Royal South Hants Hospital

Updated 5 October 2016

Royal South Hants Hospital is registered with the CQC to offer services which include a GP practice. We inspected only the GP practice as part of this inspection.The practice is known by staff and patients as Nicholstown Surgery. Solent NHS Trust are responsible for the practice.

Solent NHS Trust manages three GP practices called Nicholstown, Adelaide and Portswood Surgeries. Each practice has to opperate within the management structure of the trust.

Nicholstown Surgery was the first of the three GP practices to open in 2006 and operated out of a portababin. The practice has now expanded its patient list size now operates as a service run within the hospital.

Nicholstown Surgery is located at Fanshaw Wing, Royal South Hants Hospital, Brintons Terrace, Southampton, SO14 0YG.

The practice is located within the main hospital. There is a main reception and waiting room with the treatment and consultation rooms located in a corridor off of the main reception. The practice is wheelchair accessible and located on the ground floor.

The practice provides services to 5,500 patients. The GP service is provisioned directly by NHS England on a five yearly basis. The practice is culturally diverse with only 12% of its patients registered as White British in ethnicity. The practice has a high patient turnover rate with a turnover of 45% in 2015; this is due to a transient population which includes patients of no fixed abode. The practice is located in one of the most deprived areas compared to the average in England. 22% of the practices registered patients are under 18 years old.

There is currently two male and three female salaried GPs. There is a nursing team consisting of two advanced nurse practitioners, two practice nurses, and three health care assistants. The practice supports student nurses in training.

The practice is supported by a practice manager, receptionists and administration staff.

The practice offers 15 minute appointments to all patients as standard and is open between 8am and 6.30pm Monday to Friday. Extended hours appointments are offered on Tuesday evenings until 8pm.

Patients are directed to use the NHS 111 system when the practice is closed. This is Royal South Hants first inspection.

Updated 5 October 2016

Letter from the Chief Inspector of General Practice

We carried out an announced comprehensive inspection of the GP service provided by Royal Hants Hospital known as and referred to in this report as Nicholstown Surgery on 22 June 2016. Overall the practice is rated as requires improvement.

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.
• Risks to patients were assessed and managed with the exception of managing expiry dates of equipment and medicine in the GPs bag; monitoring and security of prescription forms and pads and ensuring regular fire drills took place.
• 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.
• Staff tailored care for patients with diabetes particularly for those who identified themselves as Muslim. This included visiting local mosques to educate patients on the importance of a healthy diet. Nurses worked with diabetic Muslim patients to tailor their treatment plans during the month of Ramadan, a religious festival whereby individuals fast for a month during daylight hours.
• Patients said they found it difficult to make an appointment with a named GP. Urgent appointments were available the same day.
• Patients reported difficulties in making an appointment via the telephone. The system currently cuts off patients after 6 minutes of being on hold.
• The practice created links with local organisations to help provide additional support for patients in the community particularly for young Muslims with Type 2 diabetes.
• 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.

The areas where the provider must make improvements are:

• Ensure that there is a robust review of all medicines management at the practice including checking the expiry dates of medicines and calibration of equipment stored within the GP bag.
• Ensure the practice follows guidelines set out by the Solent NHS Trust particularly around actioning learning points from significant events around monitoring prescription forms security.
• Ensure all staff required to undertake chaperoning duties have received training, this includes for non-clinical staff.

Professor Steve Field CBE FRCP FFPH FRCGP 

Chief Inspector of General Practice

Updated 5 October 2016

The six population groups and what we found The practice is rated as requires improvement for the care of people with long-term conditions. The provider was rated as requires improvement for safety and for well-led and good for effective, caring and responsive. The issues identified as requiring improvement overall affected all patients including this population group. There were, however, examples of good practice.

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

• For example, the percentage of patients with diabetes, on the register, in whom the last average blood sugar test was acceptable, was 82% in comparison to the Clinical Commissioning Group average of 76% and national average of 79%.

• The practice had a high population of Muslim patients.The practice worked with local Imams to help educate Muslim patients with diabetes on the importance of looking after their health.

• 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 5 October 2016

The practice is rated as requires improvement for the care of families, children and young people. The provider was rated as requires improvement for safety and for well-led and good for effective, caring and responsive. The issues identified as requiring improvement overall affected all patients including this population group. There were, however, examples of good practice.

• 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.
• 22% of the practice population was aged under 18.
• The percentage of female patients aged 25-64 with a record of having a cervical screening test was 66% which is lower than the Clinical Commissioning Group average of 73% and national average of 78%.
• 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 5 October 2016

The practice is rated as requires improvement for the care of older people. The provider was rated as requires improvement for safety and for well-led and good for effective, caring and responsive. The issues identified as requiring improvement overall affected all patients including this population group. There were, however, examples of good practice.

• 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.

• Nationally reported data showed that outcomes for patients for conditions commonly found in older patients were mixed.

Updated 5 October 2016

The practice is rated as requires improvement for the care of working-age people (including those recently retired and students). The provider was rated as requires improvement for safety and for well-led and good for effective, caring and responsive. The issues identified as requiring improvement overall affected all patients including this population group. There were, however, examples of good practice.

• 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 5 October 2016

The practice is rated as requires improvement for the care of people experiencing poor mental health (including people living with dementia). The provider was rated as requires improvement for safety and for well-led and good for effective, caring and responsive. The issues identified as requiring improvement overall affected all patients including this population group. There were, however, examples of good practice.

• 73% 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 national average.
• The percentage of patients with schizophrenia, bipolar affective disorder and other psychoses who had a documented agreed care plan was 78% in comparison to the CCG average of 75% and the national average of 77%
• 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.

Updated 5 October 2016

The practice is rated as requires improvement for the care of people whose circumstances may make them vulnerable. The provider was rated as requires improvement for safety and for well-led and good for effective, caring and responsive. The issues identified as requiring improvement overall affected all patients including this population group. There were, however, examples of good practice.

• 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.
• 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.