Archived: New Larchwood Surgery

Updated 28 May 2015

New Larchwood Surgery is a purpose built GP surgery situated in the New Larchwood supported living complex, in the heart of the Coldean area of Brighton and Hove. The practice provides general medical services for approximately 1200 registered patients within the Coldean area. This includes the student halls of residence of Varley Hall and residents living in the New Larchwood complex.

The practice delivers services to a higher number of patients who are aged 65 years and over, when compared with the local clinical commissioning group (CCG) and England average. Care is provided to patients living in local residential and nursing homes and to residents living in the supported housing facility within which the practice is situated.

The practice describes itself as a nurse practitioner-led service with sessional input provided by GPs during the week. Care and treatment is delivered by an advanced nurse practitioner and three GP partners who are based at an associated practice, Carden Surgery. The nurse practitioner provides services only from New Larchwood Surgery. One of the GPs is female and two are male.

Patients are also supported by a practice nurse and reception and administration staff. The management of the practice is provided by the GP partners and the practice manager. They are based at Carden Surgery, for a proportion of each week. Some members of staff, such as the practice nurse, work at both Carden Surgery and New Larchwood Surgery.

This practice was inspected in May 2014 and we identified improvements were needed in relation to a number of areas. These included staff recruitment processes, supervision and appraisal of staff, assessment and monitoring of risks, reporting and learning from incidents and the availability of safety equipment within the practice. We inspected the practice on 28 January 2015 to check whether improvements had been made.

Services are provided from Waldron Avenue, Coldean, Brighton BN1 9EZ.

The practice has opted out of providing out of hours services to its own patients and uses the services of a local out of hours service.

Updated 28 May 2015

Letter from the Chief Inspector of General Practice

We carried out an announced comprehensive inspection of New Larchwood Surgery on 28 January 2015. We visited the practice location at Waldron Avenue, Coldean, Brighton BN1 9EZ.

Overall the practice is rated as good. Specifically, we found the practice to be good for providing safe, effective, caring, responsive and well-led services. It was also good for providing services for older people, people with long-term conditions, families, children and young people, working age people (including those recently retired and students), people whose circumstances may make them vulnerable and people experiencing poor mental health (including people with dementia).

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. The practice was committed to providing high quality patient care and patients told us they felt the practice was caring and responsive to their needs.

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

Our key findings were as follows:

• Patients’ needs were assessed and care was planned and delivered following best practice guidance.
• Staff had received training appropriate to their roles and any further training needs had been identified and planned.
• Patients said they were treated with compassion, dignity and respect and they were involved in care and decisions about their treatment.
• The practice engaged effectively with other services to ensure continuity of care for patients.
• The practice understood the needs of the local population and planned services to meet those needs.
• The practice was located within shared premises which provided a focal point for the wellbeing of the local community in tackling social isolation. A community café, hairdressing salon, art club and reading club were located within the same premises.
• Although the practice was open for a limited number of hours each day, patients reported good access to appointments.
• The practice had improved arrangements to ensure patients were able to access advice and urgent appointments when they were closed, at their associated practice, Carden Surgery.

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

The provider should:

• Ensure continued development of a virtual patient representation group (VPRG) to further enhance the use of patient feedback to promote continuous improvement.

Professor Steve Field (CBE FRCP FFPH FRCGP) 

Chief Inspector of General Practice

Updated 28 May 2015

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. Care plans had been introduced to minimise the risk of unplanned hospital admissions. Longer appointments and home visits were available when needed. All of 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. One GP within the practice had recently undergone training in the management of patients with Human Immunodeficiency Virus (HIV) and had introduced enhanced care planning to provide improved support to these patients.

Updated 28 May 2015

The practice is rated as good 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. Practice staff had received training in the safeguarding of children relevant to their role. All staff were aware of child safeguarding procedures and how to respond if they suspected abuse. 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. Appointments were available outside of school hours and the premises were suitable for children and babies. We saw good examples of joint working with midwives and health visitors. Midwifery services were available to patients at nearby Carden Surgery. Staff within the practice had recently received updated training in providing contraceptive services.

Updated 28 May 2015

The practice is rated as good for the care of older people. Nationally reported data showed that outcomes for patients were good for conditions commonly found in older people. The practice offered proactive, personalised care to meet the needs of the older people in its population and had a range of enhanced services, for example, in dementia and end of life care. It was responsive to the needs of older people, and offered home visits and rapid access appointments for those with enhanced needs. All patients over the age of 75 years had a named GP. The practice ensured early referral to services for memory assessment.

Updated 28 May 2015

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 offered extended hours by opening early three mornings each week to meet the needs of people who worked during the day. The practice was proactive in offering online services as well as a full range of health promotion and screening that reflected the needs for this age group. Health checks were available to all new patients registering with the practice. NHS health checks were available to all patients aged from 45-74 years. The practice provided support to large numbers of university students and worked closely with the university to meet the needs of this group of patients.

Updated 28 May 2015

The practice is rated as good for the care of people experiencing poor mental health (including people with dementia). People experiencing poor mental health had received an annual physical health check. 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 identified a lead GP for the management of patients with dementia. It carried out care planning for patients with poor mental health such as dementia and learning disabilities. The practice used support tools to enhance the care of these patients, for example by providing picture books to patients with learning disabilities to assist in explaining treatments. The practice undertook dementia screening of patients and ensured early referral to memory assessment services.

The practice had provided information to patients experiencing poor mental health about how to access various support groups and voluntary organisations. A mental health charity provided support to patients from the practice on one day per week. Staff had received training on how to care for people with mental health needs and dementia. Longer appointments were available to patients if required.

Updated 28 May 2015

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. It had carried out annual health checks for people with a learning disability. Longer appointments were available to patients where needed, for example when a carer was required to attend with a patient. The practice regularly worked with multi-disciplinary teams in the case management of vulnerable people. The practice had identified those vulnerable patients requiring support to minimise the risk of accident and emergency attendance and unplanned hospital admissions. Care planning was in place to support those patients. GPs were able to make urgent referrals to a community rapid response team for those vulnerable patients requiring urgent support. Patients receiving palliative care were supported by regular multidisciplinary team reviews of their care needs. The practice worked closely with a community pharmacist to ensure patients received delivery of medication to their homes where needed. 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.