Letter from the Chief Inspector of General Practice

We carried out an announced comprehensive inspection at Fulcrum medical practice on 25 January 2017. Overall the practice is rated as good.

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

• 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.
• Patients said they found it easy to make an appointment with a named GP and there was continuity of care, with urgent appointments available the same day.
• The practice had good facilities and was well equipped to treat patients and meet their needs.
• 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 Duty of Candour is a set of specific legal requirements that providers of services must follow when things go wrong with care and treatment.)

The Fulcrum medical practice is a unique primary medical practice in Middlesbrough, which provides GP and specialist pharmacological and psychosocial services for people with addiction to drugs and alcohol. There are 712 patients registered at the practice. The mean average age of patients registered with the practice is 38 years of age. Of all of the patients registered at Fulcrum, 78% are male and 22% are female. There are only 46 children registered at the practice. Adult patients can only register at the practice if they have a substance misuse problem. For many of the practice population the substance is predominantly heroin.

We saw areas of outstanding practice:

• The practice had trained many of its patients how to use a life-saving opiate overdose reversal drug, and provided take-home kits for single patient use. Analysis of data from patient records had indicated how effective this project was in reversing heroin overdose. 325 patients were trained and given take-home kits (a medication to reverse the effects of a heroin overdose) and 71 of these patients had used the life-saving kit in the first few months of the project.

• All patients who attended for their cervical screening received a small pack of toiletries to take away, along with health promotion advice. This had greatly increased the cervical screening uptake rate (by 24%). The practice’s current uptake figure of 81% is above the national average uptake rate of 71%, within mainstream general practices. This is a significant figure in a small cohort of females in a hard-to-reach population group.
• The waiting area had been transformed into a more relaxed informal space, furnished with sofas and comfortable seating. It was used as a therapeutic space to undertake daily health promotion sessions using health promotion specialists capturing a hard to reach group and enabling them to take responsibility for their own health and development.

The areas where the provider should make improvements are:

• Include Infection Prevention and Control as part of the induction programme.

Identify the need for, and monitor the completion of, Mental Capacity Act (2005) training for all clinical staff in order for them to carry out their duties effectively and safely. 

Professor Steve Field (CBE FRCP FFPH FRCGP) 

Chief Inspector of General Practice

During the inspection we spoke with five patients, the registered manager who is also the GP and the practice manager. We also spoke with two specialist addiction nurses, the practice nurse, the business manager and reception staff.

Patients spoken with during the inspection were very happy with the care, support and treatment that they received. One person said, “The reception staff are great and you can always get an appointment when you need one. They always understand, everyone is excellent.” Another person said, “There is lots of support. I come once a month. I can talk about why I have used drugs and they listen. I talk about how I get stressed and how to deal with it.”

We found that patient’s health, safety and welfare was protected when more than one provider was involved in their care and treatment, or when they moved between different services.

We were able to observe the experiences of patients. We saw that staff treated patients with dignity and respect. We saw that patients had their care, support and treatment needs assessed and that treatment plans were in place.

We saw that patients were treated in safe, accessible surroundings and that regular checks were carried out to monitor the quality of the service provided.