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Dr Bevan & Partners Good Also known as Fairfield Park Health Centre

Inspection Summary


Overall summary & rating

Good

Updated 31 October 2016

Letter from the Chief Inspector of General Practice

In February 2016, a comprehensive inspection of Dr Bevan & Partners was conducted. The practice was rated as requires improvement for safe and good for effective, caring, responsive and well led. Overall the practice was rated as good.

We found that the practice required improvement for the provision of safe services because improvements were needed in the way the practice assessed, managed and mitigated the risk associated with the spread of infections and with fire safety.

Dr Bevan and Partners sent us an action plan which set out the changes they would make to improve in these areas.

We carried out an announced desk top inspection of Dr Bevan & Partners on 20 September 2016 to ensure the practice had made these changes and that the service was meeting regulations. At this inspection we rated the practice as good for providing safe services. The overall rating for the practice remains good. For this reason we have only rated the location for the key question to which this related. This report should be read in conjunction with the full inspection report published on 16 February 2016.

Our key findings were:

  • The practice had processes in place to prevent, detect and control the spread of infections, including those that are health care associated.
  • Comprehensive fire risk policies and procedures were in place.
  • Recommended training had been undertaken by practice staff.

Professor Steve Field CBE FRCP FFPH FRCGP

Chief Inspector of General Practice

Professor Steve Field (CBE FRCP FFPH FRCGP) 

Chief Inspector of General Practice

Inspection areas

Safe

Good

Updated 31 October 2016

The practice is rated as good for providing safe services. Since our last inspection in February 2016, systems had been put in place to ensure safe patient care.

  • The practice had an infection control risk assessment in place and had actioned the areas identified.
  • Infection control audits had been completed by the infection control leads.
  • Staff had completed training modules relating to infection control.
  • A legionella risk assessment had been undertaken legionella (Legionella is a term for a particular bacterium which can contaminate water systems in buildings). All identified actions had been completed.
  • A fire risk assessment had been completed and all identified areas actioned.
  • The practice had a fire log in place which detailed equipment testing schedules that had been undertaken.

Effective

Good

Updated 18 April 2016

The practice is rated as good for providing effective services.

  • Data from the Quality and Outcomes Framework showed patient outcomes were at or above average for the locality and 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.

  • Nursing staff and some GP’s had not received mental capacity training.

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

  • The practice supported its GP trainees effectively.

  • Staff worked with multidisciplinary teams to understand and meet the range and complexity of patients’ needs.

  • A private health zone room, near the waiting room was available for patients’ to, for example, weigh themselves and measure their blood pressure in privacy. Health promotion information was available in this room.

  • A number of services were available at the practice such as, physiotherapy, podiatry, and counselling.

Caring

Good

Updated 18 April 2016

The practice is rated as good for providing caring services.

  • Data from the National GP Patient Survey showed patients rated the practice 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.

  • The practice provided medical care for a local nursing home. A dedicated GP conducted a weekly visit.

Responsive

Good

Updated 18 April 2016

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 worked with the CCG to provide physiotherapy, podiatry and counselling services within the practice for the local area.

  • The practice operated a walk in and wait clinic each morning for all patients who wished to access GP or nurse appointments on the day rather than making an appointment.

  • Patients who had more than one chronic disease were able to book longer appointments to minimise the number of times they were asked to attend the practice for reviews.

  • The practice worked closely with university student services to identify improvements that could be made for the benefit of students.

  • The practice had good facilities and was well equipped to treat patients and meet their needs. All internal practice signs included braille.

  • 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 18 April 2016

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 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.

  • There was an overarching governance framework which supported the delivery of the strategy and good quality care.

  • 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

  • The practice proactively sought feedback from staff and patients, which it acted on. The patient participation group was active.

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

However,

The practice did not monitor services provided by outside contractors for the maintenance of the buildings and equipment.

Checks on specific services

People with long term conditions

Good

Updated 18 April 2016

The practice is rated as good for the care of patients 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.
  • Patients with more than one chronic disease were able to book a longer appointment so that visits to the practice were minimised for the patient.
  • A nurse visited housebound older patients at home and carried out annual reviews where appropriate.
  • The percentage of patients on the diabetes register, with a record of a footexamination and risk classification within the preceding 12 months (04/2014 to 03/2015) was 88% which was the same as the national average.
  • 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.

Families, children and young people

Good

Updated 18 April 2016

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

  • 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 patients who had a high number of A&E attendances. Immunisation rates were relatively high for all standard childhood immunisations.

  • Patients told us that children and young patients were treated in an age-appropriate way and were recognised as individuals, and we saw evidence to confirm this.

  • The percentage of women aged 25-64 whose notes record that a cervical screening test had been performed in the preceding 5 years was 85% compared to a national average of 82%.

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

Older people

Good

Updated 18 April 2016

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

  • The practice offered proactive, personalised care to meet the needs of the older patients in its population.

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

  • A named GP was responsible for the care of older patients in a nursing home and conducted weekly visits.

  • Care plans were in place for 324 patients that the practice had identified as being at risk of hospital admissions. One hundred and ninety nine of these were for patients over the age of 75 years.

Working age people (including those recently retired and students)

Good

Updated 18 April 2016

The practice is rated as good for the care of working-age patients (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.

  • Commuter clinics were available for both GPs and nurses on a Saturday morning.

  • The age profile of patients at the practice was mainly those of working age, students and the recently retired. 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.

  • The practice provided extensive online health promotion, advice and support which were tailored to meet the needs of its student population.

People experiencing poor mental health (including people with dementia)

Good

Updated 18 April 2016

The practice is rated as good for the care of patients experiencing poor mental health (including people living 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 91% compared to a 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.

  • 74% of patients diagnosed with dementia had had their care reviewed in a face to face meeting in the last 12 months, which is lower than the CCG average of 86% and the national average of 84%.

  • 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 hosted a counsellor on site to provide care for patients who required mental health support.

  • 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 18 April 2016

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

  • The practice held a register of patients living in vulnerable circumstances including homeless people, travellers and those with a learning disability.

  • 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.

  • 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.