Archived: Herbert Avenue

Updated 1 June 2017

Herbert Avenue, also known as Herbert Avenue Medical Centre, is situated in the town of Poole in Dorset. The practice provides a general medical service to approximately 3,600 patients and is part of NHS Dorset Clinical Commissioning Group.

The practice rents the premises from a private landlord and is based on the ground floor of a building in a residential area. The practice is situated near several public transport routes and there is patient parking available, including two designated bays for disabled drivers.

The practice’s population is in the fourth decile for deprivation, which is on a scale of one to ten. (The lower the decile the more deprived an area is compared to the national average). The practice population is predominantly White British although there is a small Polish population and a traveller's site nearby. There is a practice age distribution of male and female patients’ broadly equivalent to national average figures. The average male life expectancy for the practice area is 79 years which matches the national average of 79 years; female life expectancy is 84 years which is slightly higher than the national average of 83 years.

Herbert Avenue has two GP partners, one female and one male as well as one female salaried GP. Together the GPs provided the equivalent of 1.4 full-time GPs. The GPs are supported by a practice manager, a phlebotomist (phlebotomists are people trained to take blood samples) and seven additional administration and reception staff. At the time of our inspection, the practice did not have a permanent practice nurse. However, the practice was employing two nurses both on a temporary basis, to provide approximately three nurse sessions per week. Patients using the practice also have access to community nurses, physiotherapists, chiropodists, and other health care professionals who visit the practice on a regular basis. The health visiting team are based within the practice.

The practice is open between 8am and 6pm Monday to Friday. Appointments are offered between 8.30am and 12.30pm and between 2pm and 5.30pm. The practice offers a range of appointment types including book on the day, telephone consultations and advance appointments. Typically, the practice will also conduct two home visits a day. No extended hours are offered. Outside of these times patients are directed to contact the out of hour’s service by using the NHS 111 number. Details are also given on the practice website and information leaflet of the nearest walk in clinics.

Herbert Avenue has been inspected by us before. We conducted an announced comprehensive inspection of Herbert Avenue in July 2016. Following this inspection, we took enforcement action in relation to breaches to Regulation 17, Good Governance. We also issued a requirement notice to Regulation 12, Safe care and Treatment.

Herbert Avenue provides regulated activities from the main site at:

Herbert Avenue Medical Centre

268 Herbert Avenue

Parkstone

Poole

Dorset

BH12 4HY.

Updated 1 June 2017

Letter from the Chief Inspector of General Practice

We carried out an announced comprehensive inspection at Herbert Avenue on 14 July 2016. The overall rating for the practice was inadequate and the practice was placed in special measures for a period of six months. The full comprehensive report on the July 2016 inspection can be found by selecting the ‘all reports’ link for Herbert Avenue on our website at www.cqc.org.uk.

This inspection was undertaken following the period of special measures and was an announced comprehensive inspection on 25 April 2017. Overall the practice is now rated as good.

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

• There was a new approach to the running of the practice with an open and transparent approach to safety and an effective system in place for reporting and recording significant events.

• Risks to the safe care of patients were more clearly managed, with the exception of legionella.

• Staff assessed patients who attended the practice had their needs and delivered care in line with current evidence based guidance.

• Staff had received updated training and had the skills, knowledge and experience to deliver effective care and treatment.

• Patient feedback was consistently positive about the standard of care received.

• Information about services and how to complain was available and easy to understand.

• Complaints were investigated appropriately and in a timely manner.

• 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.

• Patients said they were treated with compassion, dignity and respect and they were involved in their care and decisions about their treatment.

• The provider was aware of and complied with the requirements of the Duty of Candour.

However, there remain areas where the provider must make improvement. The practice must:

• Ensure effective governance systems are in place to oversee systems and processes within the practice. For example regarding the cleaning of clinical equipment and testing to minimise the risks of legionella.

In addition the provider should:

• Review processes for recording consent for minor surgery, so this is consistently documented in patient notes.

• Continue to review the process for monitoring patient outcomes so that exception reporting becomes in line with local and national averages.

• Review the provision of support for patients with English as an additional language.

I am taking this service out of special measures. This recognises the significant improvements made to the quality of care provided by the service.

Professor Steve Field (CBE FRCP FFPH FRCGP) 

Chief Inspector of General Practice

Updated 1 June 2017

The provider is rated as requires improvement for effective and well-led for people with long-term conditions. These ratings mean the provider is rated as requires improvement overall for this population group.

• GPs had lead roles in long-term condition management and patients at risk of hospital admission were identified as a priority.

• Nationally reported data showed that outcomes for patients with diabetes were comparable to clinical commissioning group (CCG) and national averages. For example, 83% of patients with diabetes had an acceptable average blood sugar level compared to the CCG average of 82% and the national average of 78%. However, exception reporting for this indicator was 29% compared to a CCG average of 18% and national average of 13%.

• 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 1 June 2017

The provider is rated as good for families, children and young people.

• Herbert Avenue had a higher proportion of children up to the age of 18 years compared to the national average. Approximately 45% of patients registered at the practice fell within this age group compared to a national average of 38%.

• 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 78%, which was comparable to the CCG average of 83% and the national average of 81%.

• Appointments were available outside of school hours and the premises were suitable for children and babies. Patients told us that urgent appointments were always available for children.

• The practice worked with other professionals, such as health visitors and school nurses, to ensure the needs of this group were met.

• There was a dedicated health promotion board in the waiting area aimed at families with young children.

Updated 1 June 2017

The provider is rated as good for older people.

• Every patient at the practice including older patients aged over 75 years had a named GP.

• 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.

• Patients at risk of hospital admission were identified as a priority and regularly reviewed to ensure all of their needs were met.

Updated 1 June 2017

The provider is rated as good for 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 proactive in offering online services as well as a full range of health promotion and screening that reflects the needs for this age group.

• The practice offered telephone consultations to meet the needs of this group.

Updated 1 June 2017

The provider is rated as good for people experiencing poor mental health (including people with dementia).

• 93% of patients diagnosed with dementia had their care reviewed in a face to face meeting in the last 12 months, which is comparable to clinical commissioning group (CCG) of 86% and the national average of 84%.
• Performance for mental health related indicators was the national average. For example, of patients with schizophrenia, bipolar affective disorder and other psychoses had their alcohol consumption recorded in the preceding 12 months, compared to a CCG average and national average of 89%.

• 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.

• Practice data showed that 92% of patients with a mental health problem had received a physical health check.

• 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 1 June 2017

The provider is rated as good for 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 had 14 patients registered who also had a learning disability. At the time of our inspection, 42% of these had received an annual health check.

• The practice regularly worked with other health care professionals in the case management of vulnerable patients.

• The practice had a carers lead, who 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.