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.
• The practice hosted a midwife clinic and carried out antenatal and postnatal checks.

Updated 23 June 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, this included enhanced services for avoiding unplanned admissions to hospital and end of life care.
• The practice was responsive to the needs of older people, and offered home visits and urgent appointments for those with enhanced needs.
• The practice provided influenza, pneumonia and shingles vaccinations.
• The patient participation group (PPG) was active and were involved in organising numerous events throughout the year to support patients. This included coffee mornings for elderly and isolated patients. We saw that the PPG had organised a flu day at a local church hall, encouraging patients to receive vaccinations and incorporating blood pressure monitoring services as well as social support.

Updated 23 June 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 provided a health check to all new patients and carried out routine NHS health checks for patients aged 40-74 years.
• The practice was proactive in offering on line services as well as a full range of health promotion and screening that reflects the needs for this age group.
• Pre-bookable appointments were available on Tuesday evenings between 6.30pm and 7.30pm and on Saturday mornings from 9am and 12pm.
• The practice had enrolled in the Electronic Prescribing Service (EPS) in June 2015. This service enabled GPs to send prescriptions electronically to a pharmacy of the patient’s choice.

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Updated 23 June 2016

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

• There was a register for patients with dementia and we saw that all 72 patients currently on the register had received an annual review in the 12 months prior to our inspection.
• The practice regularly worked with multi-disciplinary teams in the case management of patients experiencing poor mental health, including those 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.
• The practice maintained a register of patients with mental health conditions. Staff had a good understanding of how to support patients with mental health needs and dementia.

Updated 23 June 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 homeless people and those with a learning disability.
• The practice offered support to homeless patients in the locality. A GP provided a weekly early morning clinic at a night shelter for the homeless. A practice nurse attended the Prebend Day Centre for the homeless on two mornings every week. We saw that between April 2015 and March 2016 the nurse had provided treatment to 381 homeless patients.
• The practice held palliative care meetings in accordance with the national gold standards framework involving district nurses, GP’s and the local MacMillan nurses.
• The practice offered longer appointments and annual health checks 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.
• The practice had identified 0.3% of the practice list as carers. The practice recognised that this was a low representation and were in the process of identifying more carers.