Forest Practice

Updated 25 February 2016

Forest Practice was started in 1977 at premises in Forest Road, Loughton, by a single handed female GP with approximately 300 patients. The numbers of patients and GPs grew over the years and the practice moved in 1990 to Station Road. In 2002 the practice moved again to its current location but retained the Station Road premises as a branch surgery.

The practice currently has a list size of 10146. The practice area covers all of the IG10 postcode area dependent on their capacity.

The practice has two female and two male GP partners and a female salaried GP.

This practice is a training practice which has GP registrars in their final stage of training. GP registrars are fully qualified and will have had at least three years of hospital experience. The gender of the GP registrars will change each intake, however at the time of our inspection there were four female GP registrars. There are two practice nurses and one health care assistant (HCA).

The practice is open between 7am and 6.30pm Monday to Friday. Appointments run throughout the day from 7am. Surgeries are staggered depending on the staffs’ differing start times, with morning surgery 2.5 hours in duration and afternoon surgery 2 hours in duration. Between surgeries GPs will complete home visits and other essential tasks.

When the practice is closed there is a doctor or deputy on call 24 hours a day to deal with genuinely urgent problems that cannot wait until the surgery is next open. This service is accessed via the usual surgery number and then a recorded message will give a contact number for patients to ring. The practice also advises patients to attend walk-in centres or, in an emergency such as chest pains, to call 999.

The practice also provides services from their Station Road branch address. This was not inspected as part of our inspection.

Updated 25 February 2016

Letter from the Chief Inspector of General Practice

We carried out an announced comprehensive inspection at Forest Practice on 9 December 2015. 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.
• There was an effective system in place for reporting, recording and investigation of significant events.
• Risks to patients were assessed and well managed.
• Staff assessed patients’ individual needs and delivered care in line with current evidence based guidance, with patients and, where appropriate, relatives involvement.
• Staff had the skills, knowledge and experience to deliver effective care and treatment.
• Information about services was available through a variety of sources and easy to understand.
• Patients said they were treated with compassion, dignity and respect and they were involved in their care and decisions about their treatment.
• The practice had good facilities and was well equipped to treat patients and meet their needs.
• There was a clear leadership structure in place. It was evident that staff felt supported by management. The practice proactively sought feedback from staff and patients via the Patient Participation Group (PPG), which it acted on.
• A culture of openness and honesty was encouraged by the partners. The provider and staff were aware of and complied with the requirements of the Duty of Candour.

The areas where the provider should make improvements are:

• Display information about how to complain.
• Consider indicating on policies the date they were written and/or the review date.
• They may wish to consider how they can organise their training records so training and training needs are easily identified.
• Consideration of how staff will be able to identify patients who become acutely unwell in the waiting areas.
• Review the security of their prescription printer paper when the consulting rooms are not in use.

Professor Steve Field (CBE FRCP FFPH FRCGP) 

Chief Inspector of General Practice

Updated 25 February 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.
• Nationally reported data showed that most outcomes for patients for long-term conditions were comparable with other practices nationally. For example, numbers of patients with long-term conditions, such as diabetes receiving appropriate reviews were comparable to the national average.
• Home visits were available when needed to monitor patients’ conditions.
• The practice provided annual multidisciplinary diabetic clinic reviews.
• All these patients had a named GP and a structured annual review to check that their health and medicines needs were being met. For those people with complex needs, the practice worked with relevant health and care professionals to deliver a multidisciplinary package of care.
• Patient reviews were according to individual needs.

Updated 25 February 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 missed hospital appointments and practice appointments.
• Children needing an urgent appointment were offered a same day appointment. If no appointments were available then the child would either be seen as an extra or advice would be sought from the duty GP.
• New mothers were seen for a combined postnatal, child development check and immunisation appointment to minimise the number of times the mother needed to attend the practice.
• A room was made available for breastfeeding mothers who preferred to feed their baby in private.
• Immunisation rates were relatively high for all standard childhood immunisations.
• Appointments were available outside of school hours and the premises were suitable for children and babies.
• We found that GPs were aware that some children may have the ability to make decisions about their own treatment.
• Nationally reported data showed that outcomes for patients for uptake of cervical smears were comparable with other practices nationally.
• We saw good examples of joint working with midwives, health visitors and school nurses.

Updated 25 February 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.
• Each care home supported by the practice had a lead GP partner who visited on a weekly basis. All other older patients had a named GP.
• It was responsive to the needs of older people, and offered home visits, where necessary, for flu vaccinations. Home visits were also provided for annual health checks for those older patients with a chronic disease who were unable to attend at the practice.
• The practice was an AGE UK hub for advice and support.
• The practice hosted regular frailty meetings with health and social care professionals invited.
• Nationally reported data showed that outcomes for patients for conditions commonly found in older people were comparable with other practices nationally. For example, the practice offered patients aged 65 and older a flu vaccination, and performed similar to the national average for uptake of this vaccination.
• The practice tried to ensure that appointments for older people took place in daylight hours to avoid them travelling in the dark.

Updated 25 February 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 access in the form of pre-bookable appointments from 7am, and book on day appointments from 7.30am.
• Prescriptions could be ordered on line and sent to any chemists of the patient’s choosing – including close to their place of work.
• The practice was proactive in offering a messaging service as well as a full range of health promotion and screening that reflects the needs for this age group.

Updated 25 February 2016

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

• The amount of people diagnosed with dementia that had their care reviewed in a face to face meeting in the last 12 months, was comparable with the national average.
• The practice was in the process of becoming a dementia friendly organisation.
• Patients were sign posted to support services as required, such as, Healthy Minds talking therapies.
• Patients were able to see a named doctor of their choice for continuity of care.
• The practice felt that this population group was an area where they could further improve patient outcomes.
• The amount of people diagnosed with schizophrenia, bipolar affective disorder and other psychosis that had their alcohol consumption recorded in the last 12 months was much lower than the national average.

Updated 25 February 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 with a learning disability. Liaison took place with a community specialist nurse as part of a multidisciplinary approach to their care and treatment. Annual checks were made as extended appointments.
• Where appointments at the hospital or the practice were missed the patient records were routinely reviewed to ensure that no intervention other than a routine reminder letter was indicated. For example, where the patient was a vulnerable child or adult further follow up may be required.
• The practice held a register of patients living in vulnerable circumstances including those at risk or experiencing domestic abuse and those with a learning disability.
• It offered longer appointments for people with a learning disability, where these were required.
• For patients who may find it difficult to be at the doctors, for example, those on the autistic spectrum or those with phobias, the practice put in place measures to minimise distress to those patients on an individual basis.
• The practice regularly worked with multi-disciplinary teams in the case management of vulnerable people.
• It had told 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.
• The practice had shared care arrangements for number of patients with substance misuse problems on their register.
• The practice had devised a visual feedback form to enable its patients with a learning disability to provide feedback on their service.