Archived: Heene Road Surgery

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