Holbrook Surgery

Updated 17 January 2017

Holbrook Surgery is practice offering general medical services to the population of Horsham and surrounding areas in West Sussex. There are approximately 15,245 registered patients.

The practice population has a higher number of patients between 40-59 years of age than the national and local CCG average. The practice population also shows a lower number of patients between the age of 70-85 plus year olds than the national and local CCG average. There are a lower number of patients with a longstanding health condition. The percentage of registered patients suffering deprivation (affecting both adults and children) is lower than the average for both the CCG area and England.

Holbrook Surgery is run by six partner GPs (Three male and three female). The practice is also supported by two female salaried GPs; three practice nurses (plus two on an active bank list), one healthcare assistant, a team of administrative and reception staff, and a practice manager.

The practice runs a number of services for its patients including asthma clinics, diabetes clinics, coronary heart disease clinics, minor surgery, child immunisation clinics, new patient checks and travel vaccines and advice.

Services are provided from one location:

Holbrook surgery

Bartholomew Way

Horsham

West Sussex

RH12 5JL

Opening hours are Monday to Friday 8am to 6.30pm Monday, Thursday and Friday and 8am to 8pm on Tuesday and Wednesday.

During the times when the practice is closed arrangements are in place for patients to access care from IC24 which is an Out of Hours provider.

Updated 17 January 2017

Letter from the Chief Inspector of General Practice

We carried out an announced comprehensive inspection of this practice on 6 July 2016. Breaches of Regulatory requirements were found during that inspection within the safe and effective domains. After the comprehensive inspection, the practice sent us an action plan detailing what they would do to meet the regulatory responsibilities in relation to the following:

• Ensure fire drills are carried out in line with national guidelines.
• Ensure infection control systems are robust and the infection control audit action plan is fully implemented.
• Ensure that a system is put in place to monitor hand written and computer printed prescription pads and forms.
• Ensure medicines were stored securely.
• Ensure staff with unsupervised access to patients had undertaken a disclosure and barring service (DBS) check and the practice has a policy in place to set out how DBS are used and risk assessed in the practice.
• Ensure staff recruitment records contain the information as set out by regulation.
• Ensure written consent is obtained for minor surgery.

We undertook this focused inspection on 15 December 2016 to check that the provider had followed their action plan and to confirm that they now met regulatory requirements.

This report only covers our findings in relation to those requirements. You can read the report from our last comprehensive inspection, by selecting the 'all reports' link for Holbrook Surgery on our website at www.cqc.org.uk.

This report should be read in conjunction with the last report published in September 2016.

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

• We saw evidence to confirm that fire drills had been undertaken.
• The infection control audit had been updated and the action plan completed. Systems were in place to demonstrate regular monitoring and testing of the hot water system following a legionella risk assessment.
• We saw evidence to demonstrate that the practice had a system for monitoring both hand written and computer generated prescriptions.
• The medicines fridges were locked and medicines stored securely.
• The practice had introduced a system of risk assessment to determine if staff required a DBS check. We saw evidence to demonstrate these checks were undertaken were needed.
• Recruitment records contained the information required by regulation.
• The practice minor surgery policy had been updated and consent was sought and recorded in line with national guidance.

Professor Steve Field (CBE FRCP FFPH FRCGP) 

Chief Inspector of General Practice

Updated 17 January 2017

The practice was rated as good for the care of people with long-term conditions on 6 July 2016. This rating has now changed to good.

• Nursing staff had lead roles in chronic disease management and patients at risk of hospital admission were identified as a priority.
• Performance for diabetes related indicators was better than the national average. For example, the percentage of patients with diabetes, on the register, in whom the last blood pressure reading (measured in the preceding 12 months) is 140/80 mmHg or less was 84% compared to the CCG 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 17 January 2017

The practice was rated as good for the care of families, children and young people on 6 July 2016. This rating has now changed to good.

• 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.

• The practice’s uptake for the cervical screening programme was 84%, which was the same as the CCG average of 84%, the national average was 82%.

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

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

Updated 17 January 2017

The practice was rated as requires improvement for the care of older people on 6 July 2016. This rating has now changed to good.

• 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.
• The practice had regular meetings with the Proactive care team to help avoid admissions. The practice provided an enhanced service for unplanned admissions – a register of the most vulnerable patients - with care plans and reviews following any unplanned hospital admissions.
• Partners had provided their personal contact details for patients receiving palliative care to ensure they have access to a practice GP at weekends and evenings.

Updated 17 January 2017

The practice was rated as good for the care of working-age people (including those recently retired and students) on 6 July 2016. This rating has now changed to good.

• 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 17 January 2017

The practice was rated as good for the care of people experiencing poor mental health (including people with dementia) on 6 July 2016. This rating has now changed to good.

• 92% of patients diagnosed with dementia had had their care reviewed in a face to face meeting in the last 12 months, which was better than the national average.
• Performance for mental health related indicators was better than the CCG and national average. For example, 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 96% compared to the CCG average of 92% and national average of 88%.
• 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 17 January 2017

The practice was rated as good for the care of people whose circumstances may make them vulnerable on 6 July 2016. This rating has now changed to good.

• 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.