Robert Frew Medical Partners

Updated 3 November 2017

Robert Frew Medical Partners is located in Wickford, Essex. The practice provides services for approximately 14000 patients.

• The practice holds a Personal Medical Services (PMS) contract and provides GP services commissioned by Basildon and Brentwood Clinical Commissioning Group.

• They have a branch surgery, Franklin Way Surgery, 2 Franklin Way, Wickford, Essex. We did not visit the branch surgery during our inspection.

• The practice serves an affluent community with low levels of deprivation for children and older people. The practice also has a higher than local and national life expectancy for both women and men.

• The practice has seven GP partners, consisting of two female and five male GPs.

• The practice nursing team consists of two nurse practitioners, two practice nurses and two health care assistants. All the nursing team are female.

• The clinical team are supported by a large administrative, reception and secretarial team overseen by the deputy and practice manager.

• The main Robert Frew Medical Partners practice base in Wickford is open between 8am and 6.45pm Monday to Friday. They operate extended hours on a Wednesday until 8.15pm and on Saturday mornings 9am to 12.30pm. Appointments are available from 9am to 11am, 2pm to 4pm and 4.30pm to 6.30pm. Extended surgery appointment times are 6.30pm to 8pm and 9am to 12.20pm on a Saturday. Appointments at the branch surgery are available Monday to Friday 9am to 11am.

• The practice has opted out of providing out-of-hours services to their patients. The practice told us the CCG arranges their out of hour’s provision and they advise patients to call the 111 service or attend the walk in centre.

• The practice has a comprehensive website. It provides an extensive range of information of their staff and services such as vaccination programmes; management of long term conditions and minor illness including signposting useful websites.

Updated 3 November 2017

Letter from the Chief Inspector of General Practice

On 28 September 2016 we carried out a comprehensive inspection at Robert Frew Medical Partners. Overall the practice was rated as requires improvement. The practice was rated as inadequate in safe, requires improvement in effective and well-led, and good in caring and responsive.

As a result of that inspection we issued the practice with requirement notices in relation to Regulation 12, Safe care and treatment, Regulation 13, Safeguarding service users from abuse and improper treatment and Regulation 17 Good governance.

The practice submitted an action plan to detail the actions taken in relation to the requirement notices.

We then carried out an announced comprehensive inspection at Robert Frew Medical Partners on 17 October 2017. Overall the practice is rated as good.

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

• There was a system in place for reporting and recording significant events and improvements had been made which reflected that the provider complied with the requirements of the duty of candour.

• From the sample of significant events that we reviewed we saw that staff were clear what constituted such events. The practice was open and transparent and we saw that staff from all areas of the practice were reporting and learning from significant events. Incidents were investigated, discussed and we saw evidence of learning to mitigate their reoccurrence.

• Medicine alert information had been consistently actioned. The practice also demonstrated that patients receiving high risk medicines were audited regularly to ensure that the monitoring and reviews were in place.

• Safeguarding arrangements had been established to enable clinicians to identify those patients potentially at risk. The practice was following up on vulnerable persons who had attended accident and emergency services or not attended their hospital appointments.

• The practice was clean and tidy. The infection control lead had received appropriate training. Cleaning schedules were in place to evidence where, when and how the facility had been cleaned. There was an action plan in place and we saw that actions had been completed.

• The practice were monitoring and recording the issue of prescription stationery within the practice.

• Staff had undertaken appropriate recruitment checks including disclosure and barring service checks.

• Risk assessments for health and safety, fire and legionella were in place.

• Medicines and medical supplies that we checked were in date.

• Data from the Quality and Outcomes Framework (QOF) showed patient outcomes were comparable or above average compared to the local and national averages.

• There was a detailed locum induction pack in place for GPs.

• Data from the national GP patient survey, published in July 2017 showed areas had improved since the survey results in 2016.

• Where low levels of satisfaction were reported with the GPs the practice had held a meeting to discuss all the areas and put actions in place to improve.

• The practice had identified carers and was working in partnership with social care professional to provide a drop-in advice service to patients.

• The practice proactively sought feedback from patients, which it acted on. The patient participation group was active and told us the partners involved them and operated with transparency.

In addition the provider should:

• Continue to seek and act on feedback from relevant persons and other persons on the services provided in the carrying on of the regulated activity, for the purposes of continually evaluating and improving such services.

Professor Steve Field (CBE FRCP FFPH FRCGP) 

Chief Inspector of General Practice

Updated 3 November 2017

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.

• Longer appointments and home visits were available when needed.

• All patients had a structured annual review to check their health and medicines needs were being met. For those patients with the most complex needs, the GP worked with relevant health and care professionals to deliver a multidisciplinary package of care.

• The practice nurses specialised in the management of chronic disease and were able to initiate insulin therapy for diabetic patients.
• The practice offered 24 hour blood pressure monitoring services and could check patient heart rhythms on their ECG machine.

Updated 3 November 2017

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

• Wednesday evening and Saturday pre-bookable appointments were available.

• 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 high for all standard childhood immunisations.

• The practice offered contraceptive advice for patients.

• The practice promoted the cervical screening programme. The practice’s uptake for the cervical screening programme was 85%, which was comparable with the CCG average of 82% and the national average of 81%.

Updated 3 November 2017

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

• The practice provided services to patients within residential and nursing homes. Meetings were held with the homes to review the services.

• The practice worked as part of an integrated care team and made referrals to specialist health and social care provision via the single point of contact team.

• The practice operated multidisciplinary team working and held palliative care meetings bi monthly

• The practice was establishing drop-in sessions with a social worker to support carers.

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

Updated 3 November 2017

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

• The practice had adjusted the services it offered to ensure these were accessible, flexible and offered continuity of care. For example, providing extended opening hours once a week and pre-bookable appointments on a Saturday.

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

• Telephone appointments were available with the GP or nursing team.

Updated 3 November 2017

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

• The practice’s data showed 89% of patients diagnosed with dementia had their care reviewed in a face to face meeting in the last 12 months, which was above the CCG average of 83% and national average of 84%.

• The practice was comparable to the CCG and national average for their management of patients with poor mental health. For example, 97% of their patients with schizophrenia, bipolar affective disorder and other psychoses had a comprehensive care plan documented in their records within the last 12 months compared with the CCG average of 87% and the national average of 89%.

• The practice regularly worked with multi-disciplinary teams in the case management of patients experiencing poor mental health, including those with dementia. Staff had a good understanding of how to support patients with mental health needs and dementia.

• The practice carried out advance care planning for patients with dementia and provided home visits for those unable to attend.

• The practice had told patients experiencing poor mental health about how to access various support groups and voluntary organisations.

• Carers were highlighted on their patient record and offered appropriate vaccinations and health checks.

Updated 3 November 2017

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 travellers 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.

• Staff were trained in meeting the diverse needs of their patients for example attending an awareness course on travelling communities.

• Staff assisted patients with literacy and communication needs.

• 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.