Waterfront and Solent Surgery

Updated 4 May 2017

Waterfront and Solent Surgery is located at Jones Lane, Hythe, Hampshire SO45 6AW. There are currently around 7200 patients registered with the practice.

The practice is located centrally in Hythe and covers areas of both relative wealth and affluence, such as Beaulieu and also areas of relative deprivation. The population that it serves has a high level of elderly patients with data showing that the practice itself has a higher elderly population than other practices in the local area.

The practice supports two large nursing homes and six residential homes in the area. Sole care is also provided to a residential home for patients with learning difficulties. There are two designated disabled parking bays in the car park and all consulting rooms in the purpose built building are located on the ground floor. The practice has baby changing facilities and accessible toilets.

At the time of the follow up inspection in March 2017 there were three GP partners, one salaried GP, one advanced nurse practitioner, three practice nurses, one health care assistant and nine administrative staff and one practice manager.

The practice is open between 8am and 6.30pm from Monday to Friday. Extended hours appointments are offered on Wednesdays until 7.45pm and on every other Saturday morning.  The reception is open every Saturday morning. Appointments can be booked in advance either on-line or through the telephone system. There are ‘rapid access’ appointments for patients with urgent needs. When the practice is closed the patients are referred to NHS 111.

Updated 4 May 2017

Letter from the Chief Inspector of General Practice

We carried out an announced comprehensive inspection at Waterfront and Solent Surgery on 24 August 2016. The practice was rated good for effective, caring, responsive and well-led, and was rated requires improvement for safe. The overall rating for the practice was good. The full comprehensive report on the August 2016 inspection can be found by selecting the ‘all reports’ link for Waterfront and Solent Surgery on our website at www.cqc.org.uk.

This inspection was an announced focused inspection carried out on 14 March 2017 to confirm that the practice had carried out their plan to meet the legal requirements in relation to the breach in regulations that we identified in our previous inspection on 24 August 2016. This report covers our findings in relation to those requirements.

At our previous inspection on 24 August 2016, we rated the practice as requires improvement for providing safe services as the practice’s waste management policy was not labelled, stored, transported and disposed of in accordance with national legislation and local policies.

It was also noted that on the previous inspection that the business continuity plan for the practice was not updated to reflect the current emergency contact numbers for staff. Information within the plan was not accessible off site.

Our key findings for 14 March 2017

• We found that the waste management was improved and waste now correctly disposed of in line with current legislation and local policy.
• The practice business continuity plan now had all the correct telephone numbers for emergency use and the information was accessible off site.

The practice is now rated as good for providing safe services.

Professor Steve Field (CBE FRCP FFPH FRCGP) 

Chief Inspector of General Practice

Updated 29 September 2016

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

• The practice kept a register of patients with chronic diseases and had lead nurses in asthma, chronic obstructive pulmonary disease (COPD), heart disease and diabetes. Patients were invited to an annual review through an electronic recall system. Annual reviews varied dependent on the disease but included the production of care plans, the provision of rescue medications, and associated general medical health checks where appropriate. Medication reviews were carried out at the same time. 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.
• GPs reviewed patients with mental health problems, rheumatology, dementia, stroke and atrial fibrillation.
• Performance for diabetes related indicators were similar or better than the national average.
• Longer appointments and home visits were available when needed.
• All GPs were trained in the use of a dermatoscope. This meant that suspicious moles or skin lesions could be looked at and a better assessment of the skin lesion can be made. This reduced the number of referrals made to secondary care. The GPs worked together and supported each other where there was doubt in diagnosis.
• The practice had a ‘two week wait’ champion to ensure patients referred down this pathway had an appointment booked and provided a liaison at this anxious time.

Updated 29 September 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. The practice had a dedicated safeguarding lead who met regularly with the liaison health visitor. Vulnerable families were discussed at clinical meetings.
• Immunisation rates were relatively high for all standard childhood immunisations.
• The practice’s uptake for the cervical screening programme was 76% in 2014/2015, which was worse than the CCG average of 82% and the national average of 82%. Following this below average score the practice took actions to improve their performance and ensure a higher uptake of the cervical screening.
• Appointments were available outside of school hours and the premises were suitable for children and babies.
• A dedicated member of the practice was responsible for sending out baby packs to new parents and ensured that children were brought to their six-week check appointment and their immunisation clinics. Parents were also informed about how they could access the practice’s service on behalf of their children which included online services.
• At the time of the teenage booster vaccinations the nurses took the opportunity to give help and advice to teenagers. The practice was part of the ‘Get it on’ scheme providing a free condom and sexual health advice to teenagers.
• The practice also provided pre-conception and early pregnancy advice along with ante-natal and post-natal care.

Updated 29 September 2016

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.
• The practice was responsive to the needs of older people, and offered home visits and urgent appointments for those with enhanced needs.
• The practice met monthly with the multi-disciplinary community care team (CCT). This team was composed of district nurses, physiotherapists, occupational therapists, social workers, members of the community intervention team, the frailty GP, the local care of the elderly consultant, the local palliative care team and the older persons mental health team. Patients with complex needs and those on the palliative care register were discussed and their needs identified.
• The practice had a frailty GP who was also a clinical commissioning group (CCG) lead for adult mental health. The frailty GP worked with the practice to identify patients who were in nursing home, residential homes, or who were housebound and worked closely with the CCT and the care navigator to deliver better quality care and a more thorough and complete service.
• The care navigator worked closely with the CCT, reception team, and the practice’s carer champion to help steer patients and carers through the complex path of support agencies such as Age Concern and Alzheimer's UK. This provided a two way link with the practice which had been highly valued.
• The practice kept a register of carers, and a designated member of staff was responsible for maintaining the register, sending out information packs, and making annual contact with the carers on the register. The practice was in the process of setting up a carer support group through the patient participation group (PPG).
• The practice had a specific template for future planning which helped to collect data for patients regarding their wishes for future care as an extension of the practice’s work on dementia, the palliative care register, and the carer register. This was considered as an overarching care plan.
• The practice was engaged in working with local practices to develop ways to tackle social isolation.

Updated 29 September 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. This included extended opening hours and the phlebotomy service on Saturdays.
• 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.
• The practice offered extensive online services and had an active newsletter mailing list enabling to deliver direct mail. The practice had a blog which had been read over 11,700 times and had both Facebook and Twitter accounts to engage with younger patients.

Updated 29 September 2016

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

• 97% of patients diagnosed with schizophrenia, bipolar affective disorder and other psychoses had had their care reviewed in a face to face meeting in the last 12 months, which was better than the clinical commissioning group (CCG) average of 89% and the national average of 88%.
• 83% of patients diagnosed with dementia had had their care reviewed in a face to face meeting in the last 12 months, which was comparable to the CCG average of 84% and to 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 worked in conjunction with the adult mental health team to provide both physical assessments of this difficult to reach group of patients on an annual basis. Mental health patients were phoned instead of sending letters to encourage attendance.
• 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.
• Staff had a good understanding of how to support patients with mental health needs and dementia. The practice was working towards becoming a dementia friendly practice. This included meeting with the local dementia organisations and the whole practice receiving training. A member of staff was the designated dementia champion who sent out data collection packs to all patients and carers to collect vital non-clinical information. This improved all staff’s ability to identify early dementia.

Updated 29 September 2016

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

• The practice had a dedicated adult safeguarding lead and held a register of patients living in vulnerable circumstances including those with a learning disability. The practice provided support and care to women and young children in the local refuge. The practice also provided the sole medical cover for a transient population of migrant workers for a local farming business.
• The practice was a sole provider to a residential home for patients with learning disabilities. There was a lead GP who performed annual checks and generated individualised care plans and performed home visits on the patients who were unable to attend. The practice was also looking to make their services more accessible to patients with learning difficulties and had recently completed a survey.
• 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.
• The practice’s staff received training regarding the Mental Capacity Act (2005) and the Deprivation of Liberty Safeguards.