Forrest Medical Centre

Updated 21 October 2016

Forrest Medical Centre is situated on the outskirts of Coventry on the edge of an area of high social and economic deprivation. The practice is registered with the Care Quality Commission (CQC) as a partnership provider and delivers a full range of family medical services, as well as providing a minor surgery service.

The practice has a General Medical Services (GMS) contract with NHS England. The GMS contract is the contract between general practices and NHS England for delivering primary care services to the local communities. At the time of the inspection, Forrest Medical Centre was providing medical care to approximately 9,240 patients.

The practice moved into the current purpose-built premises in September 2015. It has good facilities and is suitable for patients with mobility problems and for those who use wheelchairs. The consulting rooms are arranged over two floors, which can be accessed by stairs or by a lift.

Air conditioning ensures the comfort of patients in hot weather. Play tables and a play kitchen are provided for children.

There are five GP partners (three male, two female) and one non-clinical partner (male), who is also the practice manager. In addition, there are four salaried GPs (one male, three female). The partners are supported by two practice nurses, one health care assistant and administrative and reception staff.

Forrest Medical Centre is an approved training practice for trainee GPs. A trainee GP is a qualified doctor who is training to become a GP through a period of working and training in a practice. There are four GP trainers and four trainee GPs. The practice is also a teaching practice for medical students at university. The practice teaches six students a year, in three sets of two.

A Statutory Notification was submitted to the CQC in May 2016 regarding a serious injury to a patient who fell in the reception area. The incident was dealt with appropriately.

The practice is open between 7.30am and 6pm on Mondays, Tuesdays, Thursdays and Fridays. On Wednesdays, the practice is open from 7.30am to 12.30pm and from 2pm to 6pm. Appointments are available during these hours. The practice also provides pre-bookable appointments with GPs on a Saturday morning from 8.30am to 11.30am. NHS 111 provides cover when the practice is closed.

Updated 21 October 2016

Letter from the Chief Inspector of General Practice

We carried out an announced comprehensive inspection at Forrest Medical Centre on 17 August 2016. Overall the practice is rated as good.

• There was an effective system in place for reporting and recording significant events, which were discussed and analysed at monthly practice meetings.
• Risks to patients were assessed and well managed through discussion at practice meetings and multidisciplinary team meetings.
• Patients’ needs were assessed and the practice planned and delivered care in line with best practice guidance.
• Staff had the skills, knowledge and experience to deliver effective care and treatment to patients.
• Patients said they were treated with kindness, dignity and respect and that they were involved in their care and decisions about their treatment.
• The practice achieved 100% in the Quality and Outcomes Framework (QOF) targets for 2014/15. Unpublished data for 2015/16 showed that this high standard had been maintained.
• Data from the National GP Patient Survey published in July 2016 evidenced that the practice team consistently scored higher than the Coventry and Rugby Clinical Commissioning Group (CCG) or national averages.
• Information about services and how to complain was available in the reception areas and on the practice website. Improvements were made to the quality of care as a result of complaints and concerns.
• Patients told us that 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.
• In exceptional circumstances, we heard that the practice would arrange for a taxi to collect a patient who needed to be seen urgently but who was unable to get transport, thus enabling them to be seen in a more appropriate clinical environment.
• Repeat prescription requests were processed on the day that they were ordered and paper prescriptions could be collected on Saturday mornings.
• Patients could request repeat prescriptions by phone.
• Patients could book appointments for blood tests with a practice nurse at 7.30am on three days of the week. Early appointments with a GP were also available throughout the week, starting from 7.30am every day except Thursday, when GP appointments started at 8am.
• The practice was located in purpose built premises and had good facilities and was well equipped to treat patients and meet their needs.
• There was a clear leadership structure and staff commented on the supportive attitude of the management team. 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:

• Amend the Disclosure and Barring Service (DBS) policy to include the need to undertake a formal risk assessment before accepting a previously issued DBS check for a new employee.
• Maintain records for assessing competency levels for non-clinical staff.
• Maintain an audit trail of patient safety alerts, including from the Medicines and Healthcare products Regulatory Agency.
• Establish a system for checking uncollected prescriptions before destruction.

Professor Steve Field (CBE FRCP FFPH FRCGP) 

Chief Inspector of General Practice

Updated 21 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.
• The percentage of patients with diabetes on the register, in whom the last diabetic reading was at an appropriate level in the preceding 12 months was 85%, which was 8% higher than both the Clinical Commissioning Group and national averages.
• Longer appointments and home visits were available when needed.
• Medication reviews for housebound patients were done by their usual GP during home visits.
• 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 21 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 high for all standard childhood immunisations. The immnunisation clinic for children and young families was a drop-in service, although patients could book routine appointments for immunisations if the drop-in service was not convenient for them.
• 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.
• 75% of women attended cervical screening within 3.5 to 5.5 years which was comparable to the Clinical Commissioning Group (CCG) average of 73% and the national average of 74%.
• Appointments were available outside of school hours and the premises were suitable for children and babies. A play table and a play kitchen were provided for children.
• We saw positive examples of joint working with midwives, health visitors and school nurses. 

Updated 21 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.
• Home visits and urgent appointments were provided for those with enhanced needs.
• The practice had responsibility for three local nursing homes, two of which cared for patients with dementia. Each home had a designated GP, who carried out weekly visits, thus ensuring continuity of care.
• All patients over 75 years who were prescribed more than eight medicines had their medicines reviewed as part of the polypharmacy programme.
• Monthly palliative care meetings were held with multidisciplinary teams, such as the district nurses, community matron and Macmillan nurse.
• Forrest Medical Centre was the lead practice in Coventry for developing the Electronic Palliative Care Communications System (EPaCCS).
• A weekly drop-in advice service was provided by the local Carers’ Trust. The support worker had delivered training to practice staff.

Updated 21 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.
• Patients could book routine GP appointments online as well as request repeat prescriptions, submit questions and view their medical records at a time that was convenient for them.
• Patients could book appointments with a practice nurse at 7.30am.

• Extended hours were offered on a Saturday morning, which provided extra flexibility for working age patients. Paper prescriptions could also be collected on Saturday mornings.
• NHS health checks were offered to patients aged between 40 and 75 years.

Updated 21 October 2016

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

• 83% of patients diagnosed with dementia had their care reviewed in a face to face meeting in the last 12 months, which was comparable to the CCG and national averages of 82% and 84% respectively.
• 95% of patients with poor mental health had a comprehensive care plan documented in their record in the preceding 12 months, which was 11% above the CCG average and 7% above the national average.
• 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.
• Counselling and Improving Access to Psychological Therapies (IAPT) services were provided once a week at the practice.
• The manager of a local residential home that cared for patients with dementia praised the high level of care provided by the practice. We heard how the GPs had a good understanding of dementia patients’ needs and were very supportive.
• The practice had told patients experiencing poor mental health about how to access various support groups and voluntary organisations.
• 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.

Updated 21 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.
• There were 61 patients on the learning disability register, 23 of whom had had reviews since April 2016. A member of the practice’s medicines management team phoned the patient or carer two days before the appointment in order to try to reduce non-attendance.
• The practice regularly worked with other health care professionals in the case management of vulnerable patients.
• Clinical staff were flexible when vulnerable patients arrived late for appointments.
• The practice informed vulnerable patients about how to access various support groups and voluntary organisations.
• The community drug team visited the practice once a week.
• 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 child safeguarding lead met monthly with the health visitor and midwife to discuss families of concern and to identify vulnerable families in need of additional support.