The Freshford Practice

Updated 15 September 2016

The Freshford Practice is a dispensing practice providing medical services to about 7,000 patients living in a mainly rural area surrounded by the conurbations of Braintree, Great Dunmow and Haverhill. The Freshford Practice is based in the Freshwell Health Centre situated in the village of Finchingfield. The practice is supported by the community through the Community Resource Equipment And Medical Equipment Reserve Fund (CREAMER). The Creamer Fund is a medical charity, set up in Finchingfield in 1999 after a donation was made to the Freshwell Health Centre by a grateful relative of a former patient. The donation led to a committee to be set up to receive other bequests and to fund raise so that medical equipment not supplied by the NHS could be provided for the community.

The level of deprivation within the practice population is similar to the national average with income deprivation affecting children and older people marginally below the national average.

The practice team comprised of four GP partners, three GP associates; four are female GPs and three are male. Partners hold managerial and financial responsibility for running the business. The GPs are supported by a practice manager, an assistant manager, business manager; four part time practice nurses, two health care assistants, a dispensary team, administration and office team.

Reception is staffed between 8am and 6.30pm Monday to Friday (except Bank Holidays) and between 9.30am and 11.30 am on a Saturday morning. The dispensary is open 8am to 6.30pm and is closed between 1pm and 2pm each day for lunch. The dispensary does not open on Saturday; however dispensed medicines can be collected on Saturday by prior arrangement. the first GP appointment is at 8am and the last appointment is at 6pm Monday to Friday and on Saturday the duty GP provides consultations for pre-booked appointments, and emergencies between 9.15am and 11.30am. When the practice is closed the local out of hours medical cover is provided by The Partnership of East London Cooperatives (PELC), the GP out-of-hours provider, which is based in Great Dunmow.

The practice has a Personal Medical Services (PMS) and Alternative Provider Medical Services (APMS) contracts. The practice also offers enhanced services for example; timely diagnosis and support for people with dementia, memory assessments, dermatology clinic, influenza and pneumococcal immunisations as well as monitoring the health needs of vulnerable people with complex needs and learning disabilities

Updated 15 September 2016

Letter from the Chief Inspector of General Practice

We carried out an announced comprehensive inspection at Freshford Practice on 24 May 2016. Overall the practice is rated as Outstanding.

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

• Staff understood and fulfilled their responsibilities to raise concerns and report incidents and near misses. All opportunities for learning from internal and external incidents were maximised.

• All staff received annual basic life support training and emergency medicines were easily accessible to staff in a secure area of the practice and all staff knew of their location.

• There was a named GP responsible for the dispensary and all members of staff involved in dispensing medicines had received appropriate training and had opportunities for continuing learning and development.

• The practice achieved consistently high levels of performance in the Quality and Outcomes Framework across the majority of healthcare indicators.

• The practice focused on helping patients understand their conditions, and signposted patients to relevant services such as Empower for patients newly diagnosed with diabetes, exercise on prescription, smoking cessation and healthy lifestyle clinics.

• There was a strong, visible, person-centred culture within the practice. Staff were highly motivated and inspired to offer care that was kind and promoted people’s dignity.

• Patient satisfaction rates were higher than the local and national averages across all areas measured.

• The practice worked closely with other organisations and with the local community in planning how services were provided to ensure that they meet patients’ needs. For example, a visiting GP offered a community cardiology clinic which registered patients and other neighbouring practices could access this service.

• The practice proactively sought to educate their patients to manage their medical conditions and improve their lifestyles. Additional in-house services were available and delivered by staff with advanced qualifications, skills and experience.

• Patients with a learning disability and those with dementia were supported to make decisions through the use of care plans, which they were involved in and agreed with.

• The practice actively reviewed complaints and responded to, and made improvements as a result.

• The practice had a clear vision which had quality and safety as its top priority. The strategy to deliver this vision had been produced with stakeholders and was regularly reviewed and discussed with staff.

• There was strong leadership for all clinical and non-clinical areas such as monitoring patient experience of the quality of care and treatment.

We saw several areas of outstanding practice including:

• The practice had excellent facilities and was well equipped to treat patients and meet their needs. Due to the rural location the practice offered many in-house diagnostic facilities including phlebotomy, ultrasound, X-ray DEXA Scanning, near patient testing, D-Dimer, Troponin (this is a sensitive and specific indicator of damage to the heart muscle and measured in the blood to differentiate between unstable angina and a heart attack) and many others. Patient feedback was very positive about having local facilities.

• The practice used innovative and proactive methods to improve patient outcomes, working with other local providers. In-house digital X-ray and scanning equipment was linked with other organisations so images could be shared. This meant the consultant at the acute trust could view results and advise the GP of future treatment; this reduced outpatient appointments at the hospital.

The areas where the provider should make improvement are:

• Ensure a regular stock check is made of the controlled drugs and that accurate records are maintained in the register.

Professor Steve Field (CBE FRCP FFPH FRCGP) 

Chief Inspector of General Practice

Updated 15 September 2016

The practice is rated as outstanding 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.

• QOF indicators for patients with asthma, Chronic Obstructive Pulmonary Disease (COPD, a lung condition), diabetes, heart failure and epilepsy achieved 100% in 2014-15, higher than CCG and national averages.

• Longer appointments and home visits were available when needed.

• Feedback from patients confirmed they felt that their long term condition care provided was of a high standard. This was supported by the high QOF performance.

• For those patients with the most complex needs, the practice worked with relevant health and care professionals to deliver a multidisciplinary package of care.

• 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 15 September 2016

The practice is rated as outstanding 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.

• Childhood immunisation rates for the vaccinations given were slightly lower than the CCG averages for 2014/2015. 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.

• The practice’s uptake for the cervical screening programme was 82%, which was comparable to the CCG average of 82% and the national average of 82%.

• The practice had a policy that any patient requesting a same day urgent appointment would be contacted by a GP to assess urgency and asked to attend the surgery after booked appointments if appropriate.

• Appointments were available outside of school hours and the premises were suitable for children and babies. Children who were ill were treated as a priority.

• We saw positive examples of joint working with midwives, health visitors and school nurses.

• The practice provided the fitting of contraceptive and fertility devices.

Updated 15 September 2016

The practice is rated as outstanding 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 reported data showed that outcomes for patients were consistently above the national average for conditions commonly found in older people.

• The practice had introduced a number of initiatives to improve the care of older people. They had identified an increasing number of older people and organised care to better meet their needs. This included early memory loss reviews and avoiding unplanned admissions.

• In-house clinics including hearing help and toe nail cutting were available for patients to access.

• The practice liaised with hospice staff and offers a drop in clinic once a month for any patients that need support or guidance this not only included patients receiving end of life care but also their families and close friends.

• 52 patients had been identified as needing support to manage their medicines so the practice provided medicines compliance aids (boxes organised into compartments by day and time), to simplify the taking of medicines.

• Dispensary staff were available for a short time each week in two neighbouring villages to allow people to collect prescribed medicines. This reduced the need to attend the practice to pick up medicines.

• The waiting room had higher chairs for patients that found it difficult to get out of a lower level chair due to frailty or mobility issues.

Updated 15 September 2016

The practice is rated as outstanding 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 for booking appointment and ordering medicines; as well as a full range of health promotion and screening that reflects the needs for this age group.

• Access to GPs and nurses via telephone consultation was available.

• The practice had their first appointment at 8am and their last appointment at 6pm on Mondays to Fridays. Appointments with a GP and nurse were also available on a Saturday morning.

• A self-check-in system reduced the need for patients to queue at reception when attending for their appointment.

• Although the dispensary was not open on Saturdays, people were able to collect prescriptions by arrangement and there was a process in place to make sure it was done safely in the absence of the dispensing team.

Updated 15 September 2016

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

• Patients with a learning disability and those with dementia were supported to make decisions through the use of care plans, which they were involved in and agreed with.

• 93% of patients with schizophrenia, bipolar affective disorder and other psychoses who had a comprehensive, agreed care plan documented in the record, in the preceding 12 months was higher than CCG and national averages.

• 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 15 September 2016

The practice is rated as outstanding 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 and those with a learning disability.

• The practice offered longer appointments for patients with a learning disability. This information was flagged on the computer system.

• Alerts were set up to identify patients who required ‘easy access’ for example a vulnerable family.

• The practice provided an ‘easy read’ version of the practice leaflet with larger text and spacing for patients with poor sight.

• 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.