The Grove Surgery

Updated 20 March 2017

The Grove Surgery is situated in a new purpose built practice at Christchurch Hospital. The practice provides general medical services in Christchurch, Dorset. The area covered incorporates the coastal town, attracting temporary residents on holiday during the Summer months.

There is low social deprivation in the area. At the time of the inspection, there were 5,232 patients on the practice list and the majority of patients are of white British background. The Grove Surgery has nearly double the number of patients over 65 years (43.9% of the practice list) compared with the national average of 27.2%. There is a higher prevalence of chronic disease and life limiting illness for patients, with associated risks of isolation and vulnerability in old age. All of the patients have a named GP.

The practice has two GP partners and two salaried GPs (two male and two female). The practice has a higher ratio of GPs avoiding the need to use GP locums. The nursing team consists of three female practice nurses. One of the nurse holds prescribing qualifications enabling them to treat patients with minor illness. All the practice nurses specialise in certain areas of chronic disease and long term conditions management.

The Grove Surgery is an approved training practice. Two GP partners are approved as trainers. The practice normally provides placements for trainee GPs and F2 trainees (qualified doctors in the second year of their foundation training). There were two GP registrars working at the practice when we inspected.

The practice has a specialist team (Self Management in Local Environment) to support vulnerable patients, provide home visits and proactive monitoring to avoid unplanned hospital admissions where ever possible. It comprises of a female nurse and two female health care assistants (HCA). One of the HCA’s role focusses on ensuring patients who may have dementia are appropriately assessed and supported.

The practice is open 8.30am to 6.30pm Monday to Friday in line with local contractual arrangements. Phone lines are open from 8.30am to 6.30pm, with the out of hours service picking up phone calls outside of these times. GP appointment times were available morning and afternoon every weekday. The practice has a flexible appointment length and patients are encouraged to book an appointment to suit their needs. Extended opening hours are provided: Monday, Thursday and Friday. Early morning appointments are available from 7.30am every Monday and Friday, and evening appointments are available every Thursday from 6.30pm until 7.30pm. Telephone appointments are available Monday to Friday by arrangement. Patients are able to book routine appointments on line up to five weeks in advance.

Information about opening times are listed at the practice, on their website and in the patient information leaflet.

Opening hours of the practice are in line with local agreements with the clinical commissioning group. Patients requiring a GP outside of normal working hours are advised to contact the out of hours service provided by the out of hours service in Dorset.

The practice has a General Medical Service (GMS) contract.

Updated 20 March 2017

Letter from the Chief Inspector of General Practice

We carried out an announced comprehensive inspection at The Grove Surgery on 20 October 2016. Overall the practice is rated as good.

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

• Involvement of other organisations, such as public health, the clinical commissioning group and Christchurch Health and Well Being Board were integral to developing services at the practice and beyond.
• There was a holistic approach to assessing, planning and delivering care and treatment to people using services. Examples included: an over 75s GP leading the inhouse specialist team (SMILE) delivering proactive support to vulnerable patients to avoid unplanned hospital admissions where ever possible.

• The practice had a clear vision which had quality and safety as its top priority. The strategy to deliver this vision had been produced with stakeholders and was regularly reviewed and discussed with staff. Examples included: Collaboration with an adult social care provider to provide dementia specialist care and step down beds in the area; Driving up quality by collaborating with seven other GP practices in a federation.

• A GP partner was the lead clinician on the local ‘My Health, My Way’ projectaiming to equip people with a long-term health condition with the skills and information that will help them to manage their condition and make informed choices about the support they require. Patients were able to access a range of support to suit them, including one-to-one coaching, telephone support, group work, on-line tools and structured support work.Patients experienced flexible services that aimed to provide choice and continuity of care. Self health management was promoted through a partnership with the patient aimed at helping them plan and achieve quality of life goals. Patients were enabled to be self directive of the timing of appointments, which was supported by proactive triage and management of their needs.There was an open and transparent approach to safety and an effective system in place for reporting and recording significant events.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. Feedback from all 45 patients was strongly positive confirming 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 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.

• Governance systems were effective ensuring the practice focussed on patient health and social need outcomes.
• The leadership drove continuous learning and improvement at all levels within the practice. Safe innovation was celebrated.

• Integrated health and social care is strongly advocated and the practice has driven innovation in the integration of community services in Christchurch.Examples included:engagement with the community to discuss and agree health and social care priorities for Christchurch.Educating citizens in the community about early identification of malnutrition and what to do to seek help for vulnerable people.Leading the development of a hub approach with a federation of seven other GP practices to provide onsite and co-located secondary health and social care services.Patients benefitted from these initiatives by being better informed, only attending the practice when absolutely necessary and having access to a wider range of services and appointments across the Hub.

We saw one area of outstanding practice:

The practice had set up a pilot with local schools in the last 12 months providing responsive GP assessment service, whereby a child/young person was guaranteed a same day appointment to determine their fitness to attend school. Early data indicated that school absence rates had improved by 90% as a result of this pilot. In addition the practice had established a joint volunteer initiative, in which the practice helped train volunteers to support patient families with a child/young person with mental health needs. Families who could be vulnerable and isolated benefitted from the befriending support from volunteers.

The areas where the provider should make improvement are:

Safety net systems needed further development and should include the setting up of system to ensure that all urgent referrals to secondary services are successfully received.

Review audit processes to ensure multiple cycle audits are undertaken to measure service improvement.

Professor Steve Field (CBE FRCP FFPH FRCGP) 

Chief Inspector of General Practice

Updated 20 March 2017

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

• Patients experienced flexible services that aimed to provide choice and continuity of care. Self health management was promoted through a partnership with the patient aimed at helping them plan and achieve quality of life goals – ‘My Health, my way’. Patients were enabled to be self directive, setting the timing of appointments, which was supported by GP triage and prioritisation of needs accordingly.

• 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 above the national average. For example, 94% of patients on the diabetes register had a record of a foot examination and risk classification within the preceding 12 months (national average 87.4%).

• Longer appointments and home visits were available when needed and triaged by a duty GP.

• 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.

Updated 20 March 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.

• The practice’s uptake for the cervical screening programme was 83%, which was above the CCG average of 77% and the national average of 82%.

• 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, health visitors and school nurses.

Updated 20 March 2017

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

• The Grove Surgery had double the number of patients over 75 years (16.6% of the practice list) compared with the national average of 7.7%.There is a higher prevalence of chronic disease and life limiting illness for patients, with associated risks of isolation and vulnerability in old age. The SMILE (Self Management in the Local Environment) team was employed by the practice to support these patients. A dedicated over 75’s GP was responsible for overseeing the support of vulnerable patients by a nurse and two healthcare assistants. Patients experienced responsive and well managed support, the team provided home visits and proactive monitoring to avoid unplanned hospital admissions where ever possible. We saw anticipatory care plans were in place for all these patients which were being monitored by the SMILE team resulting in a higher level of continuity of treatment and care for these patients.

• The practice had a named member of staff as the carer lead who was proactive in identifying any carers, signposting and providing support to them where needed.

• The practice had a clear overview of the priorities for older people living in Christchurch. GPs had worked with the community through the Health and Wellbeing Group to encourage a provider to build an adult social care home specialising in dementia, which was a gap in provision for an ageing population. A closer relationship with the home had been established resulting in improved levels of clinical support when required.

Updated 20 March 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 including.

• Patients were able to access appointments on-line and have telephone consultations between 6.30pm and 7.30pm every weekday.

• Patients could receive SMS text prompts for appointments if they registered for this service.

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

Updated 20 March 2017

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

• 88.9% of patients diagnosed with dementia had their care reviewed in a face to face meeting in the last 12 months, which was comparable to the national average of 85%.

• Patients with potential early signs of dementia were able to access rapid assessment leading to earlier diagnosis and identification of support through the in-house SMILE team (Self management in the local environment).

• Performance for mental health related indicators was above the national average. For example, 96% of patients with schizophrenia, bipolar affective disorder and other psychoses had a comprehensive, agreed care plan documented in the record, in the preceding 12 months (national average 88.5%)

• 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 and provided information for 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.

Updated 20 March 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 homeless people, travellers and those with a learning disability.

• Patients had flexibility and choice about the length of appointments, including identification of who they wanted to support them. For example, some patients with learning disabilities received support from the learning disability specialist nursing team at appointments for women such as cervical screening.

• Vulnerable patients who were at risk due to social isolation and with complex needs received proactive support from the in-house SMILE team (Self management in the local environment).Early interventions such as befriending and additional social care were put in place to help them manage their health conditions avoiding hospital admission wherever possible.

• The practice had initiated a Malnutrition Project, which educated citizens in the community to recognise and seek early intervention from the SMILE team to provide support for people at risk of numerous health problems.

• Vulnerable families and children were receiving support through initiatives led by the practice. These included: awareness of and action to reduce the risk of abuse in vulnerable children and young people. Supporting children and young people who were vulnerable due to health conditions to increased absence from school. Through a joint venture with schools, the practice had set up a responsive GP assessment service whereby a child/young person was guaranteed a same day appointment to determine their fitness to attend school. Early data indicated that school absence rates had improved by 90%. A joint volunteer initiative, in which the practice helped train volunteers to support families with a child/young person with mental health needs.