Forest Group Practice

Updated 2 May 2017

The practice is situated on the Suffolk Norfolk borders and covers the area of Brandon and thirteen local villages. They offer health care services to approximately 7,000 patients. A two weekly GPservice, (this is a limited service) and a weekly phlebotomy service is held in the village hall in Mundfordfor those patients that find it difficult to travel to the main site at Brandon. We did not inspect the room at Mundford.

The partnership took over the practice in 2012 and they hold an Alternative Provider Medical services (APMS) contract (until 2020).

There are currently six GP partners (four male and two female) and three salaried GPs. There are also three practice nurses one nurse practitioner, one healthcare assistant/phlebotomist.

A team of administration and reception staff support the operation manager and business manager. The practice is open between 8am and 6.30pm Monday to Friday and offers pre-booked GP and nurse appointments on Saturdays from 8.30am to 12pm.

If the practice is closed, patients are asked to call the NHS111 service or to dial 999 in the event of a life threatening emergency.

The practice profile for age range of patients aged over 50 is higher than the national average. The deprivation score is below the England average; however the practice told us that it is higher than the average for the county of Suffolk.

Unemployment in the practice population is lower than the England average, the percentage of patients who provide unpaid care is in line with the national average.

Male and female life expectancy in this area is in line with the England average at 79 years for men and 84 years for women.

Updated 2 May 2017

Letter from the Chief Inspector of General Practice

We carried out an announced comprehensive inspection at Forest Group Practice on 8 August 2016. The overall rating for the practice was rated as Good overall and good for providing effective, responsive, caring and well-led services. The practice was rated as requires improvement for providing safe services. The full comprehensive report on the August 2016 inspection can be found by selecting the ‘all reports’ link for Forest Group Practice on our website at www.cqc.org.uk.

This inspection was desk-based review carried out on 31 March 2017 to confirm that the practice had carried out their plan to meet the legal requirements in relation to the breaches in regulations that we identified in our previous inspection on 8 August 2016. This report covers our findings in relation to those requirements and also additional improvements made since our last inspection.

Overall the practice is rated as Good. However, on the inspection on 8 August 2016, there were areas of practice where the provider needed to make improvements.

We found that the provider must:

• Ensure that the actions identified in the fire risk assessment are completed and that the practice conducts regular fire drill and formal awareness training. Ensure the fire exit that is accessed through a treatment room has clear signage so that staff and patients are aware.

In addition we found the practice should:

• Develop a system to ensure that regular audits are undertaken to monitor quality and performance and to encourage improvement.
• Review the practice training log to improve management oversight. When requested the practice had not been able to produce all the information easily.
• Review the system and ensure all clinical staff immunisations are recorded.
• Embed the new system to manage infection control monitoring and audit.

At this inspection we found that;

• Actions identified in the fire risk assessment were completed. Fire drills and fire training had been conducted. A fire exit that was accessed through a treatment room had clear signage to ensure staff and patients were aware of the exit.
• The practice had developed a system to ensure that regular audits were undertaken to monitor quality and performance and to encourage improvement. We saw evidence of audits having been commenced.
• The practice had reviewed the way it managed staff training and had implemented a staff training policy. An audit of staff training had been undertaken with individual training logs for each member of staff.
• The practice had implemented a staff vaccination policy and was in the process of recording all staff immunisations.
• The practice was in the process of embedding the new system to manage infection control with audits undertaken on a rolling cycle.

The areas where the provider should make improvement are:

• Continue to embed the systems in place to ensure regular audits are undertaken and reviewed to monitor quality and performance and to encourage improvement.

Professor Steve Field (CBE FRCP FFPH FRCGP) 

Chief Inspector of General Practice

Updated 30 September 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.

• 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.

Updated 30 September 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 in line with the national averages for all standard childhood immunisations.

• 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.

• 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.

Updated 30 September 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.

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

• The practice proactively cared for patients who lived in care homes and undertook regular visits.

• Home visits were available for patients who needed them.

• The practice actively encouraged patients to attend a falls prevention exercise class in the local leisure centre.

• A two weekly GP session and a weekly phlebotomy clinic were held in the village of Mundford for those patients who found it difficult to attend the main site.

Updated 30 September 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.

• The practice offered appointments on Saturday mornings for both GPs and nurses enabling patients that could not attend during the weekdays to access appointments. Telephone appointments were available for those that wished to seek advice in this way.

Updated 30 September 2016

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

• The practice had 65 patients diagnosed with dementia on the register. 90% of these patients had received an annual review. Many of the remaining 10% lived in care homes and had GP reviews throughout the year. The reviews included advance care planning. The practice had installed a clock in the waiting room which was specially designed to help patients with dementia manage their anxiety relating to time issues.

• The practice regularly worked with multi-disciplinary teams in the case management of patients experiencing poor mental health, including those with dementia. A mental health link worker was available on site.

• 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. GPs demonstrated that they managed complex patients with care plans and continuity of care.

Updated 30 September 2016

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

• There was a lead GP and 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 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.

• Not all the practice staff had received training, but the staff we spoke with 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.