Shirley Health Partnership

Updated 9 December 2016

Grove Medical Practice was inspected on Tuesday 1 November 2016. This was a comprehensive inspection.

The main practice is situated in the Shirley district of Southampton. The deprivation decile rating for this area is five (with one being the most deprived and 10 being the least deprived). This meant that this area was slightly more deprived than the national average. The practice told us that 10% of their patients did not speak English as a first language. The practice provides a primary medical service to 10,000 patients of a diverse age group. The practice is a teaching practice for medical students and a training practice for trainee GPs.

There is a team of three GPs partners and three salaried GPs. Two are female and four are male. Some work part time and some full time. The whole time equivalent is five GPs. Partners hold managerial and financial responsibility for running the business. The team are supported by a practice manager, a medicines manager, a nurse practitioner, four practice nurses, one health care assistant and additional administration staff.

Patients using the practice also have access to community district nurses, podiatrist and a dentist who are based at the practice. Other health care professionals such as mental health teams visit the practice on a regular basis.

The practice is open between the NHS contracted opening hours of 8am and 6.30pm Monday to Friday. Appointments can be offered anytime within these hours. Extended hours surgeries are offered at the following times; Monday 6.30pm to 8pm, Tuesdays 7.30am to 8am and Saturday mornings 7.30am to 10.30am.

Outside of these times patients are directed to contact the out of hour’s service by using the NHS 111 number.

The practice offers a range of appointment types including book on the day, telephone consultations and advance appointments.

The practice has a General Medical Services (GMS) contract with NHS England.

Grove Medical Practice provides regulated activities from a single location at Shirley Health Centre, Grove Road, Shirley, Southampton, Hampshire. SO15 3UA. We visited this location during our inspection.

Updated 9 December 2016

Letter from the Chief Inspector of General Practice

We carried out an announced comprehensive inspection at Grove Medical Practice on 1 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. Monthly meetings took place which included discussions about significant events and shared learning.
• Risks to patients were assessed and well managed. A legionella risk assessment had been completed in March 2016 and we saw evidence that regular checks took place. Portable appliance testing had been completed in January 2016 and was planned for completion annually.
• The practice held quarterly safeguarding meetings and invited all clinical staff, team leaders, health visitors and school nurses to attend.
• 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.
• Patients said they were treated with compassion, dignity and respect and they were involved in their care and decisions about their treatment.
• 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.
• The practice did not have systems in place to identify military veterans and ensure their priority access to secondary care in line with the national Armed Forces Covenant. The practice introduced a military veteran’s policy and protocol to address this immediately after the inspection.
• 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 in place and staff felt supported by management. The practice proactively sought feedback from staff and patients, which it acted on. The practice was undergoing a merger with a neighbouring practice planned for completion in 2017 to help provide greater flexibility of services provided.
• The provider was aware of and complied with the requirements of the duty of candour.

The area where the provider should make improvements;

The practice should ensure that all nursing staff and any staff whose role involves chaperone duties should receive a disclosure barring service check (DBS). The practice manager told us that during the forthcoming merger with a nearby practice, all staff would receive a DBS check, including chaperones and nursing staff.

Professor Steve Field (CBE FRCP FFPH FRCGP) 

Chief Inspector of General Practice

Updated 9 December 2016

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.
• The percentage of patients with diabetes, on the register, in whom the last blood sugar recording was within normal limits was 77% which was in line with the national average of 77%.
• 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. 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.
• All patients had a named GP to allow continuity of care. The practice nursing staff team knew their patients very well and ensured timely monitoring of all patients with long term conditions.
• Diabetes education courses were held at the practice.
• The practice provided near patient testing of INR using INR star algorithms with GP review of every decision. (INR stands for International Normalised Ratio and is used to monitor the effects of blood thinning medicines used to reduce the risk of stroke, heart attack, or other serious conditions. The blood test checks how long it takes for blood to clot.

Updated 9 December 2016

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.
• The practice’s uptake for the cervical screening programme was 80%, which was comparable to the CCG average of 80% and the national average of 82%. 10% of the practice patient list originated from Eastern Europe. These patients often elected to have their cervical smear undertaken by gynaecologist in their country of origin. Despite this, cervical smear rates at the practice rates were close to the national average.
• We saw positive examples of joint working with midwives, health visitors and school nurses. Midwives ran clinics within the same building and discussed concerns or additional needs with patients, GPs and nurses as necessary.
• The practice held quarterly safeguarding meetings and invited all clinical staff, team leaders, health visitors and school nurses to attend.
• The practice used online social media website such as Facebook and Twitter to engage with young adult patients.
• Free condoms, chlamydia packs, family planning and sexual health advice were discreetly available from the practice.
• Appointments were available outside of school hours and the premises were suitable for children and babies.

Updated 9 December 2016

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

• Patients aged over 70 years made up 10% of the practice population. The practice had responded to this by offering proactive, personalised care to meet the needs of the older people in its population.
• The practice was responsive to the needs of older people, and offered home visits and urgent appointments where appropriate.
• The practice had improved rates of osteoporosis treatment in patients aged over 75 through audit and education.
• The practice held regular structured meetings with the multidisciplinary team to discuss clinical cases and had effective links with to community colleagues.
• The practice access system allowed flexibility, telephone advice and assessment by GPs and flagged up patients who were on the unplanned hospital admissions avoidance register for longer appointments. These systems had reduced the number of unplanned admissions to hospital amongst patients aged over 75 years from 129 to 50 during the 2015-2016 financial year.
• The practice engaged closely with third sector organisations with whom the practice had run a person centred care planning pilot. The practice set up, funded and co-ordinated with the third sector to run a nurse led walking group which currently had approximately 20 members. The aim of the group was to enhance patient’s health and fitness and reduce social isolation.
• The practice was innovative in its approach to promoting healthy lifestyles. For example, the practice provided in house chair based exercise classes through a contractor every Monday night. The practice also ran coffee and cake sale mornings for charities which were well-attended and were often a great recruitment opportunity for the elderly and lonely to the walking group.
• The practice had developed its own bereavement leaflet to support families of those who had died through that difficult time.

Updated 9 December 2016

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.
• The practice’s uptake for the cervical screening programme was 80%, which was comparable to the CCG average of 80% and the national average of 82%. 10% of the practice patient list originated from Eastern Europe. These patients often elected to have their cervical smear undertaken by gynaecologist in their country of origin. Despite this, cervical smear rates at the practice rates were close to the national average.
• We saw positive examples of joint working with midwives, health visitors and school nurses. Midwives ran clinics within the same building and discussed concerns or additional needs with patients, GPs and nurses as necessary.
• The practice held quarterly safeguarding meetings and invited all clinical staff, team leaders, health visitors and school nurses to attend.
• The practice used online social media website such as Facebook and Twitter to engage with young adult patients.
• Free condoms, chlamydia packs, family planning and sexual health advice were discreetly available from the practice.
• Appointments were available outside of school hours and the premises were suitable for children and babies.

Updated 9 December 2016

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

• 88% of patients diagnosed with dementia had had their care reviewed in a face to face meeting in the last 12 months, which was better than the national average of 84%.
• The percentage of patients with schizophrenia, bipolar affective disorder and other psychoses whose alcohol consumption had been recorded in the preceding 12 months was 92% which was better than the national average of 90%.
• 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.
• The practice maintained a register of patients with severe mental health issues and offered them yearly health checks and mental health reviews. GPs actively planned and documented crisis management plans and where necessary completed hospital admission avoidance care plans. This demonstrated proactive management of people with severe enduring mental illness. GPs also arranged meetings with the Community Mental Health Team to facilitate appropriate active management for certain patients who were deteriorating.
• The practice had explored expanding the skills mix of their team through involvement in their local GP Federation piloting the employment of a mental health worker.

Updated 9 December 2016

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 homeless people, travellers and those with a learning disability. The practice maintained a register of all patients with learning disabilities and invited them for annual reviews through personal telephone calls as this improved attendance. Patients who had additional needs were highlighted as needing longer routine appointments.

• 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.
• Staff had received nationally recognised domestic violence training and made use of local domestic violence support services. Notices about domestic violence were on display throughout the practice.