Fairfield PMS

Updated 23 August 2016

The practice operates from one site in Charlton, London. It is one of 42 GP practices in the Greenwich Clinical Commissioning Group (CCG) area. There are approximately 10,446 patients registered at the practice. The practice is registered with the Care Quality Commission (CQC) to provide the regulated activities of diagnostic and screening procedures, family planning services, maternity and midwifery services, surgical procedures and treatment of disease, disorder or injury.

The practice has a personal medical services (PMS) contract with the NHS and is signed up to a number of enhanced services (enhanced services require an enhanced level of service provision above what is normally required under the core GP contract). These enhanced services include dementia, improving patient online access, influenza and pneumococcal immunisations, learning disabilities, minor surgery, patient participation, rotavirus and shingles immunisation, and unplanned admissions.

The practice has an above average population of male and female patients aged from birth to 15 years and from 25 to 44 years. Income deprivation levels affecting children and adults registered at the practice are above the national average.

The clinical team includes three male and two female GP partners. The GPs provide a combined total of 36 fixed sessions per week. There is a female health care assistant, a female practice nurse, a female nurse practitioner, and a female advanced nurse practitioner. There are two female locum practice nurses providing cover for a female practice nurse who is on maternity leave. The clinical team is supported by a practice manager, a deputy practice manager, eight receptionists, two administrative staff and a secretary.

The practice is open from 8.00am to 6.30pm Monday to Friday and from 9.00am to 12.30pm every alternate Saturday. It is closed on bank holidays and weekends. Appointments with GPs are available from 8.30am to 12.30pm and from 3.00pm to 6.30pm. Appointments with nurses are available from 8.40am to 12.30am and from 2.30pm to 5.00pm. Appointments with nurse practitioners are available from 9.00am to 1.00pm and from 2.30pm to 5.30pm. Extended hours are available one day a week (on rotation between Tuesdays, Wednesdays and Thursdays) from 6.30pm to 7.00pm.

The premises operates over two floors of a purpose built building. There are eight consulting rooms, four treatment rooms, and five clinical rooms which are used by external health professionals such as health visitors, midwives, podiatrists and a tissue viability nurse. There is a waiting/reception area, six administrative rooms, a meeting room, a teaching room, a staff room and three kitchens. There is wheelchair access throughout the ground floor, disabled parking and baby changing facilities available.

The practice directs patients needing urgent care out of normal hours to contact the OOH number 111 which diverts patients to a local contracted OOH service or Accident and Emergency, depending on the urgency of the patient’s medical concerns.

Updated 23 August 2016

Letter from the Chief Inspector of General Practice

We carried out an announced comprehensive inspection at Fairfield PMS on 31 May 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.

• The provider was aware of and complied with the requirements of the duty of candour.

• 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.
• Risks to patients were well assessed and well managed in most areas. Some staff members had not received fire safety training but this training was received shortly after our inspection.

• Policies and risk assessments were implemented and available to all staff, but some had not been completed appropriately.

• 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.

• There was a programme of continuous audit including clinical audits where improvements had been made to patients’ outcomes.

• 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.

The areas where the provider should make improvement are:

• Ensure all policies are updated and risk assessments are completed appropriately, and ensure new staff inductions include fire safety procedures.

• Ensure chaperones follow the practice’s chaperone policy by recording their actions on patients’ records.

• Continuously monitor patient feedback and make improvements, particularly in relation to accessing appointments, and ensure translation services available are advertised in a format patients can understand.

• Continuously monitor Quality and Outcomes Framework performance and make improvements.

• Review how patients with caring responsibilities are identified and recorded on the clinical system to ensure information, advice and support is made available to them.

Professor Steve Field (CBE FRCP FFPH FRCGP) 

Chief Inspector of General Practice

Updated 23 August 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.

• A GP was the practice’s cancer lead. The practice had created a read codes to highlight patients undergoing chemotherapy or radiotherapy, and they contacted patients within two weeks of an initial cancer diagnosis to offer them support.

• The practice ran diabetes clinics during the Ramadan season for Muslim patients with diabetes, and reduced their medicine doses where possible to avoid adverse reactions such as incidences of fainting while fasting.

• Performance for indicators related to diabetes were in line with or above the national average. For example, in the previous 12 months 85% of patients with diabetes had well-controlled blood sugar (national average 78%), and 81% had well-controlled blood pressure (national average 78%).

• Longer appointments and home visits were available when needed.

• All patients with a long term condition had a named GP and most had received 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 23 August 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 Accident and Emergency attendances.

• Patients told us that children and young people were treated in an age-appropriate way and were recognised as individuals.

• 80% of women aged 25 to 64 years had a cervical screening test in the precious five years. This was in line with the national average of 81%.

• 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 who had an office on-site, and midwives.

Updated 23 August 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.

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

• Nationally published data showed that outcomes for patients with conditions commonly found in older people was in line with the local Clinical Commissioning Group (CCG) and national averages. For example, 82% of patients with hypertension had well controlled blood pressure in the previous 12 months (CCG average 81%, national average 84%).

Updated 23 August 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 offered extended hours appointments every other Saturday and three evenings a week for patients who were unable to attend during normal opening hours.

• The practice was proactive in offering online services such as appointment booking and repeat prescription ordering.

• The practice offered as a range of health promotion and screening that reflected the needs for this age group.

Updated 23 August 2016

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

• 94% of patients with schizophrenia, bipolar affective disorder and other psychoses had a comprehensive, agreed care plan in their record in the previous 12 months. This was above the national average of 88%.

• 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 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 23 August 2016

The practice is rated as good for the care of people whose circumstances may make them vulnerable.

• The practice had spearheaded the Amber Project in 2014 to identify and assist patients, and their children, who suffered domestic violence. The project was de-commissioned in 2016 before our inspection, but the practice told us they continued to apply the principles of the project to their clinical work in order to provide continuous support for these patients. Sixty-six patients had been referred to the project during its existence.

• The practice had responded to feedback from patients suffering domestic violence by providing support contact details on small discrete pieces of paper which could be easily hidden.

• The practice held a register of patients living in vulnerable circumstances including homeless people and 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.