Archived: Forest Health Care

Updated 21 January 2016

The practice is located on Ruardean high street. Forest Health Care (Ruardean Surgery) is registered with CQC to provide primary care services, which includes access to GPs, family planning, treatment of disease, disorder or injury, diagnostic and screening procedures, maternity and midwifery services and surgical procedures.

This practice was established in Ruardean more than 50 years ago and expanded over a period of time to incorporate Cinderford. They moved into Cinderford Health Centre but maintained this branch surgery in Ruardean, which also has a dispensary.

The practice partnership is also known as Forest Health Care. The practice consists of three male partners, one female partner and one salaried female GP providing a whole time equivalent of 4.75 and 38 GP sessions. The practice team also include six practice nurses, five health care assistants; practice manager and administrative staff which include dispensary staff, receptionists, head of patient services and IT coordinator. Staff work across the provider’s two locations, Cinderford Health Centre and Ruardean Surgery on a rotational basis. The practice has a population of approximately 7800 patients and dispenses prescriptions to patients who do not have access to a pharmacy within one mile of their home address.

The practice is a training practice for GP trainees with two alternating GPs providing training support. At the time of our inspection a second year GP registrar was being supported by the practice.

The practice had a General Medical Services contract with NHS England to deliver general medical services. The practice provided enhanced services which included extended hours for appointments; facilitating timely diagnosis and support for patients with dementia and learning disabilities.

The practice is open between 8.30am and 6pm on Mondays, 8.30am and 4pm Tuesdays and Wednesdays, 8.30am and 12.45pm Thursdays and Fridays. Pre booked appointments are from 8.40am to 11.30am every morning from Monday to Friday and 2pm to 5.30pm on Monday afternoon. Urgent appointments were also available on the day and patients can access GP services at Cinderford Health Centre when this branch is closed.

The practice has opted out of providing Out Of Hours service to patients. Patients are re-directed to the Out of Hours Service via the NHS 111 service.

Updated 21 January 2016

Letter from the Chief Inspector of General Practice

We carried out an announced comprehensive inspection at Forest Health Care (Ruardean Surgery) on 5 November 2015. Overall the practice is rated as good including each of the six population groups we looked at.

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

• There were systems in place to mitigate safety risks including analysing significant events and monitor safeguarding. Systems were in place to ensure medicines including vaccines were appropriately stored and in date.

• Risks to patients were assessed and well managed.

• Staff assessed patients’ needs and delivered care in line with current evidence based guidance. Staff had 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.
• Patients said they found it easy to make an appointment with a named GP and that 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.
• The premises were clean and tidy.
• 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.

Professor Steve Field (CBE FRCP FFPH FRCGP) 

Chief Inspector of General Practice

Updated 21 January 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. Quality and Outcomes Framework (QOF) indicators for the year 2013/2014 showed the practice was performing above the national averages for diabetes related indicators. For example, the percentage of patients with diabetes, on the register, in whom the last blood pressure reading (measured in the preceding 12 months) was 140/80 mmHg or less was 91.82% compared to a national average of 78.53%.

• Longer appointments and home visits were available when needed.

• All these patients had a named GP and a structured annual review to check that their health and medicines needs were being met. For example, for patients who found it difficult managing their medicines, the dispensary arranged for a medicines management system in the form of a medicines compliance aid box to be provided for those patients.

• 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.

Updated 21 January 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 patients who had a high number of A&E attendances. Immunisation rates were relatively high for all standard childhood immunisations.

• Patients told us that children and young patients 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.

• QOF indicators for the year 2013/2014 showed that the percentage of women aged 25-64 whose notes record that a cervical screening test had been performed in the preceding five years was 82.56% compared to a national average of 81.88%.

• We saw good examples of joint working with midwives, health visitors and school nurses.

Updated 21 January 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 patients in its population.

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

• Nationally reported data showed that outcomes for patients were good for conditions commonly found in older patients.

Updated 21 January 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 as well as a full range of health promotion and screening that reflects the needs for this age group.

Updated 21 January 2016

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

• 95.56% of patients with a diagnosis of schizophrenia, bipolar affective disorder and other psychoses had a comprehensive, agreed care plan documented in the record, in the preceding 12 months (2013/2014) which was above the national average of 86.04%.

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

• It 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.

• It 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 people with mental health needs and dementia.

Updated 21 January 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.

• It offered longer appointments for patients with a learning disability. Data provided by the practice indicated that 37% of patients diagnosed with a learning disability have had an annual health check. Those patients who had not had a health check yet are recalled on the month of their birthday.

• The practice regularly worked with multi-disciplinary teams in the case management of vulnerable patients.

• It had told 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.