Archived: Fountains Medical Practice

Updated 25 October 2016

Letter from the Chief Inspector of General Practice

We carried out an announced comprehensive inspection of this practice on 19th January 2016. A breach of legal requirements was found. After the comprehensive inspection, the practice wrote to us to say what they would do to meet the legal requirements in relation to the breach. We undertook this focused inspection to check that they had followed their plan and to confirm that they now met legal requirements. This report only covers our findings in relation to those requirements. You can read the report from our last comprehensive inspection, by selecting the 'all reports' link for Fountains Medical Practice on our website at www.cqc.org.uk

Our key findings were as follows:

• Action had been taken to ensure the recruitment procedures were improved and the required information in respect of workers was obtained. A policy for periodically renewing DBS checks was not in place.

• Action had been taken to address the areas identified at the last inspection where improvements should be made.

The area where the provider should make improvements is:

• A policy for periodically renewing DBS checks should be put in place.

Professor Steve Field (CBE FRCP FFPH FRCGP) 

Chief Inspector of General Practice

Updated 10 March 2016

The practice is rated as good for the care of people with long-term conditions. The practice held information about the prevalence of specific long term conditions within its patient population such as diabetes, chronic obstructive pulmonary disease (COPD), cardio vascular disease and hypertension. This information was reflected in the services provided, for example, reviews of conditions and treatment, screening programmes and vaccination programmes. The practice had a system in place to make sure no patient missed their regular reviews for long term conditions. GPs and nurses were responsible for different long term conditions and kept up to date in their specialist areas. Clinical staff told us that clear self-management plans were developed for patients with long term conditions that reflected their views and therefore made them sustainable. The practice had multi-disciplinary meetings to discuss the needs of palliative care patients and patients with complex needs. The practice worked with other agencies and health providers to provide support and access specialist help when needed.

Updated 10 March 2016

The practice is rated as good for the care of families, children and young people. The staff were responsive to parents’ concerns about their child’s health and prioritised appointments for children presenting with an acute illness. Child health surveillance and immunisation clinics were provided. The staff we spoke with had appropriate knowledge about child protection and they had access to policies and procedures for safeguarding children. The safeguarding lead GP liaised with the health visiting service to discuss any concerns about children and their families and how they could be best supported. Family planning and sexual health services were provided.

Updated 10 March 2016

The practice is rated as good for the care of older people. The practice was knowledgeable about the number and health needs of older patients using the service. They kept up to date registers of patients’ health conditions and used this information to plan reviews of health care and to offer services such as vaccinations for flu and shingles. The practice worked with other agencies and health providers to provide support and access specialist help when needed. The practice worked with the Clinical Commissioning Group (CCG) and local practices to enhance patient care. For example, the local practices had developed a role for and employed a nurse practitioner to work with elderly patients. The aim of this role being to take practice nursing services, such as chronic disease management out to housebound patients and to prevent hospital admissions where possible. The practice provided care for four nursing homes in the area with the nurse clinician visiting these services twice a week and the same GP once a week. The staff involved in this service told us that there was a lower prevalence of acute admissions to hospital for patients in these homes when compared to other practices within the CCG. The practice had a medicines manager who worked specifically with medication for the nursing homes to ensure safe prescribing and timely medication reviews. Care plans were being developed for older people with the aim of ensuring all necessary support was provided and reducing hospital admissions. The reception staff played an active role in identifying the changing needs of the older patient population. They attended training events with clinicians to assist in this and were involved in discussions as to how the services for this group of patients could be improved. We were given examples of how this policy had led to benefits for older patients.

Updated 10 March 2016

The practice is rated as good for the care of working-age people (including those recently retired and students). The practice offered pre-bookable appointments, book on the day appointments and telephone consultations. Patients could book appointments on-line or via the telephone and repeat prescriptions could be ordered on-line which provided flexibility to working patients and those in full time education. The practice was open from 08:00 to 18:30 Monday to Friday. allowing early morning and late evening appointments to be offered to this group of patients. An extended hour’s service for routine appointments was commissioned by West Cheshire CCG. The practice had a rising number of patients who were students. They were working collaboratively with a neighbouring practice to develop services that met the unique needs of these patients. The practice website contained information specifically for students about registering with the practice, prescriptions and physical and emotional health issues.

Updated 10 March 2016

The practice is rated good for the care of people experiencing poor mental health (including people with dementia). The practice maintained a register of patients receiving support with their mental health and had identified that there was a high number of patients with dementia compared to local and national averages. The staff were responsive to patients presenting with mental health issues causing them distress and prioritised their appointments. Patients experiencing poor mental health were offered an annual review. The practice worked with multi-disciplinary teams in the case management of people experiencing poor mental health, including those with dementia. The practice carried out assessments of patients at risk of dementia to encourage early diagnosis and access to support.  Staff had recently attended training in dementia to highlight the issues patients living with dementia may face. Patients were referred to services to support them with their mental health such as counselling and psychiatry services.

Updated 10 March 2016

The practice is rated as good for the care of people whose circumstances may make them vulnerable. Services for carers were publicised and a record was kept of carers to ensure they had access to appropriate services. The needs of carers were discussed and appropriate interventions and referrals suggested to them to keep them safe and promote their health. Where a patient was known to have little social contact and support a referral to the Wellbeing Coordinator and social worker attached to the practice was made. Patients’ electronic records contained alerts for staff regarding patients requiring additional assistance. For example, if a patient had a learning disability to enable appropriate support to be provided. There was a recall system to ensure patients with a learning disability received an annual health check. Staff we spoke with had appropriate knowledge about safeguarding vulnerable adults and they had access to the practice’s policy and procedures.