Forest House Surgery

Updated 28 April 2017

Forest House Surgery is situated in the small town of Shepshed which is near to junction 23 of the M1 in North West Leicestershire. There is a local population of about 15000 which will increase as up to 3500 new homes are planned to be built over the next five years. Many local residents work in Loughborough, Leicester and Nottingham. Shepshed is an area with private housing alongside some small pockets of social deprivation. The practice has 11500 patients with relatively high numbers of elderly patients and patients with long-term conditions. It has approximately 200 patients living in nearby care homes which is substantially more than any other practice in the locality.

The practice occupies a converted grade 2 listed building which been carefully modernised and extended. Treatment and consulting rooms are on the ground floor. There is a car park which includes disabled spaces and there is an independent pharmacy adjacent to the practice.

There are 7 GPs, 2 of whom are female with 2 locum GPs to help cover absences. There are two nurse prescribers and two practice nurses (all female) who provide minor illness and urgent care, and manage long-term conditions such as diabetes, asthma and chronic pulmonary disease. (COPD) There are also four health care assistants. The clinical team is supported by a practice manager, and other support staff some of whom take lead responsibilities for areas such as reception and prescriptions. The practice is training and teaching practice which has medical students on placement and trainee GPs.

The practice is open between 8.30am and 6.30pm Monday to Friday. Appointments can be pre-booked up to 12 weeks in advance. Appointments including for telephone consultations are available of the day. Patients with who need on the day appointments on an urgent basis are slotted in at the end of a GP session on a sit and wait basis.

Out of hours services are commissioned by West Leicestershire Clinical Commissioning Group and provided by DHU (Derbyshire Health United).

Updated 28 April 2017

Letter from the Chief Inspector of General Practice

We carried out an announced comprehensive inspection at Forest House Surgery on 28 September 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.
• Urgent appointments were made available for vulnerable patients and unwell children even where sessions were fully booked.
• The practice had adequate facilities and equipment.
• 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 practice had over 200 patients living in local care homes and provided weekly ward rounds to four homes and ad hoc visits to others. Each home was visited by one of two GPs to establish continuity with the staff, patients and their families. Care plans were regularly reviewed and end of life wishes included. We received very positive feedback from a care home manager who came to the practice to meet with us on the day of inspection.

Professor Steve Field (CBE FRCP FFPH FRCGP) 

Chief Inspector of General Practice

Updated 28 April 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 with support from GPs. The practice had identified 2% of its patients who were at risk from unplanned hospital admissions and shared information with out of hours and district nurse services to help keep people out of hospital where possible.

• The practice's performance for diabetes management was similar to or slightly higher than national averages, for example, the practice scored 78% for the QOF indicator relating to blood sugar control management for diabetic patients compared to the local average of 83% and national average of 78%.

• Longer appointments and home visits were available when needed. The practice kept a register of patients who were housebound.

• All 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.

• The practice kept a list of those patients such as those receiving end of life care, patients with mental health problems and patients with multiple conditions to ensure that they received same-day call-backs from their regular GP wherever possible.

Updated 28 April 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 A&E attendances.

• Immunisation rates were above local and national averages.

• Patients told us that children and young people were treated in an age-appropriate way and were recognised as individuals.

• Data showed 82% of eligible women had received a cervical screening test compared with the local average of 83% and national average of 82%.

• Appointments were available outside of school hours and the premises were suitable for children and babies. Young children who were ill were always seen and the practice used a sepsis screening tool to help identify this condition.

• The practice offered 24 hour and 6 week baby checks.

• We saw examples of joint working with midwives, health visitors and school nurses. The practice informed the health visitor of new child registrations.

Updated 28 April 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 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. It had a register of those patients who were housebound and provided vaccinations at home when necessary.

• The practice’s approach was to undertake frailty assessments, dementia screening and an integrated approach to include where needed end of life planning and a multi-agencyapproach.

• The practice had identified those older patients at risk of hospital admission and had developed care planning which identified key health problems and their ongoing management. Special notes were included on records for out of hour’s services to avoid unnecessary or inappropriate hospital admissions.

• The practice provided care for approximately 160-200 patients living in local care homes some of whom were receiving end of life care. A named GP attended each home on a weekly basis to perform a ward round offering continuity of care for the patients. Staff at the homes were provided with a separate telephone number to improve their access especially with urgent queries. Feedback from care homes was very positive.

Updated 28 April 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.

• The practice had an automated telephone appointment booking system called ‘Patient Partner’ which allowed a patient to book an advance appointment or cancel an existing appointment at any time, day or night.

• Bookable telephone consultations were available.

• Patients who needed to be seen urgently were offered appointments on a sit and wait basis at the end of morning and afternoon sessions.

The practice offered a travel vaccination service.

Updated 28 April 2017

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

• 83% of patients living with dementia had a face-to-face care review in the previous 12 months, compared with the local average of 87% and national average of 84%.

• The practice offered dementia screening to patients identified as high risk individuals.

• The practice carried out advance care planning for patients with dementia which included appropriate end of life care plans.

• 99% of patients with severe mental health problems had a comprehensive agreed care plan documented in their records compared with the local average of 95% and national average of 89%. Alerts on their records meant that they were routinely offered longer appointments and annual health checks with a GP or Mental Health Facilitator

• 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 and where appropriate their carers 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. The practice had recognised that these patients benefited from routine and tried to ensure they saw the same GP or healthcare professional, for example, if they needed regular blood tests.

Updated 28 April 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 living in vulnerable circumstances including carers, people with a learning disability (LD), people who were housebound and those with alcohol or substance misuse problems.

• The practice offered longer appointments for patients including those with serious mental health issues and those with a learning disability.

• The practice offered annual health checks to the 54 patients on the learning disability register. Most recent figures showed that 51 of the 54 patients on the register had received a check. This included a patient who refused to visit the surgery and had not had a health check for many years. The GP was the LD leadworked with the community nurse and started to make regular visits to the patient’s home and eventually the patient allowed the GP to perform a health check.

• The practice regularly worked with other health care professionals in the case management of vulnerable patients, for example, the counsellor providing treatment for patients on the Methadone treatment programme visited the surgery so patients could avoid frequent travel for treatment.

• The practice informed vulnerable patients about how to access various support groups and voluntary organisations.

• The practice had identified 128 or 1.1% of its patients who had caring responsibilities. They were offered a referral to a local support service for a carer assessment, and given information about local authority services such as First Contact, which could offer practical assistance with a variety of housing and other matters. There was also information available in the waiting area and on the website. The practice had recognised that it was very likely that more patients than recognised had a caring responsibility and was actively trying to encourage more carers to identify themselves to the practice, for example, by working with the PPG with awareness displays in the surgery and local library.

• All 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 was able to describe situations where, for example, reception staff had raised a concern about how a child was treated in the waiting area, which the GP had taken further with the parent and health visitor.