Centre Practice

Updated 24 August 2016

Centre Practice provides general medical services and is situated in a purpose built health centre in the centre of Fareham, Hampshire.

Centre Practice has approximately 14,600 patients registered with 28% of patients over 65 years of age. Less than 3% of patients come from an ethnic minority background, mostly eastern European families, with the majority of patients identifying themselves as White British. The practice provides primary care for a regional secure psychiatric hospital, a homeless hostel, a bail hostel in addition to 22 nursing and residential homes.

Centre Practice is part of Fareham and Gosport Clinical Commissioning Group and has nine GP partners, three of whom are male and six are female. The practice also supports two GP registrars who are doctors training to become GPs. Altogether, the GPs are equivalent to seven whole time GPs. There is one prescribing nurse practitioner, six practice nurses, three health care assistants and the clinical team is supported by 30 management and administration staff.

This practice is a training practice with registrars who are training to becomes GPs.

Fareham Health Centre is situated next to a large shopping complex, close to transport links and has two entrances. One has a large wide ramp walkway into the health centre, which is shared by community services like podiatry and health visiting.

There is a large public car park nearby and there are additional disabled parking spaces to the rear of the building. The second entrance is via a lift from the car park up into the building, through a door into reception.

The health centre building is managed by NHS property services and was upgraded with new flooring throughout approximately four years ago. This ownership had limited the practice’s ability to install new telephone lines which took longer time than anticipated.

The reception waiting area is bright, airy and large with wipe-clean seats and a lowered desk area for people in wheelchairs and there is a hearing loop. Signage is colour coded and at eye level. There is a children’s play area, children’s chairs, magazines available, disabled toilets, a private room for breast feeding and for patients who wish to talk to reception staff in confidence.

All clinical rooms are found on one floor off a long wide corridor with clear signage.

From the same corridor, there is a suite of four treatment rooms linked together that is used for nurse clinics and for minor surgery.

The practice is open and the reception desk manned between 8am-6.30pm. It has a method of using GPs to triage emergency or same day requests.

The practice has appointments available between 7.30am and 8pm Monday to Friday, as follows:

• 7.30am-8pm Monday, 7.30am-6.30pm Thursday, 8am-6.30pm Tuesday, Wednesday and Friday.
• Once per week until 7.45pm on a Thursday

Every fourth Saturday, the practice provides a clinic for those patients who cannot access at other times between 9am and 12noon.

Patients are encouraged to use the 111 service before 8am and after 6.30pm. There is also a minor injuries unit at Gosport which is advertised on the practice website.

Centre Practice, Fareham Health Centre, Fareham, Hampshire PO16 7ER was inspected on 18 February 2014 and found to be compliant.

The CQC Certificate of registration has not yet been amended in order to reflect changes in partnership.

Updated 24 August 2016

Letter from the Chief Inspector of General Practice

We carried out an announced comprehensive inspection at Centre Practice on 28 April 2016. Overall the practice is rated as good.

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

• We found there was strong staff morale and resilience in the practice, with high levels of team cohesion within the practice team.
• There was an open and transparent approach to safety and an effective system in place for reporting and recording significant events.
• 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.
• 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.
• There was a clear leadership structure 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.
• In April 2016, the practice was successful in achieving ‘dementia friendly’ status. All staff had additional training in recognising and supporting people with dementia and the practice environment was dementia friendly with appropriate signage.

• There was a strong commitment to safety culture in the practice. This came across clearly through staff discussions and in the approach to adopting and championing new initiatives like sign up to safety and investing in infection control training tools.

• The practice supported patients who had no fixed address, by regularly reviewing their care and ensuring they only received weekly prescriptions to help reduce the risk of the patient from medicine or prescription theft.

Professor Steve Field (CBE FRCP FFPH FRCGP) 

Chief Inspector of General Practice

Updated 24 August 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.
• Management plans were provided for patients, for example, for patients with diabetes to encourage better self-care.
• The diabetes nurse initiated and managed insulin therapy, care and education. This included offering appointments on a Saturday four times per year for those people who were unable to attend during the week.
• The percentage of patients with diabetes, on the register, in whom the last HbA1c was acceptable in the preceding 12 months (01/04/2014 to 31/03/2015) was 81%, which is comparable to the local CCG average of 78% and the national average of 78%.

(In people who have been diagnosed with diabetes, the HbA1c test is often used to show how well their diabetes is being controlled)

• 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 24 August 2016

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. 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 79%, which was comparable to the CCG average of 84% and the national average of 82%.
• Appointments were available outside of school hours and the premises were suitable for children and babies.
• We saw documented positive examples of joint working with midwives, health visitors and school nurses. Additional ad hoc meetings occur with health visitors who are based in the same building to discuss family concerns and safeguarding issues.

Updated 24 August 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 patients in its population.
• The practice was responsive to the needs of older patients, and offered home visits and urgent appointments for those with enhanced needs, particularly in the 22 local nursing and residential homes.
• There were monthly meetings to support admission avoidance for older people.
• There were multi-displinary meetings discussing care at the end of life with specialists and district nurses every month.
• Ad hoc meetings occur with the community nurses who are based in the same building. This enables multi-disciplinary working like patient discussions to happen frequently.

Updated 24 August 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.
• The practice was proactive at identifying patients who were military veterans with the aim of expediting any treatment required and making referrals to specialist services like mental health.
• Saturday clinic appointments were available four times per year for patients with diabetes to see the specialist nurse, for those who could not attend during the week, similar to other patients’ access.

Updated 24 August 2016

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

• The practice became accredited as dementia friendly in April 2016.
• 72% of 169 patients diagnosed with dementia had their care reviewed in a face to face meeting in the last 12 months, which is lower than the national average of 84% and the CCG average of 85%.
• The percentage of patients with schizophrenia, bipolar affective disorder and other psychoses who had a comprehensive, agreed care plan documented in the record, in the preceding 12 months (01/04/2014 to 31/03/2015) was 91%, which is comparable to the local CCG average of 90% 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 living with dementia.
• The practice carried out advance care planning for patients living 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 those living with dementia, in residential care and nursing homes.
• The practice provided primary care services to a regional secure psychiatric hospital.
• The practice regularly worked with other health care professionals in the case management of vulnerable patients, particularly those with addiction issues.

Updated 24 August 2016

The practice is rated as outstanding for the care of people whose circumstances may make them vulnerable.

• The practice held a register of patients living in vulnerable circumstances including homeless patients, travellers and those with a learning disability.
• The practice offered longer appointments for patients with a learning disability.
• Practice staff had developed additional skills and experience of caring for vulnerable people because of their links with local care units like a hostel for homeless people and those on bail from prison. For example, the practice had a system that highlighted vulnerable patients who needed to have their identity protected.
• We were told of how GPs have contracts with vulnerable people to help them reduce their reliance on medicines, if that is their wish.
• The practice actively supported particularly vulnerable patients in the local area and the practice was proactive in offering support to victims of domestic abuse.
• 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.