Forestside Medical Practice

Updated 4 October 2016

Forestside Medical Practice is located at Dibden Purlieu Surgery, Beaulieu Road, Dibden Purlieu, Hampshire, SO45 4JA. The practice is based in Dibden Purlieu, a village on the eastern edge of The New Forest. The practice has approximately 11,200 registered patients. The practice told us that approximately 500 new patients had registered at the practice in the period between February to August 2016.

The practice provides services under a NHS General Medical Services contract and is part of NHS West Hampshire Clinical Commissioning Group (CCG). The practice is based in an area of low deprivation compared to the national average for England. The age profile of the practice’s patient population is similar to the national average. A total of 22% of patients at the practice are under 18 years of age compared to the national average of 21% and CCG average of 20%. 2% of the patient population are over 85 years compared to the national average of 2% and CCG average of 3%. A total of 58% of patients have a long-standing health condition, which is slightly higher than the CCG average of 55% and national average of 54%. Less than 1% of the practice population describe themselves as being from an ethnic minority group; the majority of the population are White British.

The practice has six GP partners, four of whom are male and two are female, as well as employing two female salaried GPs. Together the GPs provide care equivalent to approximately 49 sessions per week. The GPs are supported by five practice nurses and one health care assistant who provide a range of treatments and advice and are equivalent to approximately three whole time equivalent nurses. The practice also employs two phlebotomists. The clinical team are supported by a management team with secretarial and administrative staff. The practice is a training practice for doctors training to be GPs (registrars) and a teaching practice for medical students. At the time of our inspection, the practice employed two female GP trainees.

The practice is open between 8am and 6.30pm Monday to Friday. The reception desk and phone lines remain open between these times. Extended hours surgeries are available every Thursday evening until 9.15pm. Appointments with a GP are available until 12.30pm and again from 2pm until 6.15pm daily. The GPs carry out daily home visits to patients who need them. Care to patients is provided on the ground floor of a purpose built building which the practice rents from a private landlord. There are eight consulting rooms and two treatment rooms at the practice. There are also two rooms on the first floor of the practice, used for counselling and physiotherapy. The practice has a lift to support patients who are unable to manage stairs. The practice offers minor surgery to patients, such as the removal of sebaceous cysts, joint injections and removal of in-growing toe nails.

The practice has opted out of providing out-of-hours services to their own patients and refers them to another provider via the NHS 111 service. The practice offers online facilities for booking of appointments and for requesting prescriptions.

The practice has a branch surgery, known as the Marchwood Surgery, located at Old Malthouse Main Road, Marchwood, Hampshire, SO40 4UZ. We did not visit the branch surgery as part of this inspection. We visited Forestside Medical Practice as part of this inspection, which has not previously been inspected by the Care Quality Commission.

Updated 4 October 2016

Letter from the Chief Inspector of General Practice

We carried out an announced comprehensive inspection at Forestside Medical Practice on 13 September 2016. Overall the practice is rated as good.

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

• There was an open and transparent approach to safety and an effective system in place for reporting and recording significant events.
• 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 areas where the provider should make improvement are:

• Review the processes for identifying carers to ensure they are offered appropriate care and support.

Professor Steve Field (CBE FRCP FFPH FRCGP) 

Chief Inspector of General Practice

Updated 4 October 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.

• Performance for long-term conditions was similar to or better than national averages. For example, 84% of patients with diabetes had an acceptable cholesterol level in 2014-2015 compared to a national average of 81%. 83% of patients with asthma had an asthma review in the preceding 12 months which was better than the national average of 74%.

• The percentage of patients with a history of a heart attack (on or after 1 April 2011) treated with appropriate medication was 100% compared to a CCG average of 99% and national average of 97%.

• Longer appointments and home visits were available when needed.

• All these patients had a named GP and a structured review at a minimum annually to check their health and medicines needs were being met. For those patients with the most complex needs, the named GP worked with relevant health and care professionals to deliver a multidisciplinary package of care.

• The practice carried out twice yearly reviews of patients with diabetes to ensure their care and treatment was optimal.

• The practice offered insulin initiation to patients with diabetes requiring this service.

Updated 4 October 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.

• Immunisation rates were relatively high for all standard childhood immunisations. There was a system in place to follow up children who did not attend for immunisations.

• 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.

• 80% of eligible women received a cervical smear in the preceding five years, which is similar to the national and clinical commissioning group average of 82%.

• Appointments were available outside of school hours and the premises were suitable for children and babies.

• We saw positive examples of joint working with midwives, health visitors and school nurses. For example, the practice met with the health visitors every two months.

Updated 4 October 2016

The practice is rated as good for the care of older people.

• The practice offered proactive, personalised care to meet the needs of the older people in its population.

• The practice was responsive to the needs of older people, and offered home visits and urgent appointments for those with enhanced needs.

• Performance for conditions common in older patients was similar to national averages. For example, 84% of patients with high blood pressure had a last blood pressure reading which was within acceptable limits, compared to the national and clinical commissioning group average of 83%.

• In 2014-2015, 100% of patients aged 75 or over with a record of a fragility bone fracture and a diagnosis of osteoporosis, were treated with appropriate bone-sparing medication. This was better than the CCG average of 91% and national average of 92%.

Updated 4 October 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 was proactive in offering online services and extended hours as well as a full range of health promotion and screening that reflects the needs for this age group.

• Flu vaccination clinics are offered to patients at weekends and evenings during the flu campaign to promote attendance for patients unable to attend in usual working hours.

Updated 4 October 2016

The practice is rated as good for the care of people experiencing poor mental health (including people with dementia).

• Performance for mental health indicators were better than national averages. For example, 90% of patients diagnosed with dementia who had their care reviewed in a face to face meeting in the last 12 months, which is better than the national average of 84%.

• 98% of patients with schizophrenia, bipolar affective disorder and other psychoses had an agreed care plan documented in the preceding 12 months, compared to the national average of 88%.

• The practice regularly worked with multi-disciplinary teams in the case management of patients experiencing poor mental health, including those with dementia.

• The practice 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.

• The practice carried out regular welfare checks on patients with serious mental health conditions.

• The practice had a system in place to follow up patients who had attended accident and emergency where they may have been experiencing poor mental health.

• Staff had a good understanding of how to support patients with mental health needs and dementia. The practice had taken steps to achieve ‘dementia friendly’ status and were awaiting confirmation from the awarding organisation.

• The practice had improved their recognition, diagnosis and support given to patients with dementia. In 2016, the practice had identified 93 patients as having dementia. This was an increase of 43 patients since 2014.

Updated 4 October 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, travellers and those with a learning disability.

• The practice offered longer appointments for patients with a learning disability.

• The practice had identified 34 patients with a learning disability. 65% of these patients had received a physical health check in the previous 12 months.

• The practice regularly worked with other health care professionals in the case management of vulnerable patients. For example, the practice were part of a project to improve social isolation for people in the community which started in September 2016.

• The practice informed 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.