Fairbrook Medical Centre

Updated 3 October 2016

Fairbrook Medical Centre provides a range of primary medical services from its premises at 4 Fairway Avenue, Borehamwood, Hertfordshire, WD6 1PR.

The practice serves a population of approximately 14,537 and is a teaching practice. The area served is slightly less deprived compared to England as a whole. The practice population is mainly white British with some ethnic and Central and Eastern European communities. The practice serves an above average population of those aged from 0 to 14 years and 30 to 44 years. There is a lower than average population of those aged 15 to 24 years and 55 years and over.

The clinical team includes four male and four female GP partners, two female salaried GPs, five practice nurses and one consultancy nurse. The team is supported by a practice manager, a deputy practice manager, two reception managers, one Quality Outcomes and enhanced services manager and 19 other administration, reception and secretarial staff. The practice provides services under a General Medical Services (GMS) contract (a nationally agreed contract).

The practice is staffed with the doors and phone lines open from 8.30am to 1pm and 2pm to 6.30pm Monday to Friday. Between 1pm and 2pm daily the doors and phone lines are closed and patients directed to emergency numbers if required. There is extended opening until 7.30pm on Mondays and Wednesdays and from 7am on Thursdays. The practice is also open on alternate Saturdays from 8am to midday for GP and nurse pre-bookable appointments. Appointments are available from 8.30am to 12.30pm, 2pm to 4pm and 4.30pm to 6.30pm daily, with slight variations depending on the doctor and the nature of the appointment.

An out of hours service for when the practice is closed is provided by Herts Urgent Care.

Updated 3 October 2016

Letter from the Chief Inspector of General Practice

We carried out an announced comprehensive inspection at Fairbrook Medical Centre on 3 August 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.
• Risks to patients were assessed and well managed.

• Staff assessed patients’ needs and delivered care in line with current evidence based guidance. Staff had the skills, knowledge and experience to deliver effective care and treatment.
• The patients we spoke with or who left comments for us were positive about the standard of care they received and about staff behaviours. They said staff were polite, caring, supportive and thorough. They told us that their privacy and dignity was respected 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 it could be difficult to get through to the practice by phone and book appointments in advance. However, they were positive about access to same day and urgent appointments at the practice.
• The practice had good facilities and was well equipped to treat patients and meet their needs.
• There was a clear leadership structure and staff felt supported by management. The practice 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.

The areas where the provider should make improvements are:

• Ensure that all staff employed are supported by completing the essential training relevant to their roles, including infection prevention and control and basic life support training.
• Ensure that a process is in place for the practice wide discussion of and response to Medicines and Healthcare products Regulatory Agency (MHRA) and patient safety alerts.
• Ensure that medicine fridges are in working order with locking mechanisms in place to ensure safe storage of medicines.
• Take steps to ensure systems are in place so that GPs have sight of the appropriate blood test results and subsequent analysis before the prescribing of certain high risk medicines to patients.
• Ensure the health and safety legislation posters contain up to date contact information.
• Ensure the necessary actions to resolve risks identified by the Legionella risk assessment are completed, including the management of hot water temperatures to ensure they are kept within the required levels.
• Ensure that a documented policy on patient consent is in place.
• Ensure that, where practicable and appropriate, all reasonable adjustments are made for patients with a disability in line with the Equality Act (2010).
• Continue to take steps to ensure improvement to National GP Patient Survey results, including access to routine pre-bookable appointments and access to the practice by telephone. Ensure that the current action plan makes provision for the practice’s response to below CCG and national average satisfaction scores on consultations with GPs and nurses.

Professor Steve Field (CBE FRCP FFPH FRCGP) 

Chief Inspector of General Practice

Updated 3 October 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.
• 69% of patients on the asthma register had their care reviewed in the last 12 months. This was similar to the CCG average of 76% and the national average of 75%.
• Performance for diabetes related indicators was comparable with the CCG and national averages. The practice achieved 92% of the points available compared to the CCG average of 91% and the national average of 89%.
• All newly diagnosed patients with diabetes were managed in line with an agreed pathway.
• Longer appointments and home visits were available when needed.
• 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 GPs worked with relevant health and care professionals to deliver a multi-disciplinary package of care.

Updated 3 October 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 may be at risk, for example, children and young people who had a high number of A&E attendances. Immunisation rates were slightly better than other practices in the local area 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.
• The practice’s uptake for the cervical screening programme was 93% compared to the CCG average of 83% and the national average of 82%.
• Appointments were available outside of school hours and the premises were suitable for children and babies.
• Following a complaint about the lack of emergency appointments for children in the afternoon, the practice allocated eight appointment slots between 5pm and 6pm daily for children aged from 0 to 14 years.
• There were six week post-natal checks for mothers and their children.
• A range of contraceptive and family planning services were available.

Updated 3 October 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.
• Older people had access to targeted immunisations such as the flu vaccination. The practice had 1,952 patients aged over 65 years. Of those 1,482 (76%) had received the flu vaccination in the 2015/2016 year.
• There were three named GPs for a large local older people’s nursing home village and each GP visited once each week on separate days to ensure continuity of care for those patients. Also, one of the practice nurses had dedicated time over three days each week to visit patients in their own homes, including local residential homes, to provide care in the community.

Updated 3 October 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 online services such as limited appointment booking and repeat prescriptions as well as a full range of health promotion and screening that reflects the needs for this age group.
• There was additional out of working hours access to meet the needs of working age patients. There was extended opening until 7.30pm on Mondays and Wednesdays and from 7am on Thursdays. The practice also opened on alternate Saturdays from 8am to midday for GP and nurse pre-bookable appointments.

Updated 3 October 2016

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

• 83% of patients diagnosed with dementia had their care reviewed in a face to face meeting in the last 12 months. This was similar to the CCG average of 85% and the national average of 84%.
• Performance for mental health related indicators was similar to the CCG and national averages. The practice achieved 97% of the points available compared to the CCG average of 96% and the national average of 93%.
• The practice regularly worked with multi-disciplinary teams in the case management of people 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.
• Staff had a good understanding of how to support patients with mental health needs and dementia.
• NHS counsellors were based at the practice on Mondays, Wednesdays and Thursdays (morning only) each week. Patients could access this service to obtain psychological and emotional counselling and advice through referral from the GPs.
• There were GP leads for mental health and dementia.

Updated 3 October 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 living in vulnerable circumstances including those with a learning disability. There were 56 patients on the practice’s learning disability register at the time of our inspection. Of those, all 56 were invited for and 51 (91%) had accepted and received a health review in the past 12 months.
• The practice offered longer appointments for patients with a learning disability and there was a GP lead for these patients.
• The practice regularly worked with multi-disciplinary teams in the case management of vulnerable people.
• 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.
• Additional information was available for patients who were identified as carers and there was a nominated staff lead for these patients. Once each month the lead held a drop-in clinic to provide advice including signposting carers to support services.
• The practice had identified 327 patients on the practice list as carers. This was approximately 2.3% of the practice’s patient list. Of those, all were invited for and 66 (20%) had accepted and received a health review in the past 12 months.