Archived: Heene Road Surgery

Updated 26 November 2015

Heene Road Surgery offers general medical services to people living in Worthing. There are approximately 5839 registered patients.

The practice is registered as a partnership with three GP partners. Currently only one of these partners now works at the practice supported by locum GPs, two nurses, a healthcare assistant, a phlebotomist and a team of receptionists and administration staff. Operational management was provided by two practice managers.

The practice runs a number of services for its patients including asthma clinics, child immunisation clinics, diabetes clinics, new patient checks, and weight management support.

The practice has opted out of providing Out of Hours services to their patients. There are arrangements for patients to access care from an Out of Hours provider.

Updated 26 November 2015

Letter from the Chief Inspector of General Practice

We carried out an unannounced comprehensive inspection of Heene Road Surgery on 15 September 2015. Overall the practice is rated as requires improvement.

Specifically, we found the practice to require improvement in being well-led and for providing safe, responsive and effective services. It was good for providing a caring service.

The Heene Road Surgery provides primary medical services to people living in Worthing. At the time of our inspection there were approximately 5839 patients registered at the practice. The partnership consists of three registered GPs. However only one GP was working at the practice at the time of our inspection and we were informed that two of the partners have recently left the practice. The practice was using locum GPs to cover the shortfall and was also being supported by another practice in the area. The practice was also supported by a team of nurses, healthcare assistants, reception and administrative staff.

The inspection team spoke with staff and patients and reviewed policies and procedures. The practice understood the needs of the local population and engaged effectively with other services. There was a culture of openness and transparency within the practice however staff told us they did not always feel supported. The practice was committed to providing high quality patient care and patients told us they felt the practice was caring.

Our key findings were as follows:

• Staff understood and fulfilled their responsibilities to raise concerns, and to report incidents and near misses. Information about safety was recorded, monitored, appropriately reviewed and addressed.
• Infection control audits and cleaning schedules were in place and the practice was seen to be clean and tidy.
• Patients’ needs were assessed and care was planned and delivered following best practice guidance.
• Staff had received training appropriate to their roles. However the systems for monitoring training were inconsistent in their implementation and lacked detail.
• Patients said they were treated with compassion, dignity and respect and they were involved in their care and decisions about their treatment.
• The practice had good facilities and was equipped to treat patients and meet their needs.
• Whilst there was a leadership structure this was depleted by recent changes of staff and staff had not always felt supported by the practice management.
• The practice had the appropriate equipment, medicines and procedures to manage foreseeable patient emergencies.
• Patients were generally unsatisfied with the appointments system. They confirmed that they found it difficult to see a doctor on the same day if they needed to. The feedback we received on the day of our inspection and the national data we reviewed showed that the practice was struggling to meet patient appointment needs. The system that was in place failed to address the practice and patient needs.
• The practice, with assistance from another local primary care provider was in the process of responding to concerns from patients about not being able to get appointments at a time that suited them.
• The practice had systems to keep patients safe including safeguarding procedures and means of sharing information in relation to patients who were vulnerable. However staff were not always clear on who the safeguarding lead was in the practice due to changes in staffing.

• The practice had not proactively sought feedback from staff and patients, to improve the service.

• Whilst significant events and complaints were discussed at practice management meetings there was no evidence that the practice had learned from these incidents as there were no follow up reviews undertaken.
• The practice was significantly behind in meeting the total number of annual health checks for patients with a learning disability and the nurse we spoke with estimated they had over 50% still to complete.

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

The areas where the provider must make improvements are;

• Ensure systems are put in place to demonstrate that the practice learns from and disseminate information related to risk, complaints and incidents.
• Ensure the proposed improvements to patient access to appointments is implemented and maintained.
• Ensure that plans are developed for a Patient Participation Group and that other ways are developed of gathering feedback from patients including hard to reach patients and groups.
• Ensure progress against plans to improve the quality and safety of services are monitored, and take appropriate action without delay where progress is not achieved as expected.
• Develop plans to implement and record regular multidisciplinary meetings, practice and clinical meetings.
• Improve the recording and management of staff training records.

Professor Steve Field (CBE FRCP FFPH FRCGP) 

Chief Inspector of General Practice

Updated 26 November 2015

The practice was rated as requires improvement for providing safe, effective, responsive and well-led services. The concerns which led to these ratings apply to everyone using the practice, including this population group. The practice nurse had a lead role and was trained in chronic disease management, including asthma and COPD. We viewed plans for additional training for clinical staff in diabetes management. Patients at risk of hospital admission were identified as a priority and longer appointments and home visits were available when needed. All these patients had a named GP and a structured annual review to check that their health and medication needs were being met. For those people with the most complex needs, the named GP worked with relevant health and care professionals to deliver a multidisciplinary package of care.

Updated 26 November 2015

The practice was rated as requires improvement for providing safe, effective, responsive and well-led services.The concerns which led to these ratings apply to everyone using the practice, including this population group.

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 would be flagged on the electronic system. Immunisation rates were relatively high (90%) for all standard childhood immunisations. Appointments were available outside of school hours and the premises were suitable for children and babies. Safeguarding policies and procedures were readily available for staff and the appropriate processes to follow were clearly visible on notice boards in staff areas.

Updated 26 November 2015

The practice is rated as requires improvement for the care of older people. The practice was rated as requires improvement for providing safe, effective, responsive and well-led services. The concerns which led to these ratings apply to everyone using the practice, including this population group. Nationally reported data showed that outcomes for patients were good for conditions commonly found in older people. The practice offered continuity of care with a named GP. Elderly patients with complex care needs and those at risk of hospital admission all had personalised care plans that were shared with local organisations to facilitate the continuity of care. The practice was responsive to the needs of older people, and offered home visits. The practice supported residents within local residential and nursing homes.

Updated 26 November 2015

The practice was rated as requires improvement for providing safe, effective, responsive and well-led services.The concerns which led to these ratings apply to everyone using the practice, including this population group.

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 opened longer on Monday evenings to allow for evening appointments.

Updated 26 November 2015

The practice was rated as requires improvement for providing safe, effective, responsive and well-led services.The concerns which led to these ratings apply to everyone using the practice, including this population group.

Patients at risk of dementia and those with dementia were flagged on the practice computer system and had an annual review. We saw that 81% of dementia reviews had been carried out. The practice regularly worked with multi-disciplinary teams in the case management of people experiencing poor mental health, including those 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 (A&E) where they may have been experiencing poor mental health. Staff had received training on how to care for people with mental health needs and dementia.

Updated 26 November 2015

The practice was rated as requires improvement for providing safe, effective, responsive and well-led services.The concerns which led to these ratings apply to everyone using the practice, including this population group.

The practice held a register of patients living in vulnerable circumstances including patients with a learning disability. The practice offered longer appointments for people with a learning disability. The practice regularly worked with multi-disciplinary teams in the case management of vulnerable people. It had told 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 H ours.