The Lighthouse Medical Practice

Updated 22 August 2016

The Lighthouse Medical Practice is a surgery offering general medical services to the population of Eastbourne. There are approximately 14,900 registered patients. The practice has a branch surgery which we did not inspect as part of this inspection process.

The Lighthouse Medical Practice is run by eleven partners made up of GPs and a business partner who is also the practice manager. The partners were supported by two salaried GPs. There are five female and seven male GPs. The GPs hours add up to 10.5 full time equivalent GPs. The senior partner and practice manager who is also the business manager and a partner form an executive team that takes decisions on behalf of the partners when necessary. The practice also employs five practice nurses, three healthcare assistants (HCAs), a phlebotomist, three operations managers and a team of administrative / reception staff.

The practice is a teaching practice for GP registrars (doctors training to be GPs) and four of the partners have been or are GP trainers.

The practice runs a number of services for its patients including asthma and chronic obstructive pulmonary disease (COPD) clinics,diabetes clinics, new patient checks, microsuction and ear syringing, sexual health clinics including coils and implants, smoking cessation advice and treatment and holiday vaccinations and advice.

Services are provided from two locations:

College Road Surgery

6 College Road

Eastbourne

BN21 4HY

And a branch surgery located at:

Ian Gow Memorial Health Centre

Milfoil Drive

Langney

Eastbourne

BN23 8BR

We did not inspect the branch surgery during this inspection.

The surgery at College Road is a converted building which further significant refurbishment in 2012. This included three additional consulting rooms and a lift. The building is owned by the partners. The Ian Gow site in Langney is managed by the NHS Property Services.

The practice is open between 8am and 6pm Monday to Friday. Appointments for GPs at both sites are available from 8.15am to 11.30am (normal surgery) or 11.50am (duty doctor surgery) every morning and 3pm to 5pm (normal surgery) or 5.25pm (duty doctor surgery) in the afternoon. In addition extra urgent appointments are also available. The nursing team offer appointments from 8.15am -12.30pm and from 1pm to 5.30pm. Extended hours appointments are offered at both sites on alternate weeks on Monday evenings from 6.30pm to 8.15pm and one Saturday a month from 8am to 9.30am again on alternate sites. Extended hour surgeries are available for GPs, nurses and HCAs and are pre-bookable. In addition to pre-bookable appointments that could be booked up to four weeks in advance, urgent appointments are also available for people that needed them.

The demographics of the populations across the two surgery catchment areas are quite different. College Road has an elderly population larger than the national average whereas Ian Gow has a younger population and is based in a local government ward with the highest percentage of population aged 19 years and under in East Sussex. The practice population for the Ian Gow surgery is classed as deprived with a large percentage of families unemployed and living on benefits.

The practice population has a higher number of patients over 65 years of age (26.8%) than the national average (17.1%). It also shows a slightly lower number of patients under 18 years (19.3%) than the national average (20.7%). There is a higher than average percentage of patients with a long standing health condition (80%, national average 54%). The percentage of registered patients suffering deprivation (affecting both adults and children) is just higher than the national average and higher than the local average, but one ward in their catchment area shows significantly higher than average child deprivation.

Updated 22 August 2016

Letter from the Chief Inspector of General Practice

We carried out an announced comprehensive inspection at The Lighthouse Medical Practice on 21 June 2016. Overall the practice is rated as outstanding.

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

• Staff understood and fulfilled their responsibilities to raise concerns and report incidents and near misses and were actively encouraged to do so. All opportunities for learning from internal and external incidents were maximised.

• Risks to patients were constantly assessed and were well managed.

• 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.

• Patients said they found it easy to make an appointment, but not always 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. Information about services and how to complain was available and easy to understand. The practice actively reviewed complaints and how they are managed and responded to, and made improvements as a result. Complaints were discussed at significant events meetings if appropriate and reviewed annually.
• The practice used innovative and proactive methods to improve patient outcomes, working with other local providers to share best practice.

• The practice implemented suggestions for improvements and made changes to the way it delivered services as a consequence of feedback from patients and from the patient forum (patient participation group). For example they had introduced an automated telephone booking system to help improve access to appointments.

• The practice had a clear vision which had quality and safety as its top priority. The strategy to deliver this vision had been produced with stakeholders and was regularly reviewed and discussed with staff.

• The practice had strong and visible clinical and managerial leadership and governance arrangements.

• Feedback from patients about their care was consistently positive.

We saw several areas of outstanding practice:

• External stakeholders such as patients, nursing home staff and members of the wider multi-disciplinary team were invited to attend the section of significant events meetings that they were involved in, ensuring transparency throughout the process.

• Multi-disciplinary team (MDT) meetings included local voluntary support agencies.

• The practice lead GP in information technology (IT) and the practice clinical governance lead had devised a robust system of ‘spiral audit’ whereby areas of clinical activity could be examined, reviewed and acted on on a continuous basis. This was a highly reactive system allowing the practice to immediately input the latest National Institute for Health and Care Excellence (NICE) or Medicines and Health Products Regulatory Agency (MHRA) guidelines and therefore identify and review patients that may be at risk. This meant that patient outcomes were continuously reviewed and improved.

• The practice had identified a high proportion of carers (4.4%) amongst their patients and had both a practice carers’ lead and a patient forum carers’ lead as well as a patients’ lead. They worked together with the practice team to identify and support carers. The practice was pro-active in identifying young carers. An extensive carers’ protocol was available on the website.

• There was a chaplain attached to the practice who could be contacted by people of all and no religion, faith or belief.

• The practice business manager was also the managing partner and as a consequence was committed to driving forward new initiatives.

Professor Steve Field (CBE FRCP FFPH FRCGP) 

Chief Inspector of General Practice

Updated 22 August 2016

The practice is rated as outstanding for the care of people with long-term conditions. The provider was rated as outstanding for safety, responsiveness and for being well-led. The issues identified as outstanding overall affected all patients including this population group.

• Nursing staff had lead roles in chronic disease management and patients at risk of hospital admission were identified as a priority.

• The GPs and nurses held focused clinical meetings looking at specific chronic disease areas to ensure their knowledge and skills were up to date and to discuss specific patients.

• There was a GP clinical lead for each chronic disease area.

• The practice would link clinic appointments for patients with more than one chronic disease so that patients on two disease registers need only attend on one day.

• Annual reviews were carried out during birthday months to help patients remember diary dates and to spread the workload over the year.

• The percentage of patients with diabetes, on the register, in whom the last blood pressure reading (measured in the preceding 12 months) was 140/80 mmHg or less was 79% (CCG 81%, national average 78%)

• 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 had held chronic disease awareness days for patients which included a two day health awareness weekend where a large number of organisations provided healthcare information and support which had been organised by the patient forum.

Updated 22 August 2016

The practice is rated as outstanding for the care of families, children and young people. The provider was rated as outstanding for safety, responsiveness and for being well-led. The issues identified as outstanding overall affected all patients 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 or failed to keep appointments. Immunisation rates were average for all standard childhood immunisations.

• Patients who missed immunisations were followed up to encourage attendance

• The practice informed the local authority protection register team if children who had moved in to the area and were flagged on the notes as having child protection issues did not appear on the local authority protection register within a month.

• All children on the at risk register were identified on the practice’s electronic patient record system.

• All instances where children did not attend appointments were followed up.

• Patients told us that children and young people were treated in an age-appropriate way and were recognised as individuals.

• The percentage of women aged 25-64 whose notes record that a cervical screening test has been performed in the preceding 5 years was 76% (CCG and national averages 82%).

• Appointments were available outside of school hours and the premises were suitable for children and babies.

• Patients were referred to the local Child and Adolescent Mental Health Service (CAMHS) where appropriate.

• The practice and patient forum engaged with young people attending secondary school. They had also devised a questionnaire which included a question specifically about young carers.

• There was a specific page on the practice website which provided advice and information for teenagers.

• They ran an emergency contraception service.

• We saw positive examples of joint working with midwives and health visitors.

Updated 22 August 2016

The practice is rated as outstanding for the care of older people. The provider was rated as outstanding for safety, responsiveness and for being well-led. The issues identified as outstanding overall affected all patients including this population group.

• The practice offered proactive, personalised care to meet the needs of the older people in its population.

• Care plans were offered to patients identified at risk of avoidable hospital admission.

• The practice assisted patients with the development end of life care plans.

• Members of the patients’ forum were available to help and assist older patients at seasonal flu clinics and at busy surgery times. They also helped to identify carers.

• The practice team assessed elderly patients’ needs and offered proactive home visits where required. They also had systems in place to offer urgent reactive home visits during surgery time without disrupting the normal running of the surgery.

• Multi-disciplinary team (MDT) meetings included local voluntary support agencies.

• Priority seating was available in the waiting room.

• A lift had been installed in the College Road site at the partners’ expense to improve access to the first floor for patients with mobility problems.

Updated 22 August 2016

The practice is rated as outstanding for the care of working age people (including those recently retired and students). The provider was rated as outstanding for safety, responsiveness and for being well-led. The issues identified as outstanding overall affected all patients 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. They had been offering them for several years and were an NHS England beacon practice for the provision of online services (a practice identified by NHS England as excelling in a particular discipline and used to support and train other providers). They had made an educational video for NHS England advising practices how to increase patient uptake of online access and services.

• The practice offered extended opening hours that provided GP, practice nurse and health care assistant (including smoking cessation) services for patients who could not attend during normal working hours.

• Individual patient access requirements and preferences could be added to their records.

• Patients could email the GP for advice and their correspondence was answered throughout the day.

• A full range of health promotion and screening that reflects the needs for this age group was offered.

Updated 22 August 2016

The practice is rated as outstanding for the care of people experiencing poor mental health (including people with dementia). The provider was rated as outstanding for safety, responsiveness and for being well-led. The issues identified as outstanding overall affected all patients including this population group.

• 81% of patients diagnosed with dementia who had their care reviewed in a face to face meeting in the last 12 months, which is comparable to the CCG (79%) and national (84%) averages.

• The practice offered dementia training for clinical and non clinical staff. Some staff had been identified as ‘dementia friends’.

• Receptionists called patients who needed reminding about appointments and there were dementia friendly signs on toilet doors.

• The percentage of patients with schizophrenia, bipolar affective disorder and other psychoses who have a comprehensive, agreed care plan documented in the record, in the preceding 12 months was 89% which was comparable to CCG (90%) and national (88%) averages.

• GPs referred patients to a local counselling service. Staff at the practice assisted patients to self refer and they had compiled a list of self-help resources that they offered patients with mental health problems.

• Care plans for patients with a learning disability and dementia included a section where the patient could add their own requests to be included in the plan. (Called patient voice in the care plan).

• The practice regularly worked with multi-disciplinary teams in the case management of patients experiencing poor mental health, including those with dementia. The practice had access to crisis teams and referrals were also made to the locality mental health team.

• The practice provided training to all staff on the specific needs of ethnic minorities in relation to mental health.

• There was a ‘did not attend’ policy to support and help patients those who regularly failed appointments.

• The practice provided training for staff on dealing with suicidal callers.

• 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.

Updated 22 August 2016

The practice is rated as outstanding for the care of people who circumstances may make them vulnerable. The provider was rated as outstanding for safety, responsiveness and for being well-led. The issues identified as outstanding overall affected all patients including this population group.

• The practice held a register of vulnerable patients which included patients with learning difficulties,

• The practice worked closely with local agencies, projects, schools and pharmacies particularly at their Ian Gow site where patients had more difficulties accessing primary care.

• Staff had had training in cultural competency and communicating with different patient groups.

• The practice offered a dedicated service to patients from a local disability accommodation and support centre.

• They had been instrumental in setting up the locality Vulnerable Patient Locally Commissioned Service which involved devising care plans for patients at risk in addition to the two per cent most vulnerable patients in the practice. They had developed a computer template to help administer this and shared it with other practices.

• Patients on the palliative care register (not just those with a diagnosis of cancer), were put on the vulnerable patients list. They had a written care plan which included a preferred place of care and death and any wishes with regard to resuscitation. The information was shared with the ambulance and out of hours services with the patient’s consent.

• The practice had a carers’ lead and a patient forum carers’ lead and they actively worked with local carers’ organisations.

• The practice offered longer appointments for patients with a learning disability. All patients with a learning disability were seen for an annual review The practice used ‘easy read’ formats where appropriate to communicate with these patients.

• The practice regularly worked with other health care and social services professionals in the case management of vulnerable patients.

• The practice informed vulnerable patients about how to access various support groups and voluntary organisations.

• There was a fortnightly welfare benefits drop in clinic at the Ian Gow surgery. A number of GPs and staff had had welfare benefits training.

• 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.