Highcliffe Medical Centre

Updated 20 September 2016

Highcliffe Medical Practice was inspected on Monday 22 August 2016. This was a comprehensive inspection.

The main practice is situated in the Highcliffe suburb of Christchurch. This area is rated as 10 on the deprivation decile, with one being the most deprived and 10 being the least deprived. This means that the area is among the most affluent nationally. The 2011 census shows that 97% of the population identify themselves as being white British.

The practice provides a primary medical service to 10,409 patients. 26% of the practice population are aged over 75 years which is higher than the national average of 7.8% and the clinical commissioning group average of 11%. The practice is a teaching practice for medical students and is also a training practice. This enables it to support GP trainees and medical students. The practice currently has one GP registrar, and has had 12 medical students working at the practice over the last eight weeks.

There is a team of five GPs partners and four salaried GPs, five female and four male. Some work part time and some full time. The whole time equivalent is 6.2 GPs. Partners hold managerial and financial responsibility for running the business. The team are supported by a practice manager, one nurse prescriber, an advanced paramedic, six practice nurses, three health care assistants, and additional administration staff.

Patients using the practice also have access to community nurses who are based at the practice. There is an independent pharmacy co-located at the practice. The practice also rents out space to other healthcare professionals such as physiotherapists, aromatherapists and chiropodists.

The practice is open between the NHS contracted opening hours 8am and 6.30pm Monday to Friday. Appointments are offered anytime within these hours. Extended hours surgeries are offered every evening from 6.30pm until 7.30pm, together with the first Saturday in every month from 8.30am until 12 noon.

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 have a Personal Medical Services (PMS) contract with NHS England.

The practice provides regulated activities from a single location at 248 Lymington Road, Highcliffe, Christchurch, Dorset BH23 5ET. We visited this location during our inspection.

Updated 20 September 2016

Letter from the Chief Inspector of General Practice

We carried out an announced comprehensive inspection at Highcliffe Medical Centre on 22 August 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.
• The majority of risks to patients were assessed and well managed. However, we found an area of infection control involving the use of shower trays which should be addressed by the practice.
• 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.
• The practice liaised closely with a carer’s champion employed by a registered charity who signposted carers to relevant services and advice. The equivalent of 4% of the patient list were identified as carers. The carers champion had also successfully developed and ran a male carers group, which had the positive impact of reducing social isolation and providing relevant support for approximately 30 male carers.
• 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.
• 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 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.

We saw one area of outstanding practice:

The practice succeeded in reducing the number of unplanned hospital admissions through the employment of an outreach nursing team which proactively supported patients aged over 75 years by carrying out frequent home visits, advanced care planning and regular reviews.

The areas where the provider should make improvement are:

The provider should review processes and risk assessments for infection control in regard of the usage and cleaning of shower trays for the treatment of leg ulcers, in line with current practice.

Professor Steve Field (CBE FRCP FFPH FRCGP) 

Chief Inspector of General Practice

Updated 20 September 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 IFCC-HbA1c was 64 mmol/mol or less in the preceding 12 months, was 80% which was higher than 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.

Updated 20 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. 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.

• Monthly Saturday morning opening from 8.30am until 12 noon included a children’s immunisation clinic, together with a cervical smear clinic. This was intended to support working parents and those who found it difficult to attend the practice during the week.

• The percentage of women aged 25-64 whose notes record that a cervical screening test has been performed in the preceding 5 years was 90% which was higher than 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 September 2016

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

• The practice employed an outreach nursing team which supported the 26% of practice patients who were aged over 75 years with over 2,900 home visits in the last 12 months. The team comprised of two nurses and a health care assistant. On a daily basis the outreach team looked at the list of patients who phoned up for same day appointments and if the patient was aged over 75 years they contacted them about the need to do a home visits and also carried out advanced care planning, routine annual home visits and followed up on all hospital discharges.

• The practice liaised closely with a carer’s champion employed by a registered charity. The carer’s champion provided signposting to relevant services and advice to the carers registered at the practice, the equivalent of 4% of the patient list were identified as carers. The carers champion had also successfully developed and ran a male carers group, which had the positive impact of reducing social isolation and providing relevant support for approximately 30 male carers.

• 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.

Updated 20 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.

• 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.

Updated 20 September 2016

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

• The percentage of patients diagnosed with dementia whose care has been reviewed in a face-to-face review in the preceding 12 months

• 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 20 September 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 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.