The Forest Edge Practice

Updated 28 October 2016

The Forest Edge Practice is located in Chigwell in north east London. It is one of the 47 member GP practices in the NHS Redbridge Clinical Commissioning Group (CCG).

The practice is located in the fifth more deprived decile of areas in England. Its catchment area however includes parts of Hainault, which is in the second more deprived decile, as well as Chigwell. Census data shows 14% of the local population does not speak English as their main language. At 79 years, male life expectancy is equal to the England average and at 84 years, female life expectancy is higher than the England average of 83 years.

The practice has approximately 11,000 registered patients. The practice age distribution is similar to that of the England average. Services are provided by The Forest Edge Practice GP partnership under a General Medical Services (GMS) contract with NHS England. The partnership is made up for four GPs.

The practice is in purpose built health care premises which the provider does not own and facilities services are managed by an external company. On street parking is available nearby including disabled parking spaces. There are eight consulting rooms and one treatment room. The premises and facilities are wheelchair accessible. The practice shares the premises with community services including, for example, dietetics, physiotherapy, Integrated Care Management, and MacMillan Support Services. The practice builds on this close proximity with these services, for example to provided joined up care to patients receiving end of life treatment.

The four partners together with one salaried GP provide the equivalent of 4.2 whole time GPs. There are four female GPs and one male GP. There are three part time practice nurses, a part time advisor for the elderly and a part time healthcare assistant. There is a team of reception, administrative and secretarial staff and a practice manager. One of the receptionists is also a trained phlebotomist.

The practice is an accredited GP training and teaching practice, and two the GP partners are approved trainers. There are two GP in training doctors attached to the practice at the time of our visit. Locum GP cover is provided by GPs who completed their training at the practice, or by one of the partners when required, to sustain continuity of care.

The practice’s opening times are:

• 8.30am to 6.30pm on Monday. Tuesday, Wednesday and Friday.

• 8.30am to 2.00pm on Tuesday to Friday.

Patients are directed to an out of hours GP service outside these times.

Appointments are available at the following times:

• 8.30am to 11.30pm and 2.00pm to 6.30pm on Monday and Tuesday.

• 8.30am to 11.30pm and 4.00pm to 6.30pm on Wednesday and Friday.

• 8.30am to 11.30pm and 1.30pm to 4.30pm on Thursday.

• 9.00am to 11.30am on Saturday (extended hours).

Appointments are also available at other local practices during the evening and at weekends under GP federation hub arrangements in Redbridge.

The Forest Edge Practice is registered with the Care Quality Commission to carry on the following regulated activities at Hainault Health Centre, Manford Way, Chigwell, Essex IG7 4DF: Diagnostic and screening procedures, Family planning, Maternity and midwifery services, Surgical procedures and Treatment of disease, disorder or injury.

Updated 28 October 2016

Letter from the Chief Inspector of General Practice

We carried out an announced comprehensive inspection at The Forest Edge Practice on 14 April 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:

• Consider further ways of meeting the needs of patients with long term conditions given the comparatively high exception reporting rates in some clinical domains.
• Staff demonstrated understanding of the consent and decision-making requirements of the Mental Capacity Act 2005, however they had not received formal training.

• The practice recognised carers’ needs and supported them; however less than one per cent of the practice list had been formally identified as a carer: census data indicates 10% of patients on a GP practice list are carers.

• Consider installing an induction loop to improve access to the service by people who use a hearing aid.

Professor Steve Field (CBE FRCP FFPH FRCGP) 

Chief Inspector of General Practice

Updated 28 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 against indicators for diabetes care was in line with local and national averages. There was an experienced diabetes nurse and one of the GPs had a special interest in diabetes. The practice held a dedicated diabetes clinic and provided insulin initiation.

• The practice also had nurses experienced in asthma and COPD, and offered spirometry.

• Longer appointments and home visits were available when needed.

• All these patients had a named GP and a structured annual review 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.

Updated 28 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.

• The percentage of eligible women who had a cervical screening test performed in the preceding five years was 82% which was the same as the national average.

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

• We saw positive examples of joint working with health visitors.

Updated 28 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, including longer appointments for people aged over 75 years.

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

• The practice was developing the role of Nurse Adviser for the Elderly to provide additional support and regular contact with older patients who needed this.

• There were phlebotomy sessions at the practice for patients aged over 75 years and others who needed this.

• Medicines were prescribed in dossett boxes where this helped the patient with taking their medicines.

Updated 28 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 as well as a full range of health promotion and screening that reflects the needs for this age group.

Updated 28 October 2016

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

• 86% of patients diagnosed with dementia who had their care reviewed in a face to face meeting in the last 12 months, which is comparable to the national average than the national average of 84%.

• The practice’s patient outcomes for mental health indicators compared well with national averages. The percentage of patients with schizophrenia, bipolar affective disorder and other psychoses:

  • Who have a comprehensive agreed care plan documented in the record in the preceding 12 months was 91%

  • Whose alcohol consumption has been recorded in the preceding 12 month was 92% (England 90%).

• The practice regularly worked with other health and care providers 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.

• Staff had a good understanding of how to support patients with mental health needs and dementia.

Updated 28 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 those with a learning disability.

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

• The practice regularly worked with other health care professionals in the case management of vulnerable patients.

• 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.