Coastal Medical Partnership

Updated 20 September 2016

The Arnewood Practice, also known as Milton Medical Centre, is located in a purpose built building at Avenue Road, New Milton, Hampshire, BH25 5JP. The practice is based near the town centre of New Milton, on the western edge of The New Forest. The practice has approximately 13,300 registered patients.

The practice provides services under a NHS General Medical Services contract and is part of NHS West Hampshire Clinical Commissioning Group (CCG). The practice is based in an area of low deprivation compared to the national average for England. A total of 5% of patients are over 85 years of age which is higher than the national average of 2% and CCG average of 3%. A total of 57% of patients at the practice have a long-standing health condition, which is slightly higher than the CCG average of 55% and national average of 54%. Less than 1% of the practice population describe themselves as being from an ethnic minority group; the majority of the population are White British.

The practice has eight GP partners, three of whom are female and five are male. The practice also employs four female salaried GPs. Together the GPs provide care equivalent to approximately 70 sessions per week or just over eight whole time equivalent GPs. The GPs are supported by an advanced nurse practitioner, three practice nurses and three health care assistants who provide a range of treatments. All of the nursing team are female and together provide care equivalent to just under four whole time nurses. The practice also employs a phlebotomist. The clinical team are supported by a management team with secretarial and administrative staff. The practice is a training practice for doctors training to be GPs (registrars) and a teaching practice for medical and nursing students. At the time of our inspection the practice were supporting four doctors training to be GPs.

The Arnewood Practice is open between 8am and 6.30pm Monday to Friday. The practice closes every Tuesday between 1pm and 2pm for staff training; however the phone lines remain open. Extended hours surgeries are available every Monday morning from 7.30am, Monday evenings until 8pm and every other Saturday of the month from 8.30am until 12pm. Appointments with a GP are available until 12.30 pm and again from 2pm until 6pm daily. The GPs also offer home visits to patients who need them. Care to patients is provided on the ground and first floor of the building. The practice has a lift to support patients who are unable to manage stairs.

The practice provides out-of-hours services to their patients from 8am- 8pm each day of the week as part of an agreement with six other local GP practices. Patients requiring care outside of 8am-8pm were referred to the NHS 111 service. The practice offers online facilities for booking of appointments and for requesting prescriptions. The practice also offered an online GP consultation service. Using a link on the practice website, patients were able to answer questions about their concern. The details were then emailed to a GP who contacted patients by the end of the next working day.

We visited The Arnewood Practice as part of this inspection, which has not previously been inspected by the Care Quality Commission.

Updated 20 September 2016

Letter from the Chief Inspector of General Practice

We carried out an announced comprehensive inspection at The Arnewood Practice on 12 July 2016. Overall the practice is rated as good.

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

• There was an open and transparent approach to safety and an effective system in place for reporting and recording significant events. All opportunities for learning from internal and external incidents were maximised.
• Risks to patients were assessed and 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.
• The practice achieved consistently positive patient feedback. The most recent national GP survey results were consistently above local and national averages for patient satisfaction.
• Information about services and how to complain was available and easy to understand. Improvements were made to the quality of care as a result of complaints and concerns.
• Patients said they found it easy to make an appointment 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.
• The practice worked closely with other organisations and with the local community in planning how services were provided to ensure that they meet patients’ needs. For example, the practice worked with local schools to secure a health and well-being worker for school-aged children.
• The practice had strong and visible clinical and managerial leadership and governance arrangements and staff felt supported by management. The practice proactively sought feedback from staff and patients, which it acted on.
• The provider was aware of and complied with the requirements of the duty of candour.

We saw areas of outstanding practice:

• The practice led a collaboration of six other local practices to offer a seven day GP service to patients. Patients registered at one of these practices could access urgent and routine GP appointments and other primary care services at a local community hospital every day from 8am until 8pm. The practices shared the same computer system with the hospital and could easily share care plans and urgent communication. We saw feedback from patients who valued the additional choice and availability of appointments of this service.
• The practice had exemplary systems in place to keep patients safe and safeguard them from abuse. For example, the practice conducted frequent safeguarding audits and implemented changes to improve practice when identified.

Professor Steve Field (CBE FRCP FFPH FRCGP) 

Chief Inspector of General Practice

Updated 20 September 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.
• 89% of patients with diabetes had an acceptable blood pressure reading in 2014-2015 compared to a CCG average of 80% and national average of 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.

Updated 20 September 2016

The practice is rated as outstanding 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.
• 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.
• 83% of eligible women received a cervical smear in the preceding five years, which is similar to the national average of 82%.
• Appointments were available outside of school hours and the premises were suitable for children and babies.
• The practice actively engaged with schools in its local community to improve the health and well-being of children. The practice takes part in an annual health week in a local primary school to provide health education and advice.
• Staff acted appropriately and maintained a high level of vigilance for safeguarding concerns.

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

Updated 20 September 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.
• Performance for conditions common in older people was better than national averages. For example, 100% of patients with atrial fibrillation (an irregular heart beat) were prescribed appropriate medicines, compared to the National and clinical commissioning group average of 98%.

Updated 20 September 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.

Updated 20 September 2016

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

• 82% of patients diagnosed with dementia who had their care reviewed in a face to face meeting in the last 12 months, which is similar to the national and CCG average of 84%.
• 91% of patients with schizophrenia, bipolar affective disorder and other psychoses had an agreed care plan recorded, which is similar to the national average of 89%.
• 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.
• 93% of patients with poor mental health received an annual health check.
• 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 20 September 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 those with a learning disability.
• The practice offered longer appointments for patients with a learning disability.
• 67% of patients with a learning disability received an annual physical health check.
• 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.