Archived: Fulfen Practice

Updated 7 January 2016

Fulfen Practice is located in Burntwood, a town that forms part of the Lichfield district and has a population of around 26,000. The practice is part of the NHS South East Staffordshire and Seisdon Peninsula Clinical Commissioning Group. The town is an ex-mining community and is now home to a mainly white British community including many that commute into the West Midlands. The town of Burntwood has low deprivation. The branch surgery at Chasetown is in a more deprived area. The local acute hospitals serving the community are in Walsall, New Cross and Burton upon Trent and there are minor injury units locally at hospitals in Lichfield and Cannock. The total practice patient population has increased significantly since 2013 with the merger of two single-handed practices. In 2015 a local branch practice closed and Fulfen Practice were allocated approximately five hundred of the patients. The list size has increased substantially from approximately 3,800 in April 2013 to 6,900 in November 2015.

There are five male GPs and one female GP who provide services which equate to four and a half whole time equivalent GPs. The practice team includes three management staff, two nurse practitioners, two practice nurses, one healthcare assistant (HCA) and a phlebotomist. There were 11 practice support staff including secretaries, receptionists and administrators. In total there are 3 GP partners and 25 staff employed either full or part time hours. A second healthcare assistant was also employed as part of the organisation structure. At the time of the inspection this role was vacant and recruitment was underway. 

The practice provides a number of clinics for example long-term condition management including asthma, diabetes and high blood pressure. It also offers child immunisations, minor surgery and travel vaccinations.

The practice has a Personal Medical Services (PMS) contract with NHS England. This is a contract for the practice to deliver locally agreed contracts with NHS England services to the local community or communities. They also provide some enhanced services, for example they offer minor surgery and have Directed Enhanced Services, such as the childhood vaccination and immunisation scheme, minor surgery, risk profiling and case management, rotavirus and shingles immunisation and extended hours.

Fulfen practice opening times are 8am to 7pm Monday to Friday. Phone lines are closed at 6.30pm but GP pre-bookable appointments continue until 7pm each day. The Chasetown branch opening hours are 8am to 6.30pm Monday to Friday. The practice does not provide an out-of-hours service to its own patients but has alternative arrangements for patients to be seen when the practice is closed through Staffordshire Doctors Urgent Care (SDUC) their out-of-hours service provider. The practice telephones switch to the out of hours service at 6.30pm each weekday evening and at weekends and bank holidays

The practice is a member of a local GP Federation which had recently been formed. The practice reported that no collaborative work of note had been started at the time of inspection. The building is owned by NHS Properties and the partners were in discussion to relocate to new premises.

Updated 7 January 2016

Letter from the Chief Inspector of General Practice

We carried out an announced comprehensive inspection at Fulfen Practice on 2 November 2015. Overall the practice is rated as good.

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

• Staff understood and fulfilled their responsibilities to raise concerns, and to report incidents and near misses. Information about safety was recorded, monitored, appropriately reviewed and addressed.
• Patients’ needs were assessed and care was planned and delivered following best practice guidance. Staff had received training appropriate to their roles and any further training needs had been identified and planned.
• 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 could make an appointment with a named GP and that there was continuity of care, with urgent appointments available the same day.
• Risks to patients were assessed and well managed, with the exception of those relating to infection prevention and control.
• The practice had regular meetings for all staff.
• 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.

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

The provider must:

• Ensure that an effective system is in place to protect patients from the risks of infection.

The provider should:

• Assess the emergency medications held at the practice to ensure they are age appropriate.

• Ensure that an audit trail exists to record the status of action points from staff meetings.

Professor Steve Field (CBE FRCP FFPH FRCGP) 

Chief Inspector of General Practice

Updated 7 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 have set up a pre-diabetes register for at risk patients identified through diabetes screening. The healthcare assistant (HCA) organised an internal weight reduction clinic. 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 medication needs were being met. The practice had a high prevalence for hypertension and promoted evidence based self-care by lending blood pressure monitoring machines to patients.

Updated 7 January 2016

The practice is rated as good for the care of families, children and young people. There were systems in place to provide rapid access to treatment for children under five. Immunisation rates were similar to the CCG average for all standard childhood immunisations. The nurse practitioners demonstrated significant knowledge in family planning and contraceptive services. Appointments were available outside of school hours and the premises were suitable for children and babies. We saw good examples of joint working with midwives and health visitors.

Updated 7 January 2016

The practice is rated as good for the care of older people. Nationally reported data showed that outcomes for patients were good for conditions commonly found in older people. The practice offered proactive, personalised care to meet the needs of the older people in its population and had a range of enhanced services, for example, a chronic disease management (CDM) service was offered to patients annually. It was responsive to the needs of older people, and offered home visits and a carers’ service providing monthly clinics to the patients.

Updated 7 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, for example, pre-bookable appointments are available to 7pm Monday to Friday.  The practice was proactive in offering online services as well as a full range of health promotion and screening that reflected the needs for this age group.  

Updated 7 January 2016

The practice is rated as good for the care of people experiencing poor mental health (including people with dementia). An annual care plan had been completed for 80% of patients experiencing poor mental health. The practice regularly worked with multi-disciplinary teams in the case management of patients experiencing poor mental health, including those with 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 (A&E) where they may have been experiencing poor mental health.

Updated 7 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 those with a learning disability. The practice participated in the delivery of an enhanced service for patients with learning difficulties.

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 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.