Archived: Farfield Group Practice Also known as Modality Partnership

Updated 7 February 2017

Farfield Medical Practice is a member of the Airedale Wharfedale and Craven Clinical Commissioning Group (CCG). Personal Medical Services (PMS) are provided under a contract with NHS England. They also offer a range of enhanced services, which include:

• Childhood vaccination and immunisations

• The provision of influenza and pneumococcal immunisations

• Facilitating timely diagnosis and support for patient with dementia

• Extended hours access

• Improving online access

Farfield Medical Practice is located at St Andrew’s Surgeries, West Lane, Keighley, Bradford BD21 2LD which is a former mill town in a semi-rural location and is within the 20% most deprived localities in England.

The practice is situated in purpose built premises. There are facilities for people with disabilities and all patients areas are on the ground floor. There are car parking facilities on site with designated disabled parking.

The practice has a patient list size of 12,793 which is made up of a population with an almost 50:50 ratio of male and female patients. The practice has close links with local residential care homes, where some registered patients reside. The practice population had 8% of patients from a south east Asian background and although interpretations services were available the demand was relatively low. The practice population higher prevalence of diabetes, heart and respiratory disease than the England average.

There are eight GP (two male and six female), and two regular locum GP’s. who are supported by two advanced nurse practitioner, seven practice nurses and two health care assistant, two pharmacists, two care navigators and a physiotherapist. There is a practice manager and a team of administration and reception staff. The practice also has the support of a CCG employed medicines management pharmacists. The practice is also a training practice.

The practice is open Mondays to Friday between 8.30am and 6.00pm. The practice offers late night surgeries until 8pm Monday and Thursdays for those not able to attend in normal surgery. The practice offered a range of appointments throughout the opening hours. When the practice is closed out-of-hours services, and telephone access from 6pm to 6.30pm are provided by Local Care Direct, which can be accessed via the surgery telephone number or by calling the NHS 111 service.

The practice has good working relationships with local health, social and third sector services to support provision of care for its patients. (The third sector includes a very diverse range of organisations including voluntary, community, tenants’ and residents’ groups.)

Updated 7 February 2017

Letter from the Chief Inspector of General Practice

We carried out an announced comprehensive inspection at Farfield Group Practice on 18 October 2016. Overall the practice is rated as good for providing safe, effective, caring, responsive and well-led care for all of the population groups it serves.

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

• The ethos and culture of the practice was to provide good quality service and care to patients.

• Patients told us they were treated with compassion, dignity and respect and were involved in care and decisions about their treatment.

• Patients’ needs were assessed and care was planned and delivered following best practice guidance.

• The practice had good facilities and was well equipped to treat and meet the needs of patients. Information regarding the services provided by the practice and how to make a complaint was readily available for patients.

• Patients we spoke with were positive about access to the service. They said they found it generally easy to make an appointment, there was continuity of care and urgent appointments were available on the same day as requested.

• The practice had a good understanding of, and complied with, the requirements of the duty of candour. (The duty of candour is a set of specific legal requirements that providers of services must follow when things go wrong with care and treatment.)

• The partners had a culture of openness and honesty which was reflected in their approach to safety.

• Risks to patients were assessed and well managed.

• There were comprehensive safeguarding systems in place; particularly around vulnerable children and adults.

• The practice sought patient views how improvements could be made to the service, through the use of patient surveys, the NHS Friends and Family Test and the Patient Participation Group (PPG).

• There was a clear leadership structure.

• The GP partners were forward thinking, aware of future challenges to the practice and were open to innovative practice.

We saw an area of outstanding practice including:

• The use of care navigators for patients with complex health needs ensuring they receive the right care at the right time by the right person. Initial evaluation of this service demonstrated positive outcomes for patients.

Professor Steve Field (CBE FRCP FFPH FRCGP) 

Chief Inspector of General Practice

Updated 7 February 2017

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

• The GPs had lead roles in the management of long term conditions and were supported by the nursing staff. Annual reviews were undertaken to check patients’ health care and treatment needs were being met. Holistic reviews were undertaken with patients who had several co-morbidities, which avoided the need for multiple appointments.
• The practice maintained a register of patients who were a high risk of an unplanned hospital admission. Care plans and support were in place for these patients.
• 66% of diagnosed diabetic patients had a blood sugar level within the normal limits in the preceding 12 months (CCG average 81%, national average 78%).
• 76% of patients with hypertension (high blood pressure) who had a reading within normal limits in the last 12 months (CCG average 84% and national averages of 83%).
• 60% of patients diagnosed with asthma, on the register and had received a review in the last 12 months (CCG average 77% and national average 75%).
• The practice identified those patients who had complex needs. The practice ensured that those patients with life limiting conditions were on the palliative care register. These patients were discussed at the Gold Standards Framework (GSF) meeting to ensure the correct support and care was delivered.
• Patients nearing the end of their life had access to a ‘Goldline’ telephone service providing them with support and advice.
• The practice delivered a diabetic clinic with the support of a specialist nurse which includes the initiation of insulin.
• They had a blood pressure monitoring machine available a private area of the reception, to enable patients to check their own blood pressure and report the results to the practice.
• Care navigators ensured patients with complex health needs were treated in a timely manner by the most appropriate person.

Updated 7 February 2017

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

• The practice worked with midwives, health visitors and school nurses to support the needs of this population group. For example, through the provision of ante-natal, post-natal and child health surveillance clinics.

• There were systems in place to identify and follow up children living in disadvantaged circumstances and who were at risk.

• Patients told us children and young people were treated in an age-appropriate way and were recognised as individuals.

• Appointments were available outside of school hours and the premises were suitable for children and babies.

• Immunisation rates were with the CCG and national rates for all standard childhood immunisations

• An open access sexual health, contraceptive and cervical screening services were provided at the practice.

• 80% of eligible patients had received cervical screening (CCG average 84% and national average 82%).

• Appointments were available with both male and female GPs

• The practice extensively used text messaging to increase uptake and attendance for health care.

• There was a weekly health visitor led baby clinic at the surgery.

Updated 7 February 2017

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

• The practice provided proactive, responsive and person-centred care to meet the needs of the older people in its population. All elderly patients had a named GP.
• The practice worked closely with other health and social care professionals, such as the district nursing and local neighbourhood teams, to ensure housebound patients received the care and support they needed.
• The practice participated in Airedale Wharfedale and Craven Clinical Commissioning Group (CCG) initiatives to reduce the rate of elderly patients’ acute admission to hospital.
• Patients who were considered to be at risk of frailty were identified and support offered as appropriate.
• Personalised care plans were in place for those patients who were considered to have a high risk of an unplanned hospital admission and patients were reviewed as needed.
• Health checks were offered for all patients over the age of 75 who had not seen a clinician in the previous 12 months.
• Patients were signposted to other local services for access to additional support, particularly for those who were isolated or lonely.
• The practice delivered a successful Enhanced Primary Care Scheme to assist with the care of complex patients and reduce hospital admissions. Data was being collected to evidence the impacts but it was too early to demonstrate the exact patient impacts.

Updated 7 February 2017

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

• The needs of these patients 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 provided extended hours appointments on Monday and Thursday late evenings, telephone consultations, online booking of appointments and ordering of prescriptions.
• The practice offered a range of health promotion and screening that reflected the needs for this age group.
• Health checks were offered to patients aged between 40 and 74 who had not seen a GP in the last three years.
• Students were offered public health recommended vaccinations prior to attending university.
• Travel health advice and vaccinations were available.
• The practice utilised electronic booking of appointments, prescribing and telephone appointments to provide improved access for working people.

Updated 7 February 2017

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

• The practice regularly worked with multidisciplinary teams in the case management of people in this population group, for example the local mental health team.
• Patients and/or their carer were given information on how to access various support groups and voluntary organisations.
• 83% of patients diagnosed with dementia had received a face to face review of their care in the preceding 12 months (CCG average 85%, national average 84%).
• 89% of patients who had a complex mental health problem, such as schizophrenia, bipolar affective disorder and other psychoses, who had a comprehensive, agreed care plan documented in their record in the preceding 12 months (CCG average 91% and national averages of 89%).
• Staff had a good understanding of how to support patients with mental health needs or dementia and offered flexible appointments.
• All staff had completed the Dementia Friendly Training.
• Deprivations of Liberty Safeguards were written in the patient’s clinical notes.
• The practice used the support of voluntary organisations (such as the Alzheimer Society) to develop additional services for their patients.

Updated 7 February 2017

The practice is rated as good for the care of people whose circumstances may make them vulnerable.

• Staff knew how to recognise signs of abuse.They 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 could evidence a number of children who were on a child protection plan (this is a plan which identifies how health and social care professionals will help to keep a child safe).

• Patients who had a learning disability received an annual review of their health needs and a care plan was put in place. Carers of these patients were also encouraged to attend, were offered a health review and signposted to other services as needed.

• We saw there was information available on how patients could access various local support groups and voluntary organisations.

• There was a substance misuse service in the surgery which supported the reduced use of Methadone in drug dependant patients.

• Transgender and adoptive children had an option to be called by a number instead of their name on the next patient call system.

• When a GP was notified of a patient’s death this was followed up with a telephone call to the next of kin by the person best known to the family.

• The practice had British Sign Language trained receptionists available.