Archived: Field Road Surgery

Updated 14 January 2016

Field Road Surgery provides primary medical services to approximately 4000 patients in the local community. There are two GP partners (one male and one female) working at the practice together with two salaried GPs (one male and one female). The practice is a training practice for GP trainees (fully qualified doctors who wish to become general practitioners). At the time of the inspection there was one trainee GP. The GPs are supported by an advanced nurse practitioner (ANP), a practice nurse and a phlebotomist. The non-clinical team consists of administrative and reception staff and a practice manager.

The practice has a General Medical Services contract (GMS) with NHS England. A GMS contract ensures practices provide essential services for people who are sick as well as, for example, chronic disease management and end of life care. The practice also provides some directed enhanced services such as childhood vaccination and immunisation and minor surgery (joint injection). Enhanced services require an enhanced level of service provision above what is normally required under the core GP contract.

The practice is an ‘Any qualified provider’ (AQP) for diabetes services. This enabled both patients registered at the practice and patients registered elsewhere to receive diabetes services usually undertaken in secondary care services at the practice.

The practice opening times are Tuesdays, Wednesdays and Thursdays from 8.30am to 6.30pm with the exception of Fridays when the practice closes at 1pm and does not re-open during the afternoon. The practice provides an extended hours service on Mondays when it is open from 8.30am to 8pm.

The practice has opted out of providing out-of-hours services to their own patients. This service is provided by ‘Badger’ the external out of hours service provider. When the practice is closed during core hours on a Friday afternoon patients can access general medical service by contacting ‘WALDOC’ which is an out-of-hours service provider.

We reviewed the most recent data available to us from Public Health England which showed that the practice is located in an area with a low deprivation score compared to other practices nationally. Data showed that the practice has a slightly higher than average practice population aged 75 years and over in comparison to other practices nationally with a value of 9% compared to the national average of 7.6%. The practice also has a slightly higher than the national average number of patients with caring responsibilities with a rate of 19.5% compared to the national average of 18.2%. The practice had a higher than national average number of patients with a long standing health condition with a rate of 65.7% compared with a national average of 54%.

The practice achieved 99.4% points for the Quality and Outcomes Framework (QOF) for the financial year 2013-2014. This was above the national average of 94.2% with a 3.6% exception reporting. The QOF includes the concept of ‘exception reporting’ to ensure that practices are not penalised where, for example, patients do not attend for review, or where a medication cannot be prescribed due to a contraindication or side-effect. The QOF is a voluntary annual reward and incentive programme which awards practices achievement points for managing some of the most common chronic diseases, for example asthma and diabetes.

Updated 14 January 2016

Letter from the Chief Inspector of General Practice

We carried out an announced comprehensive inspection at Field Road Surgery on 27 October 2015. Overall the practice is rated as good.

Specifically, we rated the practice as good for providing safe, effective, caring, and responsive and well led services. The service provided to the following population groups was rated as good:

• Older people

• People with long-term conditions

• Families, children and young people

• Working age people (including those recently retired and students)

• People whose circumstances may make them vulnerable

• People experiencing poor mental health (including people with dementia).

Our key findings across all the areas we inspected were as follows:

• Staff understood and fulfilled their responsibilities to raise concerns, and to report incidents and near misses. Information about safety was recorded, monitored, appropriately reviewed and addressed. However, some essential safety checks were due updates.

• Patients’ needs were assessed and care was planned and delivered following best practice guidance.

• 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.

• There was a clear leadership structure and staff felt supported by management.

However, there was an area of practice where the provider needs to make improvements.

The provider should :

• Review the results of the 2015 national GP patient survey and consider whether improvements are needed to improve patients’ experience of the service.

Professor Steve Field (CBE FRCP FFPH FRCGP) 

Chief Inspector of General Practice

Updated 14 January 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 that their health and medication needs were being met. For those people with the most complex needs, the named GP worked with relevant health and care professionals to deliver a multidisciplinary package of care. The practice was an ‘Any qualified provider’ (AQP) for diabetes services. This enabled both patients registered at the practice and patients registered elsewhere to receive diabetes services usually undertaken in secondary care services at the practice.

Updated 14 January 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. Rates for standard childhood immunisation were mostly above the CCG averages. Appointments were available outside of school hours and the premises were suitable for children and babies.

Updated 14 January 2016

The practice is rated as good for the care of older people. Nationally reported data showed that outcomes for patients were good for conditions commonly found in older people. The practice offered proactive, personalised care to meet the needs of the older people in its population and had a range of enhanced services, for example, in dementia and end of life care. It was responsive to the needs of older people, and offered home visits and rapid access appointments for those with enhanced needs. The practice employed a pharmacist to undertake reviews for patients over the age of 75 years. This enabled patients to receive their annual health check including a review of their medication and an assessment of risk factors such as dementia screening and potential risk of emergency hospital admissions. There were 196 patients, of these 51% had received a reviews.

Updated 14 January 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 offered online services and telephone consultations as well as a full range of health promotion and screening that reflected the needs of this age group. The practice had increased access for working age patients by reserving extended hour opening for those patients who worked.

Updated 14 January 2016

The practice is rated as good for the care of people experiencing poor mental health (including people with dementia). There were 26 patients on the mental health register and the practice had carried out annual health checks for most of these patients with further reviews planned. The practice regularly worked with multidisciplinary teams in the case management of people experiencing poor mental health, including those with dementia. It 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. It had a system in place to follow up patients who had attended accident and emergency (A&E) as a result of experiencing poor mental health.

Updated 14 January 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. We saw that there were 16 patients on the learning disability register and the practice had carried out annual health checks for most of these patients with further reviews planned. It offered longer appointments for people with a learning disability.

The practice regularly worked with multidisciplinary teams in the case management of vulnerable people. It had told 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.