Archived: Estuary Healthcare Services Also known as Victoria Surgery

Updated 9 August 2016

Estuary Healthcare Services is located in an adapted building in Southend town centre.

The practice holds a Personal Medical Services (PMS) contract and provides GP services commissioned by NHS England and Southend Clinical Commissioning Group. A PMS contract is one between NHS England and the practice where elements of the contract such as services provided and opening times are agreed locally. The practice provides services for 283 patients who have drug and / or alcohol dependency and misuse, who may be homeless and patients on the special allocations scheme (for patients who have been removed form GPs practice lists due to violent, aggressive or threatening behaviour).

Patients may only register at this practice if they are engaged with the Southend Treatment and Recovery Service (STARS).

Economic deprivation levels affecting older people are higher than the practice average across England.

The practice is managed by two GP partners who hold financial and managerial responsibility. One of the GP partners is the Registered Manager. A Registered Manager is a person who is registered with the Care Quality Commission to manage the service. Like registered providers, they are ‘registered persons’. Registered persons have legal responsibility for meeting the requirements in the Health and Social Care Act 2008 and associated Regulations about how the practice is run.

The practice employs a small team including one practice nurse, a practice manager and two receptionists / administrative staff.

The practice is open from 10am to 5.30pm on Mondays, Tuesdays, Wednesdays and Thursdays and between 10am and 3pm on Fridays. Appointments are available from 11am to 1pm. Patients who require treatment outside of these times are advised to contact the NHS 111 service.

The practice has opted out of providing GP out of hour’s services. Unscheduled out-of-hours care is provided by IC24 and patients who contact the surgery outside of opening hours are provided with information on how to contact the service.

Updated 9 August 2016

Letter from the Chief Inspector of General Practice

We carried out an announced comprehensive inspection at Estuary Healthcare Services on 14 April 2016. Overall the practice is rated as good. The practice provides services for 283 patients who have drug and / or alcohol dependency and misuse, who may be homeless and patients on the special allocations scheme (for patients who have been removed form GPs practice lists due to violent, aggressive or threatening behaviour). Patients may only register at this practice if they are engaged with the Southend Treatment and Recovery Service (STARS).

The practice did not provide services to patients who were over 65 years or to children under 18 years or families. For this reason we did not rate the population groups for older people or families, children and young people.

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

• The practice referred to and used published safety information such as safety alerts to monitor and improve safety outcomes for patients. Staff were aware of how to report concerns about patient safety, and when things went wrong these were fully investigated. Learning from safety incidents was shared with staff to minimise recurrences.
• There were arrangements in place to help safeguard patients against the risk of abuse. Staff had undertaken relevant training and had access to appropriate policies and procedures.
• Risks to patients and staff were assessed and managed. There were risk assessments in place for areas including fire safety, infection control, health and safety, premises and equipment. There was information available in relation to the Control of Substances Hazardous to Health (COSHH) such as cleaning materials.
• All equipment was routinely checked, serviced and calibrated in line with the manufacturer’s instructions.
• There was a detailed business continuity plan in place to deal with any untoward incidents which may disrupt the running of the practice.
• Appropriate checks including employment references, proof of identity and registration with professional bodies (where appropriate) and DBS checks were carried out when new staff were employed to work at the practice.
• Newly employed staff undertook a period of role specific induction.
• There were arrangements in place for managing medicines.
• Emergency medicines and equipment were available in line with current guidance and legislation.

• The practice used published guidelines, reviews and audits to monitor how patients’ needs were assessed and the delivery of care and treatment.

• Clinical audits were carried out routinely to monitor and improve outcomes for patients.

• Patients consent to care and treatment was sought in line with current legislation and guidance.

• The practice performance for the management of some long term conditions was lower than other GP practices locally and nationally. This was due to a number of factors including a lack of patient engagement with treatment and in some cases treatment was unsuitable for some patients.

• Information was shared appropriately with other health and social care professionals to help ensure that patients received coordinated care and treatment.

• Patients said they were treated with respect and care. They said that they were very happy with the care that they received. They told us that staff were professional, welcoming and caring.
• Complaints were investigated and responded to appropriately and apologies given to patients when things went wrong or they experienced poor care or services.
• The practice had facilities and equipment to treat patients and meet their needs.
• The premises were accessible to patients with disabilities.
• Translation services were available as required.

• 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.

However there were areas of practice where the provider needs to make improvements.

The practice SHOULD

• Review the procedures for sharing learning from when things go wrong so that locum GPs working at the practice are made aware of this learning to help secure improvements.

• Review the procedures for dealing with medical emergencies to include training for staff in the use of, and assess risks associated with the storage of oxygen at the practice.

• Review its systems for carrying out clinical audits to monitor and improve outcomes for patients.

Professor Steve Field (CBE FRCP FFPH FRCGP) 

Chief Inspector of General Practice

Updated 9 August 2016

The practice is rated as good for people with long term conditions.

The practice provided GP services to patients who were engaged with the Southend Treatment and Recovery Service. These included patients who may have alcohol and / or drug dependency, patients who were homeless and patients who were part of the Special Allocations Scheme (SAS).

The practice:

• Offered dedicated appointments for long term conditions, medicine reviews and health screening and followed up on patients where they failed to attend appointments.

• Offered health and wellbeing advice and smoking cessation sessions.

• Referred to and used a range of published guidance to monitor and improve patient care and treatment.

• Provided a range of information to patients about the management of long term conditions including diabetes and heart disease.

• Data for 2014/15 showed that the practice performance for the management of the majority of long term conditions and disease management such as heart disease and diabetes was lower than other practices both locally and nationally. This was due to a number of factors including lack of patient engagement and compliance with treatment. We saw that the GP and nurse proactively encouraged patients to attend for health reviews and that they carried out some health checks opportunistically when they could do so.

Updated 9 August 2016

The practice is rated as good for working-age people (including those recently retired and students).

• Appointments were available between 11am and 1pm each day and where patients failed to attend at these times they would be offered another appointment or a telephone consultation.

• The practice offered a full range of health promotion and screening that reflected the needs for this age group including NHS health checks.

Updated 9 August 2016

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

• Patients with mental health conditions were invited to have an annual assessment of their physical health needs.

• Longer appointments and home visits were provided as required.

• The practice met with other health and social care professional’s each month to review the care and treatment of patients who were vulnerable, including patients who were experiencing poor mental health.

• Information was shared with local mental health organisations who were involved in patient’s treatment where this was appropriate.

• Information was available about the range of local support and advice services available.

• Patients were referred to specialist services as required.

Updated 9 August 2016

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

The practice provided GP services to patients who were engaged with the Southend Treatment and Recovery Service. These included patients who may have alcohol and / or drug dependency, patients who were homeless and patients who were part of the Special Allocations Scheme (SAS).

• Staff undertook safeguarding training and the practice had a dedicated safeguarding lead.

• The GP had a specialist interest and had undertaken extra training in understanding and treating patients with alcohol and drug dependency issues.

• The practice proactively promoted annual health checks for patients with learning disabilities.

• The practice regularly worked with multi-disciplinary teams including homeless charities, hospital consultants and mental health consultants to help ensure that patients whose circumstances made them vulnerable were supported holistically.