Parklands Surgery

Updated 14 March 2017

Parklands Surgery is located in a residential area of Chichester and provides primary medical services to approximately 9,800 patients. The practice also provides care and treatment for the residents of nearby care homes, which serves individuals with dementia or nursing needs.

There are four GP partners and three salaried GP (four male, three female). Collectively they equate to almost seven full time GPs. The practice is registered as a GP training practice, supporting medical students and providing training opportunities for doctors seeking to become fully qualified GPs.

There are nine female members of the nursing team; one nurse manager, one nurse prescriber, four practice nurses and three health care assistants. GPs and nurses are supported by the practice manager, a deputy practice manager, and a team of reception/administration staff.

The practice is open from 8am to 6:30pm Monday to Friday. Extended hours appointments are offered Tuesday and Thursday mornings from 7:30am to 8:30am and Saturday mornings 9:30am to 11:30am. Phlebotomy appointments are also offered on Wednesday mornings from 7am to 8am. Appointments can be booked over the telephone, online or in person at the surgery. Patients are provided information on how to access an out of hours service by calling the surgery or viewing the practice website.

The practice runs a number of services for its patients including; family planning, health checks, smoking cessation, and travel vaccines.

Data available to the Care Quality Commission (CQC) shows the practice serves a higher than average number of patients who are aged over 65 when compared to the national average. The number of patients under 4 years of age is slightly below the national average. The number of

registered patients suffering income deprivation is below the national average.

The practice has a General Medical Services (GMS) contract with NHS England. (GMS is one of the three contracting routes that have been available to enable commissioning of primary medical services). The practice is part of the NHS Coastal West Sussex Clinical Commissioning Group.

Updated 14 March 2017

Letter from the Chief Inspector of General Practice

We carried out an announced comprehensive inspection at Parklands Surgery on 17 May 2016. During this inspection we found breaches of legal requirement and the provider was rated as requires improvement under the safe domain. The full comprehensive report on the May 2016 inspection can be found by selecting the ‘all reports’ link for Parklands Surgery on our website at www.cqc.org.uk. The practice sent to us an action plan detailing what they would do to meet the legal requirements in relation to the following:-

• Ensuring that all significant events are fully recorded centrally at the practice to ensure a comprehensive audit trail is maintained.

• Ensuring that clearly defined and embedded systems, processes and practices are in place to keep patients safe and safeguarded from abuse. Ensure that staff who are chaperones receive appropriate training.

• Ensuring all staff receive safeguarding training appropriate to their role.

• Ensuring that an assessment of cleanliness is regularly completed, and that cleaning undertaken is recorded and monitored, including that curtains and carpets are regularly cleaned. Ensure that actions from infection control audits are completed and recorded.

• Ensuring the security and tracking of blank prescription forms at all times.

• Ensuring that patients prescribed with high risk medicines are regularly monitored.

• Ensuring that all Patient Specific Directions are recorded and completed correctly, in line with legislation.

Additionally we found that:

The practice needed to continue to:

• Improve the pathways for the obtaining and dissemination of relevant and current evidence based guidance and standards, including National Institute for Health and Care Excellence (NICE) best practice guidelines.

• Improve recording processes to ensure that the details of all care plans are retained by the practice to ensure care and treatment is monitored.

• Ensure patients who are carers and who are cared for are pro-actively identified and supported.

This inspection was an announced focused inspection carried out on 2 February 2017 to confirm that the practice had carried out their plan to meet the legal requirements in relation to the breaches in regulations that we identified in our previous inspection on 17 May 2016. This report covers our findings in relation to those requirements and also additional improvements made since our last inspection.

Overall the practice is rated as good.

Our key findings were as follows:

• We found that the practice had a comprehensive database in place to track, monitor and audit all significant events and alerts.

• Since our last inspection staff identified as chaperones had undertaken training in this area. Safeguarding training had been delivered to all staff at appropriate levels.

• Evidence was seen to confirm that curtains and carpets were regularly cleaned.

• We saw evidence that medicine management practices were comprehensive and kept patients safe.
• Care plans were in place and any follow up reviews were clearly recorded within the patient’s records.
• Systems were in place to monitor and identify carers and their support needs. The practice had identified 156 carers and increase of 13 since our last inspection which is approximately 1.7% of the patient list.
• The practice had developed systems to make NICE guidelines and best practice information more accessible. The practice had links on their computers to access these guidelines and the clinical commissioning group (CCG) clinical guidance pages.

Professor Steve Field (CBE FRCP FFPH FRCGP) 

Chief Inspector of General Practice

Updated 15 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.
• The percentage of patients with diabetes who had a record of a foot examination and risk classification within the preceding 12 months was 91% compared with a national average of 88%.
• 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.
• The practice offered a range of services to people with long term conditions. This included clinics for diabetes, asthma and hypertension.

Updated 15 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. The practice had a policy to notify the child health services if a child repeatedly missed their immunisation appointments.
• 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 87%, which was slightly above the CCG average of 83% and the national average of 82%.
• Appointments were available outside of school hours and the premises were suitable for children and babies.

Updated 15 August 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.

Updated 15 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.
• 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 was proactive in offering online services including booking/cancelling appointments and an electronic prescribing service.

Updated 15 August 2016

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

• Data from the Quality and Outcomes Framework (QOF) showed results were better than national averages for this population group. For example the percentage of patients diagnosed with dementia whose care had been reviewed in the preceding 12 months was 92% which was better than 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 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 15 August 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.