The Fairfields Practice

Updated 28 May 2015

The Fairfields Practice provides primary medical care services to approximately 6,600 patients. The practice is based the Hyson Green area of the city of Nottingham; it is an inner city practice based in a multicultural area with a diverse population. 31.4% of the population is British/Mixed British, 17.4% Pakistani/ British Pakistani, 5.3% Caribbean, 4.7% Indian/British Indian, 4.6% Polish and the remaining 36.6% of the practice is made up of 47 separate ethnic groups. The practice has a high-turnover of patients and registers on average 70 new patients a month, many of the new patients are new to the area.

The practice is located in a purpose built building, which is accessible to patients with restricted mobility; the consulting rooms and waiting areas being at ground level. The practice is housed in the Mary Potter Centre which is a joint service centre with a range of local services. These include: City Council services, three local GP practices (including the Fairfields practice), a range of clinics, Nottingham City Homes and there are bookable community meeting spaces and public toilets, a pharmacy and a community café.

The practice has a General Medical Services (GMS) contract with NHS England. This is a contract for the practice to deliver primary care services to the local community or communities.

There are five GPs at the practice, all of whom are partners. There are four female GPs and one male GP. The practice is a training practice for doctors and there are two whole time equivalent doctors in training working at the practice. At the time of our inspection one of the GP partners was away on maternity leave and a locum GP was working five sessions per week to cover.

In addition the nursing team comprises of one practice nurse and one nurse prescriber. The clinical team are supported by the practice manager and an administrative team. Four of the five GP partners work part time, as a result there are three whole time equivalents working at the practice.

The Fairfield Practice has opted out of providing out-of-hours services to its own patients. Out-of-hours services are provided by Nottingham emergency medical services (NEMS). In addition Nottingham has a number of walk in centres where patients can be seen when their practice is closed.

Updated 28 May 2015

Letter from the Chief Inspector of General Practice

We carried out an announced comprehensive inspection at the Fairfields Practice on 4 November 2014. The practice operates from the Mary Potter Centre, Gregory Boulevard, Hyson Green, Nottingham NG7 5HY.

This practice has an overall rating of good.

Specifically, we found the practice to be good for providing safe, effective, caring, responsive and well-led services. It was also good for providing services for older people; people with long-term conditions; families, children and young people; working age people (including the recently retired); people living in vulnerable circumstances; and people experiencing poor mental health (including people with dementia).

• Staff understood and fulfilled their responsibilities to raise concerns, and to report incidents and near misses. Information about safety was recorded, monitored, appropriately reviewed and addressed.
• Risks to patients were assessed and well managed.
• Patients’ needs were assessed and care was planned and delivered following best practice guidance. Staff had received training appropriate to their roles and any further training needs had been identified and planned.
• Patients said they were treated with compassion, dignity and respect and they were involved in their care and decisions about their treatment.
• The practice was positive in promoting good health and encouraging patients to lead healthier lifestyles. For example several GPs had been involved in recognised research projects (practice and cluster service designs for the entire population). This had led to heavy smokers having had spirometry to screen for chronic obstructive pulmonary disease (COPD). Earlier diagnosis supported patients to get the advice and treatment they needed to manage their health and wellbeing.
• Information about services and how to complain was available and easy to understand.
• Patients said they found it easy to make an appointment with a named GP and that 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.
• 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.
• Staff recognised and respected the totality of patient’s needs. There was a proactive approach to understanding the needs of different groups of patients and delivering care in a way that met those needs and promoted equality. For example the practice had made sure that interpreters had been present in the practice to assist patients whose first language was not English to complete the patient satisfaction surveys.

Professor Steve Field (CBE FRCP FFPH FRCGP) 

Chief Inspector of General Practice

Updated 28 May 2015

The practice is rated as good for the care of people with long-term conditions.

There were emergency processes in place and referrals were made for patients whose health deteriorated suddenly. Longer appointments and home visits were available when needed. All these patients had a named GP and a structured annual review to check that their health and medication needs were being met.

For those people with the most complex needs, the named GP worked with relevant health and care professionals to deliver a multidisciplinary package of care. The practice offered an in-house spirometry service for the diagnosis of COPD This allowed a quicker service and did not require the patient being referred to a secondary service for diagnosis.

Updated 28 May 2015

The practice is rated as good for the care of families, children and young people.

The practice used innovative ways to ensure that children were immunised appropriately. The practice nurses used a recognised internet site to verify and check the childhood immunisation programmes in other countries to ensure that they provided the correct immunisation to children coming from those countries.

This information allowed staff at the practice to encourage mothers from overseas to have their children immunised. As a result of the nurse’s work in this area immunisation rates among families with children who were from overseas were higher than similar practices in the area.

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. Immunisation rates were relatively high 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, we saw evidence to confirm this.

Appointments were available outside of school hours and the premises were suitable for children and babies. We saw good examples of joint working with midwives, health visitors and school nurses. Emergency processes were in place and referrals were made for children and pregnant women whose health deteriorated suddenly.

Updated 28 May 2015

The practice is rated as good for the care of older people.

Nationally reported data showed that outcomes for patients were good for conditions commonly found in older people. The practice offered proactive, personalised care to meet the needs of the older people in its population and had a range of enhanced services, for example, in dementia and end of life care. It was responsive to the needs of older people, and offered home visits and rapid access appointments for those with enhanced needs.

Updated 28 May 2015

The practice is rated as good for the care of working-age people (including those recently retired and students).

The practice used innovative ways to protect the health of working age patients. For example the practice provided an offer of PSA (prostate specific antigen) testing to high risk groups (over 50’s) which led to improved care such as urology referral.

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 as well as a full range of health promotion and screening that reflects the needs for this age group.

Updated 28 May 2015

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

Most patients experiencing poor mental health had received an annual physical health check. The practice regularly worked with multi-disciplinary teams in the case management of people experiencing poor mental health, including those with dementia. It carried out advance care planning for patients with dementia.

The practice signposted and referred patients experiencing poor mental health to talking therapies through the improving access to psychological therapies (IAPT) programme. This was in response to very high number of patients registered with the practice experiencing severe mental ill health.

The practice had a system in place to follow up patients who had attended accident and emergency (A&E) where they may have been experiencing poor mental health. Staff had received training on how to care for people with mental health needs and dementia.

Updated 28 May 2015

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 such as those with a learning disability. Those who were homeless or patients from the travelling community were coded on the electronic system to identify they may be living in potentially vulnerable circumstance.

The practice had carried out annual health checks for people with a learning disability. It offered longer appointments for people with a learning disability.

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.