14 November 2018
Dr. Joseph Fowler is registered with the Care Quality Commission as an individual GP provider. The practice is part of the NHS Wolverhampton Clinical Commissioning Group. The practice holds a General Medical Services (GMS) contract with NHS England. A GMS contract is a contract between NHS England and general practices for delivering general medical services.
The practice operates from 470 Stafford Road, Wolverhampton, WV10 6AR. The practice provides a number of clinics such as long-term condition management including asthma, diabetes and high blood pressure. It also offers child immunisations and travel health as well as minor surgery. Patients have access to a psychologist for counselling and support each Thursday following a GP referral.
The total practice patient population is approximately 1,996. The practice is in an area considered as a third most deprived when compared nationally. People living in more deprived areas tend to have greater need for health services. The practice has a higher proportion of patients aged 65 years and above (37.6%) than the expected England average (27%).
The clinical staff team currently comprises of a male full time GP working 10 sessions a week and an advanced nurse practitioner who works part time hours, equivalent to three sessions per week. Clinical staff are supported by a practice manager and three reception staff, employed either full or part time hours.
Dr Joseph Fowler practice opening times are Monday to Friday (except Tuesdays), 9am to 12.30pm and 5pm to 6.30pm. Tuesday opening times are 9am to 12.30pm and 4pm to 6.30pm. A GP telephone advice service is available each day after the morning surgery normally between 12.30pm and 2.30pm.
The practice does not provide an out-of-hours service to its own patients but has alternative arrangements for patients to be seen when the practice is closed through the NHS 111 telephone service where telephone calls are directed to Vocare, the out of hours service.
We undertook a comprehensive inspection of Dr Joseph Fowler on 22 November 2018 under Section 60 of the Health and Social Care Act 2008 as part of our regulatory functions. The practice was rated as good overall with requires improvement for providing safe services. The full comprehensive report following the inspection on November 2018 can be found by selecting the ‘all reports’ link for Dr Joseph Fowler on our website at www.cqc.org.uk.
We undertook a follow up focused inspection of Dr Joseph Fowler on 10 October 2018. This inspection was carried out to review in detail the actions taken by the practice to improve the quality of care and to confirm that the practice was now meeting legal requirements.
14 November 2018
At our previous inspection on 22 November 2018, the overall rating for the practice was good with requires improvement for providing safe services. The full comprehensive report on the November 2018 inspection can be found by selecting the ‘all reports’ link for Dr Joseph Fowler on our website at www.cqc.org.uk.
This inspection was an announced focused inspection carried out on 10 October 2018 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 22 November 2018. This report covers our findings in relation to those requirements and any additional improvements made since our last inspection.
Overall the practice is now rated as good.
At this inspection we found:
- Systems were in place for the safe management of high risk medicines.
- A system to track blank prescription pads and forms used in printers throughout the practice had been introduced.
- The practice had introduced a consistent approach to the documentation of significant events so that the sequence of events, analysis, investigation, follow up and learning was clearly identified.
- The practice had reviewed its approach to identifying carers.
- The results of the July 2018 national GP patient survey showed that patients were very satisfied with the service they received from the practice. The practice had scored higher than the clinical commissioning group (CCG) averages in all questions.
- Reception staff had received varied training to ensure they were aware of ‘red flag’ sepsis symptoms that might be reported by patients and how they should respond.
- Appropriate systems in line with NICE guidance had been implemented for the assessment of patients with presumed sepsis.
- Despite patients’ reluctance, the practice continued to actively encourage patients to form a patient participation group (PPG). The practice ensured that patients were kept up to date through other media which included detailed quarterly newsletters, posters and impromptu conversations in the waiting room.
Professor Steve Field CBE FRCP FFPH FRCGP
Chief Inspector of General Practice
16 July 2015
The practice is rated as good for the care of people with long-term conditions. The practice nurse had the lead role 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 patients had a named GP and a structured annual review to check that their health and medication needs were being met. The practice had
62.9% of patients registered at the practice with a long-standing health condition and those with a long-term condition had received an annual review. 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.
16 July 2015
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 regular communication with the Health Visitor. Children’s immunisation rates were higher than the local Clinical Commissioning Group (CCG) average for all standard childhood immunisations with only one exception. 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.
16 July 2015
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 support such as 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.
16 July 2015
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 and was in the process of setting up online prescription services and offered a full range of health promotion and screening that reflects the needs for this age group.
16 July 2015
The practice is rated as good for the care of people experiencing poor mental health (including people with dementia). We saw that eight out of 12 patients with dementia had a care plan in place. The practice informed us this was an on-going process and these figures were from March 2015. The practice continued to make progress and review dementia and mental health patients to ensure they received an appropriate care plan and annual physical health check. The practice regularly worked with multi-disciplinary teams the majority of the time these were discussions rather than meetings in the case management of people experiencing poor mental health, including those with dementia. The practice acted on its feedback from a questionnaire and introduced educational literature and support for patients on subjects such as depression and anxiety in January 2015. 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) where they may have been experiencing poor mental health.
16 July 2015
The practice is rated as good for the care of people whose circumstances may make them vulnerable. The practice had systems in place to ensure that they could identify patients living in vulnerable circumstances including homeless people, travellers and those with a learning disability. It had carried out health checks and offered longer appointments to people with a learning disability.