The Forum Health Centre

Updated 14 February 2017

The Forum Health Centre is a long established GP group practice located in the Wyken area of Coventry. The practice provided general medical services to a population to approximately 16,000 patients who live in Wyken, Stoke, Binley and Walsgrave areas of Coventry. The practice recognised some time ago that the population of the area was developing and growing rapidly. In July 2016 the practice moved into purpose built premises following successful planning and funding bids and collaboration with NHS England and local stakeholders. The practice provides services under a General Medical Services (GMS) contract. A GMS contract is a nationally agreed contract between general practices and NHS England for delivering primary care services to local communities. The practice is part of a local GP federation known as the GP Alliance. A federation is formed of a group of practices who work together to share best practice and maximize opportunities to improve patient outcomes. They are also working collaboratively with two other practices and are part of a Multispecialty Community Provider (MCP) project which explores new models of primary care working to improve outcomes for patients and provide services closer to home.

The practice population is predominantly white British, with a significant number of patients from ethnic groups such as Asian, Indian, African and Eastern European. The practice population has a higher than average number of patients aged 0 to 20 years slightly higher than average aged 25 to 30 years and 40 to 50 years. The practice area is one which experiences moderate levels of deprivation.

The practice has five GP partners (four male and one female) and two salaried GPs (one male and one female). The practice also employs three nurse practitioners, two health care assistants, a practice manager and an office manager who are supported by a team of reception and administration staff. The practice is a teaching practice who were supporting three trainee GPs at the time of our inspection. A trainee GP is a qualified doctor who is carrying out additional training to become a GP.

The practice is open from 8am to 6.30pm Monday to Friday and appointments are available during these times. Extended hours appointments are available on Mondays to Friday from 7.30am to 8am and on Saturday mornings from 8.30am until 11.30am.

When the practice is closed, patients can access out of hours care by calling the practice where they would be directed to the out of hours service provider via NHS 111. This information is also available on the practice’s website.

Updated 14 February 2017

Letter from the Chief Inspector of General Practice

We carried out an announced comprehensive inspection at The Forum Health Centre on 1 December 2016. Overall the practice is rated as outstanding.

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

• There was an open and transparent approach to safety with an effective system for reporting and recording significant events which was summarised and demonstrated shared learning. The practice had also shared learning nationally by uploading learning via the National Reporting and Learning System (NRLS) website.
• Risks to patients were assessed and well managed and there were systems which enabled routine assessment of risk. Safeguarding procedures and documentation had been reviewed by the safeguarding lead who had brought together all areas to enable easy access and guidance for staff. There was also evidence of detailed sharing of information, review and summarisation of actions regarding safeguarding showing positive outcomes for children and their families as a result of structured multi-disciplinary team working.
• The practice showed a commitment to learning, specifically regarding safeguarding. They had engaged in a project which resulted in a review of their procedures and the introduction of detailed summaries showing involvement, planning, and outcomes of intervention of child protection cases.

• 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. GPs and nurses had areas of special interest which they had developed to improve services for patients, such as in sexual health and care of the elderly.
• Patients said they were treated with compassion, dignity and respect and they were involved in their care and decisions about their treatment. Patient feedback was consistently positive regarding the care offered by all staff at the practice. The practice had also addressed services for carers and had taken additional steps to ensure staff were trained regarding carers and implemented measures to increase the number of carers identified.
• Information about services and how to complain was available and easy to understand and 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 purpose built facilities, providing disabled access, additional space to allow easy movement for patients with mobility aids, access to specific areas of the practice using electronic doors and had a lift facility. The building had been designed to allow for growth and development of services.
• The practice demonstrated strong leadership and evidence of long term strategic planning to develop and provide services in the community in corroboration with other stakeholders. Discussions took place with secondary care, the local authority, the local CCG and other community health care services and plans were regularly revisited to review and realise the vision for the practice.
• The practice was committed to driving changes in primary care and were involved in leading projects to improve services for patients. 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.

There were two areas where the practice should make improvements:

• Confirm in writing the outcome of complaints investigations following discussion with patients.

• Monitor the revised process for repeat prescriptions for high risk medicines to ensure it is operating effectively.

There were areas of outstanding practice:

The practice demonstrated a commitment to promoting health and uptake of screening and had achieved improved rates of cervical screening as a result of a proactive approach to patients who did not attend. The lead nurse had introduced a system which enabled them to contact all women who had not attended, to discuss the procedure and alleviate concerns which may have impacted on their reasons for non-attendance. As a result they had increased the number of women who attended after their initial response to decline. Cervical screening uptake rates were 86% which were significantly higher than the CCG and national average rates of 75% and 76% respectively.

The practice had a GP lead for women’s health and family planning and another GP who had a Diploma of the Faculty of Family Planning and Reproductive Medicine and a special interest in this area of health. They offered long acting reversible contraception (LARC) which included implants and intrauterine contraceptive device fitting (IUCD). The practice increased the number of sessions available for this service in response to increasing teenage pregnancies. We noted as a result that the practice termination of pregnancy rates had reduced significantly since 2013. For example, in 2013/14 there had been 30 cases, 2014/15 there had been 21 cases and in 2015/16 this had reduced to 13 cases.

The practice had been involved in a local project for Integrated Neighbourhood Teams (INT), which had resulted in the introduction of INTs in the area. They also had a GP who had led a project to introduce Acute Frailty Pathways for older people to reduce the length of stay and need for hospital admission which had demonstrated a reduction in length of stay from 11 to four days for elderly frail patients. This was then introduced across the area.

Professor Steve Field CBE FRCP FFPH FRCGP

Chief Inspector of General Practice

Updated 14 February 2017

The practice is rated as outstanding for the care of people with long-term conditions. This is because they were outstanding for being effective and well led for this population group.

• Nursing staff had lead roles in chronic disease management and patients at risk of hospital admission were identified as a priority.
• There was a delegated member of staff responsible for the recall of patients with long term conditions and staff demonstrated a commitment and vigilance in monitoring uptake, following up patients who did not attend where necessary. The practice Quality and Outcomes Framework (QOF) achievement reflected this and the overall achievement was above the CCG and national averages in all areas. For example:

• The overall practice achievement for patients with diabetes was 96% which was above the CCG and national averages of 90%.
• The overall practice achievement for patients with chronic obstructive pulmonary disease (COPD) was 99% which was above the CCG and national averages of 94% and 95% respectively.
• The practice carried out regular audits on patient with long term conditions to ensure monitoring and medication was optimum.

• Longer appointments and home visits were available when needed.
• Diabetes education sessions were hosted at the practice for which the practice encouraged patients to attend.
• The practice had engaged patients with diabetes onto the PPG. The input from these patients had alerted the practice to ensure that patients received their last blood test in advance of their annual review to allow them to consider questions they may have.
• 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.
• The practice had worked with Public Health (Fitter Futures) and Coventry Solihull and Warwickshire Sport, and Sport England and Coventry City council towards delivery of a fitness programme to promote active lifestyles. This was to commence in January 2017.

Updated 14 February 2017

The practice is rated as outstanding for the care of families, children and young people. This is because they were outstanding for being effective and well led for this population group.

There were systems 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.

• 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.
• Appointments were available outside of school hours and the premises were suitable for children and babies.
• The practice allowed 20 minute appointments for childhood immunisation to provide time for parents to ask questions and give sufficient information regarding the vaccines and aftercare. Child immunisation rates were higher than the CCG and national averages. For example, childhood immunisation rates for the vaccinations given to under two year olds ranged from 98% to 99%. These were higher than the national rates of 73% and 93%.
• We saw positive examples of joint working with midwives and health visitors.
• The practice offered separate flu clinics for children with timed appointments to minimise wait and anxiety.
• The practice offered text messages and email to improve engagement of young people on the PPG.
• The practice promoted sexual health and made information readily available in the reception area for young people and encouraged chlamydia screening.
• 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. For example, NHS Health Checks, sexual health and contraception services including fitting of contraceptive devices and implants. They had been proactive in offering long acting reversible contraceptive implants (LARCS) which had resulted on a year on year reduction in termination of pregnancy over three years. For example, in 2013/14 there had been 30 cases, 2014/15 there had been 21 cases and in 2015/16 this had reduced to 13 cases.

• One of the nurse practitioners was the lead for nurse for the CCG in cytology and had a special interest in this area. They had worked with one of the administration team to identify patients who had not attended for their cervical smear after three attempts to encourage them to do so. They contacted patients personally to advise of the importance of this and offer additional appointments. This had resulted in higher than the average CCG and national uptake of screening. For example, the practice rate was 82% compared to the CCG and national average of 75% and 76% respectively.

Updated 14 February 2017

The practice is rated as outstanding for the care of older people. This is because they were outstanding for being effective and well led for this population group.

• The practice offered proactive, personalised care to meet the needs of the older people in its population. The practice used specialised templates to identify patients at risk of admission to hospital and those who may benefit from input from the Integrated Neighbourhood Teams (INT). They also hosted the INT team in the building.

• The practice hosted the Age UK GP navigator based in the practice who conducted home assessments of frail elderly patients, and the dementia navigator service for support for carers and relatives of patients with dementia.
• The practice had been involved in projects in frail elderly care which had demonstrated a reduction in length of stay in hospital as a result. For example, the average length of stay had reduced from 11 to four days for frail elderly vulnerable adults. They had also become involved in a social prescribing project which was to be introduced in January 2017. Staff had been trained in readiness for this. (Social prescribing is a means of enabling primary care services to refer patients with social, emotional or practical needs to a range of non-clinical services which are often provided by the voluntary sector).
• The practice had a medicine review process for patients over 75 years of age.
• The practice was responsive to the needs of older people, offered home visits and urgent appointments for those with enhanced needs.
• The practice held multi-disciplinary team meetings which included the geriatrician, community matrons and consultants.
• The practice supported and advertised the local public health Live Well programmes which promoted health living and exercise such as walking programmes.

Updated 14 February 2017

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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.

• Early appointments were available to allow patients who worked to attend. This included appointments for cervical screening.

• The practice sent out birthday cards to all patients on their 40th and 60th birthdays to invite them for health checks and vaccinations to promote knowledge and uptake of these services.

• The practice website provided a comprehensive self-help section which had been developed specifically to reflect the needs of patients and the practice to promote self-care. They had sought the views of the PPG when developing this and had created a ‘My Health’ resource area.

Updated 14 February 2017

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

Staff had an understanding of how to support patients with mental health needs and dementia.

• 94% of patients diagnosed with dementia had had their care reviewed in a face to face meeting in the last 12 months, which is above to the CCG and national averages of 81% and 84 respectively.

• 93% of patients with schizophrenia, bipolar affective disorder and other psychoses had a comprehensive care plan documented in their record which was higher than the CCG and national average of 85% and 89% respectively.
• 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 had a system for following up patients who had attended A&E where they may have been experiencing poor mental health.
• The practice employed their own counsellor to provide support to patients with mental health problems and the Improving Access to Psychological Therapies (IAPT) counsellor attended the practice weekly.
• The practice had engaged with local stakeholders and had approval for a mental health practitioner to be based at the practice from April 2017 to support patients with mental health issues in the community.

Updated 14 February 2017

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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.
• Patients with learning disabilities were flagged on the clinical system to alert staff that longer appointments may be required.
• 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. The practice had been proactive and involved in a local project to improve interagency working. As a result the safeguarding lead had reviewed and revised the practice documentation to centralise and make all information and guidance easily available to all staff. They practice reviewed all cases and demonstrated how working with the multi-disciplinary team, prompt response, and tailored support and care had achieved positive outcomes for children and families as a result. 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 practice were engaged in a social prescribing service pilot project with Age UK to offer support to patients over 18 years who were suffering social isolation.
• The practice supported the Coventry City Council Live Well programme which promoted healthy living and exercise for patients with learning disabilities.
• Appointments for health checks for patients with a learning disability were booked by telephone to offer a convenient time for patients and carers.

The practice worked closely with the Coventry Carers Trust and hosted information sessions for patients to provide advice and support to carers. The practice had been proactive in increasing the number of carers and had incorporated information into their own patient survey to do this which resulted in identification of an additional 81 carers . The practice offered health checks and signposted carers to appropriate services.