The Forge Surgery - Care Quality Commission (2024)

Background to this inspection

Updated 7 August 2018

The Forge Surgery is located in a residential area of Gravesend, Kent and provides primary medical services to approximately 3400 patients. The practice is based in Fleet Health Campus a purpose built health centre which is shared with other GP practices, a walk-in centre and a community pharmacy. The centre is purpose built and has good access for patients with limited mobility and parents with young babies/children. There is a large car park for patient use.

There are two GP partners at the practice, one female and one male. There are two locum female practice nurses. The GPs and nurse are supported by the practice manager and a team of three reception/administration staff.

The practice demographic is similar to the national average though there are fewer male patients between the ages of 15 and 44 than nationally. Unemployment in the area is higher than the national average. High demand for health services is sometimes correlated with higher unemployment.

The practice is open from Monday to Friday between 8am and 6.30pm except for Thursday, when the practice closes at 1pm. Appointments are from 9.30am to 1pm and from 4.30pm to 6.30pm. There is an extended hours surgery on Monday evening from 6.30pm to 8pm. On Thursday afternoons a GP from another local practice is on call for emergencies. Appointments can be booked over the telephone, online or in person at the practice. Patients are provided with information on how to access an out of hours provider by calling the surgery and on the website.

The practice runs a number of services for its patients including; chronic disease management, new patient checks, minor surgery, family planning and travel advice. The practice does not provide out of hours services which are accessed through NHS 111. There is information on the practice’s website and displayed at the practice regarding accessing care when the practice is closed.

Services are provided from The Forge Surgery, Fleet Campus, Vale Road, Gravesend, Kent, DA11 8BZ.

People with long term conditions

Good

Updated 10 November 2017

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

  • GPs undertook the lead roles in long-term disease management and patients at risk of hospital admission were identified as a priority.
  • Performance for diabetes related indicators was indicators were better than the national average. For example, 92% of patients with diabetes had an acceptable blood pressure reading in the preceding 12 months, compared with a national average of 78%. The percentage of patients with diabetes who had a record of a foot examination and risk classification within the preceding 12 months was 92% compared with a national average of 88%.
  • The practice had scored 100% in all 14 areas of disease management measured under the Quality and Outcomes Framework system.
  • The practice followed up on patients with long-term conditions discharged from hospital and ensured that their care plans were updated to reflect any additional needs.
  • There were emergency processes for patients with long-term conditions who experienced a sudden deterioration in health.
  • All these patients had a named GP and there was a system to recall patients for a structured annual review to check their health and medicines needs were being met. For those patients with the most complex needs, the named GP worked with relevant health and care professionals to deliver a multidisciplinary package of care.

Families, children and young people

Good

Updated 10 November 2017

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

  • From the sample of documented examples we reviewed we found there were systems to identify and follow up children living in disadvantaged circ*mstances and who were at risk. However children at risk were not “flagged” on the practice’s patient record so that all staff were aware of when they were dealing with them.
  • 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.
  • The practice worked with midwives, health visitors and school nurses to support this population group. For example, in the provision of ante-natal, post-natal and child health surveillance clinics.
  • The practice had emergency processes for acutely ill children and young people and for acute pregnancy complications.

Older people

Good

Updated 10 November 2017

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 patients in its population.
  • The practice was responsive to the needs of older patients, and offered home visits and urgent appointments for those with enhanced needs.
  • The practice identified at an early stage older patients who may need palliative care as they were approaching the end of life. It involved older patients in planning and making decisions about their care, including their end of life care.
  • The practice followed up on older patients discharged from hospital and ensured that their care plans were updated to reflect any extra needs.
  • Older patients were provided with health promotional advice and support to help them to maintain their health and independence for as long as possible

Working age people (including those recently retired and students)

Good

Updated 10 November 2017

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

  • The needs of these populations had been identified and the practice had adjusted the services it offered to ensure these were accessible, flexible and offered continuity of care, for example, extended opening hours and Saturday appointments.
  • 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.

People experiencing poor mental health (including people with dementia)

Good

Updated 10 November 2017

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

  • The practice carried out advance care planning for patients living with dementia.
  • Seventy seven percent of patients diagnosed with dementia had had their care reviewed in a face to face meeting in the last 12 months, which is comparable to the national average of 78%.
  • The practice had a system for monitoring repeat prescribing for patients receiving medicines for mental health needs.
  • Performance for mental health related indicators was better than the national average. For example 94% of patients with schizophrenia bipolar affective disorder and other psychoses had a comprehensive, agreed care plan documented in the last 12 months compared with a national average of 88%.
  • The practice regularly worked with multi-disciplinary teams in the case management of patients experiencing poor mental health, including those living with dementia.
  • Patients at risk of dementia were identified and offered an assessment.
  • The practice had information available for patients experiencing poor mental health about how they could access various support groups and voluntary organisations.
  • The practice had a system to follow up patients who had attended accident and emergency where they may have been experiencing poor mental health.
  • Staff interviewed had a good understanding of how to support patients with mental health needs and dementia.

People whose circ*mstances may make them vulnerable

Good

Updated 10 November 2017

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

  • End of life care was delivered in a coordinated way which took into account the needs of those whose circ*mstances may make them vulnerable.
  • 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.
  • The practice had information available for vulnerable patients about how to access various support groups and voluntary organisations.
  • Staff interviewed knew how to recognise signs of abuse in children, young people and adults whose circ*mstances may make them vulnerable. 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.
  • Vulnerable patients were not “flagged” on the practice’s patient record so that staff were aware of when they were dealing with a vulnerable patient.
The Forge Surgery
            - Care Quality Commission (2024)
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