Letter from the Chief Inspector of General Practice

We carried out an announced comprehensive inspection at The Forum Health Centre on 1 December 2016. Overall the practice is rated as outstanding.

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

• There was an open and transparent approach to safety with an effective system for reporting and recording significant events which was summarised and demonstrated shared learning. The practice had also shared learning nationally by uploading learning via the National Reporting and Learning System (NRLS) website.
• Risks to patients were assessed and well managed and there were systems which enabled routine assessment of risk. Safeguarding procedures and documentation had been reviewed by the safeguarding lead who had brought together all areas to enable easy access and guidance for staff. There was also evidence of detailed sharing of information, review and summarisation of actions regarding safeguarding showing positive outcomes for children and their families as a result of structured multi-disciplinary team working.

• The practice showed a commitment to learning, specifically regarding safeguarding. They had engaged in a project which resulted in a review of their procedures and the introduction of detailed summaries showing involvement, planning, and outcomes of intervention of child protection cases.

• 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. GPs and nurses had areas of special interest which they had developed to improve services for patients, such as in sexual health and care of the elderly.
• Patients said they were treated with compassion, dignity and respect and they were involved in their care and decisions about their treatment. Patient feedback was consistently positive regarding the care offered by all staff at the practice. The practice had also addressed services for carers and had taken additional steps to ensure staff were trained regarding carers and implemented measures to increase the number of carers identified.
• Information about services and how to complain was available and easy to understand and 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 purpose built facilities, providing disabled access, additional space to allow easy movement for patients with mobility aids, access to specific areas of the practice using electronic doors and had a lift facility. The building had been designed to allow for growth and development of services.
• The practice demonstrated strong leadership and evidence of long term strategic planning to develop and provide services in the community in corroboration with other stakeholders. Discussions took place with secondary care, the local authority, the local CCG and other community health care services and plans were regularly revisited to review and realise the vision for the practice.

• The practice was committed to driving changes in primary care and were involved in leading projects to improve services for patients. 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.

There were two areas where the practice should make improvements:

• Confirm in writing the outcome of complaints investigations following discussion with patients.

• Monitor the revised process for repeat prescriptions for high risk medicines to ensure it is operating effectively.

There were areas of outstanding practice:

The practice demonstrated a commitment to promoting health and uptake of screening and had achieved improved rates of cervical screening as a result of a proactive approach to patients who did not attend. The lead nurse had introduced a system which enabled them to contact all women who had not attended, to discuss the procedure and alleviate concerns which may have impacted on their reasons for non-attendance. As a result they had increased the number of women who attended after their initial response to decline. Cervical screening uptake rates were 86% which were significantly higher than the CCG and national average rates of 75% and 76% respectively.

The practice had a GP lead for women’s health and family planning and another GP who had a Diploma of the Faculty of Family Planning and Reproductive Medicine and a special interest in this area of health. They offered long acting reversible contraception (LARC) which included implants and intrauterine contraceptive device fitting (IUCD). The practice increased the number of sessions available for this service in response to increasing teenage pregnancies. We noted as a result that the practice termination of pregnancy rates had reduced significantly since 2013. For example, in 2013/14 there had been 30 cases, 2014/15 there had been 21 cases and in 2015/16 this had reduced to 13 cases.

The practice had been involved in a local project for Integrated Neighbourhood Teams (INT), which had resulted in the introduction of INTs in the area. They also had a GP who had led a project to introduce Acute Frailty Pathways for older people to reduce the length of stay and need for hospital admission which had demonstrated a reduction in length of stay from 11 to four days for elderly frail patients. This was then introduced across the area.

Professor Steve Field CBE FRCP FFPH FRCGP

Chief Inspector of General Practice