Carisbrooke Surgery

Updated 10 January 2017

Carisbrooke Surgery is situated in the coastal town of Hastings, East Sussex and operates from:

Falaise Road

Hastings

East Sussex

TN34 1EU

The current premises are temporary following a fire in 2013 at the original premises. The practice told us they were not able to return to the original premises and were currently sourcing a new permanent site.

The practice provides services for approximately 7,410 patients living within the Hastings area. The practice holds a general medical services (GMS) contract and provides GP services commissioned by NHS England. (A GMS contract is one between the practice and NHS England where elements of the contract such as opening times are standard). The practice is situated in one of the most deprived electoral wards in England which could mean an increased demand for GP services.

As well as a team of six GP partners and one salaried GP (three male and four female), the practice also employs three practice nurses, an advanced nurse practitioner , a health care assistant and a phlebotomist. A practice manager and a deputy practice manager are employed and there is a team of receptionists, secretaries and administrative clerks.

The practice is a training practice for GP trainees, foundation level two doctors, medical students and students nurses.

Carisbrooke Surgery is open between 8.30am and 6.30pm on Mondays and between 8.30am and 6pm from Tuesday to Friday. Appointments are available from 8.30am and 6.30pm on Mondays and from 8.30am and 6pm from Tuesday to Friday. An out of hours service is provided from 8am to 8.30am Monday to Friday and from 6pm to 6.30pm from Tuesday to Friday. Weekly minor surgery and joint injection clinics, which are run by the lead GP for the benefit of the practice, are available from the practice.

There are phone appointments available with GPs throughout the day according to patient need and a duty GP. Routine appointments are bookable up to six weeks in advance. Patients are able to book appointments by phone, online or in person.

Patients are provided with information on how to access the duty GP or the out of hour’s service by calling the practice or by referring to its website.

The practice is registered to provide the regulated activities of diagnostic and screening procedures; treatment of disease, disorder and injury; maternity and midwifery services and surgical procedures.

Updated 10 January 2017

Letter from the Chief Inspector of General Practice

We carried out an announced comprehensive inspection at Carisbrooke Surgery on 10 November 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 been trained to provide them with the skills, knowledge and experience to deliver effective care and treatment.

• Data from the Quality and Outcomes Framework (QOF) showed patient outcomes were at or above average compared to the national average particularly for patients with severe and enduring mental health problems.

• Patients said they were treated with compassion, dignity and respect and they were involved in their care and decisions about their treatment.
• Results from the national GP patient survey in 2014/2015 showed the practice was above average for its satisfaction scores on consultations with GPs and nurses. For example 97% of patients who responded said the GP was good at listening to them compared to the national average of 89% and 95% of patients who responded said the last nurse they spoke to was good at treating them with care and concern compared to the national average of 91%.
• 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 they found it easy to make an appointment with a named GP and 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.
• The provider was aware of and complied with the requirements of the duty of candour.

The area where the provider should make improvement is:

• Ensure pre-employment checks are undertaken in accordance with the practice’s recruitment policy.

Professor Steve Field (CBE FRCP FFPH FRCGP) 

Chief Inspector of General Practice

Updated 10 January 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.

• Performance for diabetes related indicators was comparable to the clinical commissioning group (CCG) and national averages. For example, the percentage of patients with diabetes, on the register, in whom the last blood glucose level was 64mmol/mol or less in the preceding 12 months was 83% compared to the CCG average of 80% and the national average of 78%.

• 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.

• The practice held a list of those patients with the most complex needs, which was reviewed on a monthly basis and the named GP worked with relevant health and care professionals to deliver a multidisciplinary package of care.

Updated 10 January 2017

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 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, and we saw evidence to confirm this.

• Baby changing facilities were available and the practice had a room available for breast feeding.

• The practice’s uptake for the cervical screening programme was 80%, which was comparable to the clinical commissioning group (CCG) average of 84% and the national average of 81%.

• Same day appointments were available for children and babies.

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

• We saw positive examples of joint working with midwives and health visitors.

Updated 10 January 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 people in its population and communicated with other health professionals regularly.

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

• Flu vaccines were offered at home to patients who were housebound.

• GPs visited local care homes to undertake annual reviews of their patients.

Updated 10 January 2017

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 was open for appointments until 6.30pm on Mondays for people who could not attend during working hours.

• The practice offered phone consultations when appropriate.

• Seasonal flu clinics were offered on Saturday mornings for patients’ convenience.

• 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 10 January 2017

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

• The practice performance for management of patients with poor mental health was significantly better than the local and national averages. For example, 98% of their patients with severe and enduring mental health problems had a comprehensive care plan documented in their records within the last 12 months compared to the CCG average of 87% and the national average of 89%. Exception reporting was 15%, which was in line with local and national averages (11% CCG and 13% nationally).

• The practice performance for the management of patients diagnosed with dementia was similar to local and national averages. For example 86% of these patients had received a face-to-face review within the preceding 12 months in comparison with the CCG average of 81% and the national average of 84%.

• The practice regularly worked with multi-disciplinary teams in the case management of patients 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.

• The practice had a system in place to follow up patients who had attended accident and emergency where they may have been experiencing poor mental health.

• Staff had a good understanding of how to support patients with mental health needs and dementia.

• People experiencing poor mental health and people with dementia were allocated their own clinician who they were able to see for all appointments to improve continuity of care.

• A counselling service based at the practice was available on a weekly basis.

Updated 10 January 2017

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

• The practice told us the high levels of deprivation meant they also had high numbers of vulnerable patients on the practice register, The practice was running a pilot for their vulnerable patients, for example the frail elderly and patients with dementia who live alone. This ensured that patients with complex health or social needs were identified and had their care co-ordinated by a designated GP and practice nurse lead. Each of these patients had a detailed care plan that identified the health and social support they required to enable them to continue living at home.
• The practice held a register of patients living in vulnerable circumstances including those with a learning disability.
• The practice had a significant number of patients on its register who misused drugs. A fortnightly drug misuse clinic was run by the advanced nurse specialist at the practice.
• 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 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.
• Vulnerable patients were allocated their own clinician who they were able to see for all appointments to improve continuity of care.