Archived: Family Healthcare Centre

Updated 12 November 2015

The Family Healthcare Centre (formerly know as Dr Keivan Maleki) at 1 East Anglian Way,Gorleston-on-Sea provides primary health care to 5360 registered patients. Four regular locum GPs provide additional medical support between one and three days each week. Three of the employed doctors are females to ensure that patients have a choice about the gender of the GP they see. Additional support is available from a nurse practitioner, two part time practice nurses and a part time health care assistant. A practice manager and team of administrative and reception staff complete the overall team. Training is provided to first year medical students throughout the year.

The practice holds a General Medical Services (GMS) contract to provide services. It is open between 8.15 and 6.30pm Monday to Friday. Extended hours surgeries are offered from 6-8pm on Wednesdays and Thursdays. The practice is closed at weekends. An out of hours service is provided by IC24 and can be accessed by patients if they call 111. If patients call the practice when it is closed, an answerphone message advises patients of the correct telephone number to ring depending on the circumstances.

This inspection took place to follow up on our concerns identified at our previous inspection on 28 October 2014 when the practice was rated as inadequate and placed into special measures for six months. The previous report can be found at www.cqc.org.uk

Updated 12 November 2015

Letter from the Chief Inspector of General Practice

We carried out an announced comprehensive inspection at the Family Healthcare Centre on 14 September 2015. This followed an inspection in October 2014 that placed the practice into special measures due to its rating of inadequate. The outcome of this inspection has identified that the practice is now rated as requires improvement.

Specifically, we found the practice to require improvement for providing safe, effective, responsive and well led services. It also requires improvement for providing services for older people, people with long-term conditions, families children and young people, working age people (including those recently retired) and people experiencing poor mental health (including people with dementia). It was good for providing a caring service to patients.

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

• Most areas of risk associated with the safe running of the service were managed safely although some areas still required improvement such as legionella management and complaints.
• Patients said they were treated with dignity, kindness and respect and they were involved in their care and decisions about their treatment.
• Patients told us they sometimes had difficulty arranging an appointment although urgent appointments were usually available on the day they were requested.
• The practice was visibly clean and they had improved systems to ensure that safe infection prevention and control procedures were being followed.
• Staff told us that communication within the practice had improved and they valued being part of a team.

Please note that when referring to information throughout this report, for example any reference to the Quality and Outcomes Framework data, this relates to the most recent information available to the CQC at that time.

However, there were also areas of practice where the provider needs to make improvements.

Importantly, the provider must:

• Ensure that systems are in place to manage and monitor risks to the quality and safety of the service in relation to legionella management and risks to the continuity of the service.
• Ensure that the incident reporting procedure is followed by staff at all times.
• Non -clinical staff who act as a chaperone must receive appropriate training and a risk assessment so that an appropriate level of criminal records check is completed before they undertake the role
• Ensure that patient information received from specialist services are accurately recorded in the electronic records so that medicines are safely and accurately prescribed.
• Ensure that records are maintained to demonstrate that appropriate staff are employed by the practice.

• Improve the complaints process so that all complaints are managed in a timely way and in accordance with the policy so that learning is shared and actioned.

In addition the provider should:

• Make information available to patients about chaperones on the practice’s website.
• Include guidelines in the recruitment policy on which staff roles require a check with the Disclosure and Barring Service.
• Develop care plans for all patients at high risk of unplanned admissions to hospital.
• Ensure audits of the completeness of clinical records are in place

On the basis of the ratings given to this practice at this inspection, we are removing this provider from special measures. We will inspect the practice again to ensure that it continues to make improvements.

Professor Steve Field (CBE FRCP FFPH FRCGP) 

Chief Inspector of General Practice

Updated 12 November 2015

The provider was rated as requires improvement for safe, effective, responsive and well-led. They were rated as good for caring services. The concerns which led to these ratings apply to everyone using this practice, including this population group.

The practice offered a phlebotomy service and clinics for people with long term conditions such as asthma, diabetes and high blood pressure. The clinics focused on keeping people healthy and included the provision of relevant vaccination programs. A diabetes specialist nurse visited the practice to support patients with more complex needs and advise staff. Plans were in place to run a drop-in support clinic for patients with long term conditions to seek practical, non-medical advice. This was being arranged by the patient participation group.

Updated 12 November 2015

Although the practice is rated as good for providing caring services it is rated as requires improvement for safe, effective, responsive and well-led services. The concerns which led to these ratings apply to everyone using this practice, including this population group.

A midwife held a clinic at the practice every two weeks to monitor pregnant women. Alternatively women could access a clinic held on a different day at a nearby location.

Staff had access to a health visiting team who attended meetings at the practice when possible. Childhood immunisation programmes were available. The practice had a policy of seeing children under the age of five on the same day as the appointment request. This was to manage the risk of their condition changing quickly. In addition the local hospital had a system of direct access to the children's ward. This meant that when a sick child was seen by the practice if they did not require hospital admission at that time but might do so within 24 hours if they deteriorated, the child could be taken go straight to hospital.

Young people could access support and advice in health promotion and sexual health. There were links with the children's mental health team if referrals were required.

Updated 12 November 2015

Although the practice is rated as good for providing caring services it is rated as requires improvement for safe, effective, responsive and well-led services. The concerns which led to these ratings apply to everyone using this practice, including this population group.

22% of the practice population are aged over 65 years. The practice supported people to live healthy lives for longer and offered a range of health promotion materials and services including immunisation programs such as influenza, shingles and pneumococcal. When required, home visits were provided for the housebound patients and immunisations could also be provided. The practice also supported two local care homes and regular visits were provided by the lead GP or nurse practitioner to review patients and advise staff and patients about their health needs.

Practice staff liaised with community health teams to ensure that support for older people was being provided to meet their needs. Multidisciplinary team meetings were held each month and this included a review of the most frail and vulnerable patients to ensure that they were receiving care that met their needs.

Updated 12 November 2015

Although the practice is rated as good for providing caring services it is rated as requires improvement for safe, effective, responsive and well-led services. The concerns which led to these ratings apply to everyone using this practice, including this population group.

The practice offered evening appointments twice a week and tried to accommodate the working patterns of patients as far as possible. If patients registered to do so, they could book or cancel appointments online and request repeat prescription.

Private medical examinations were available for patients who required them for occupational reasons e.g. HGV medicals.

Travel vaccinations and pre-travel assessment and advice were also available from the practice nurses.

Updated 12 November 2015

Although the practice is rated as good for providing caring services it is rated as requires improvement for safe, effective, responsive and well-led services. The concerns which led to these ratings apply to everyone using this practice, including this population group.

The practice regularly worked with multi-disciplinary teams in the case management of people experiencing poor mental health, including those with dementia. Regular health checks were provided to patients taking long term medication for their condition where there are risks to their physical health as a result of long term use.

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 might have been experiencing poor mental health.

Updated 12 November 2015

Although the practice is rated as good for providing caring services it is rated as requires improvement for safe, effective, responsive and well-led services. The concerns which led to these ratings apply to everyone using this practice, including this population group.

The practice did not have a population of vulnerable groups such as sex workers, homeless people or travellers. However, they had a policy to accommodate anyone who came to the surgery who required treatment.

There were two care homes for adults with a learning disability which were supported by the practice. Visits were provided to the care homes upon request or longer appointments could be arranged at the surgery. Annual health checks were completed by staff in the practice or home as appropriate.

The practice regularly worked with multi-disciplinary teams in the case management of their most vulnerable patients. This included for example working with the ambulance service in response to patients who were frequent callers. Information to signpost patients about how to access various support groups and voluntary organisations were readily available. 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 records for visually impaired patients were flagged so that clinicians and administration staff can take this into account. The practice website could be enlarged for people with some visual impairment and it could also be translated into other languages. A hearing loop was available for hearing impaired patients.