Christchurch Medical Practice

Updated 1 November 2016

We inspected the practice in May 2016 and found improvements were needed in the area of safety. The provider sent us an action plan which detailed the steps they would take to meet the breaches in regulation. During our latest desktop review on 16 September 2016 we found the provider had made the required improvements.

The Orchard Surgery is situated at Christchurch Medical Centre, working collaboratively with two other GP practices located there (Farmhouse Surgery and The Barn Surgery). 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 in May 2016, there were 7271 patients on the practice list and the majority of patients are of white British background. The Orchard Surgery has nearly double the number of patients over 75 years (12.3% 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. All of the patients have a named GP.

The practice has three GP partners and two salaried GPs (two male and three female). The practice uses the same GP locums for continuity where ever possible. The nursing team consists of ten female nurses. Four nurses are qualified practice nurse and one is a nurse practitioner. All the practice nurses specialise in certain areas of chronic disease and long term conditions management. The Orchard Surgery is managed by a team shared with the other two practices at Christchurch Medical Centre. Leading the team is a strategic business manager and a practice support manager who are supported by administrative and reception staff. Some of these roles are shared across all three surgeries promoting close working with Farmhouse and Barn surgeries.

Orchard Surgery is an approved teaching practice with Health Education Wessex. 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). Teaching placements are provided for medical students. No students were at the practice at the time of the inspection.

The practice has an Action Management Before Emergency Risk team (AMBER) approach, which is co-ordinated on behalf of the other practices by a GP from Orchard Surgery. The team works across all three practices based at Christchurch Medical Centre. The purpose is to support vulnerable patients, provide home visits and proactive monitoring to avoid unplanned hospital admissions where ever possible. It comprises of two female nurses, three healthcare assistants and a dedicated administrator.

The practice is open 8.30am to 6.30pm Monday to Friday. 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. Extended opening hours are provided: early morning appointments are available from 7.30am every Tuesday, 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 this is listed on the practice website and 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 closes for two afternoons a year for staff training and information about this is posted on the practice website.

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

The following regulated activities are carried out at the practice: Treatment of disease, disorder or injury; Surgical procedures; Family planning; Diagnostic and screening procedures; Maternity and midwifery services. These are carried out at the following location;

1 Purewell Cross Road

Christchurch

Dorset

BH23 3AF

Updated 1 November 2016

Letter from the Chief Inspector of General Practice

We carried out a desktop review of the Orchard Surgery on 16 September 2016. This review was performed to check on the progress of actions taken following an inspection we made in May 2016. Following that inspection the provider sent us an action plan which detailed the steps they would take to meet their breach of regulation. During our latest desktop review on 16 September 2016 we found the provider had made the necessary improvements.

This report covers our findings in relation to the requirements and should be read in conjunction with the report published in August 2016. This can be done by selecting the 'all reports' link for the Orchard Surgery on our website at www.cqc.org.uk

Our key findings at this inspection were as follows:

The practice had improved the governance systems ensuring that mandatory training was managed effectively so that patient safety was promoted and any risks that could affect the quality of care were reduced. This included the introduction of:

• A system to monitor training, which provided managers with an overview of all staff training at the practice.

• The inclusion of training needs and gaps as a standing item for discussion at GP partnership meetings.

• Oversight of fire safety training and drills was carried out by a named person and monitored at GP partnership meetings.

• Chaperone training was provided in July 2016 for all staff undertaking this role.

• Mental Capacity Act 2005 training was provided for 10 staff in July 2016.

• A fire drill took place across Christchurch Medical Centre in September 2016.

Professor Steve Field (CBE FRCP FFPH FRCGP) 

Chief Inspector of General Practice

Updated 26 August 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.

• 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 88.3%).

• 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.

Updated 26 August 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 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 26 August 2016

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

• The Orchard Surgery has nearly double the number of patients over 75 years (12.3% of the practice list) compared with the national average of 7.7%. There was a higher prevalence of chronic disease and life limiting illness for patients, with associated risks of isolation and vulnerability in old age.

• The practice offered proactive, personalised care to meet the needs of the older people in its population. All of the patients had a named GP and their health needs closely monitored.

• The practice was responsive to the needs of older people.It had a well resourced Action Management Before Emergency Risk team (AMBER) approach, supporting vulnerable people. The team provided home visits and proactive monitoring to avoid unplanned hospital admissions.

• 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 were needed.  

Updated 26 August 2016

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. Extended hours were provided between 7.30pm and 8am on Tuesday and between 6.30pm and 8pm on Thursday.  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 26 August 2016

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

• 77.3% 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%.

• Performance for mental health related indicators was above 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 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 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 26 August 2016

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

• The three practices at Christchurch Medical Centre had an Action Management Before Emergency Risk team (AMBER) approach to supporting vulnerable patients. The team provided home visits and proactive monitoring to avoid unplanned hospital admissions where ever possible. Unlike other similar schemes in Dorset, the team had greater resources and comprised of two female nurses, three healthcare assistants and a dedicated administrator. Data provided by the practice demonstrated that for the period January to March 2016, 114 patients were supported by the team. Of these, 23 patients were high risk and vulnerable. During the period, there had been only 12 hospital admissions, which were for emergencies, for patients registered at the Orchard Surgery.

• The practice held a register of patients living in vulnerable circumstances including homeless people, travellers and those with a learning disability.

• 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.