Archived: Northbourne Surgery

Updated 16 February 2017

Northbourne Surgery is located at 1368 Wimborne Road, Bournemouth, Dorset BH10 7AR. The practice is located in a residential area of north Bournemouth. Northbourne Surgery is part of the Dorset Clinical Commissioning Group. The practice operates from a building which is owned by the GP partners. The practice building has five consulting rooms and two treatment rooms. A physiotherapist and a local counselling service also use the building.

The practice has two male GP partners and use locum GPs when needed. At the time of our inspection the practice was further supported by a GP registrar. Support is also provided by a locum advanced nurse practitioner, two practice nurses and a health care assistant. The practice is further supported by a practice manager, reception and administrative staff.

Northbourne Surgery is a training practice and has trainee GPs supporting the practice and working alongside the partner GPs.

The practice provides a range of primary medical services to approximately 5600 patients and has a general medical services (GMS) contract with NHS England. The GMS contract is the contract between general practices and NHS England for delivering primary care services to local communities.

The practice is open on Monday to Friday between 8am and 6.30pm. Extended hours appointments are available until 8.15pm on Thursdays.

The Care Quality Commission draws on existing national data sources and includes indicators covering a range of GP practice activity and patient experience including the Quality and Outcomes Framework, the National Patient Survey and data from Public Health England. This data shows that the practice provides care and treatment to a higher than average number of patients who are over the age of 65 compared with the average for England. This includes care and treatment to people who are living in a large nursing home and other care homes in the area.

The GPs at this practice have opted out of providing out of hours services to their patients. When the practice is closed out of hours care and treatment is provided by South Western Ambulance Trust. Patients can access this service through the NHS 111 telephone number.

Updated 16 February 2017

Letter from the Chief Inspector of General Practice

We carried out an announced comprehensive inspection at Northbourne Surgery on 18 October 2016. This inspection was undertaken following the period of special measures. Overall the practice is now rated as requires improvement.

Following the inspection in March 2016 the practice was rated as inadequate overall. The practice was inadequate in safe, effective, responsive and well led; and requires improvement in caring. Two warning notices were served which related to the safe care and treatment of patients and good governance of the practice. We carried out an inspection in July 2016 to assess the improvements needed as identified in the warning notices. The Care Quality Commission was satisfied that the areas within the warning notices were addressed adequately.

As part of this inspection in October 2016 we completed a comprehensive inspection and in particular reviewed the areas which did not meet the regulations following our inspection in March 2016 which were:

• There was a lack of systems to ensure there were appropriate staff trained and checked as suitable to act as chaperones.

• Investigation results and other reports were not reviewed and acted upon in a timely way.

• Patients on high risk medicines did not have these reviewed at regular intervals with required blood tests being carried out, to ensure they were being prescribed appropriately.

• Processes for medicines management including handling, administration, storage and prescription did not protect patients from harm.

• Infection control processes and cleaning regimes of equipment and the premises did not protect patients form harm.

• Checks and storage of emergency equipment and medicines were not effective and placed patients at risk of harm.

• There was a lack of formal governance arrangements including systems for assessing and monitoring risks and the quality of the service provision. This placed patients and others at risk of harm. This included managing significant events, incidents and near misses; systematic updating of policies and procedures to ensure they were current and relevant; ensuring there were suitable numbers of staff who were competent to carry on the regulated activities; engaging with staff and patients about how the practice was run; and ensuring the complaints system was accessible for all patients and concerns were responded to in a comprehensive manner.

• Patients were not proactively engaged in their care and treatment and appointments were not tailored to meet patient need.

The key findings from this inspection are:

• Significant input had been made to the running of the practice to make improvements to the governance and safe service for the benefit of patients.

• 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.

• A programme of appraisals had been put in place and appraisals had been carried out for all staff.

• Patients said they were treated with compassion, dignity and respect and they were involved in their care and decisions about their treatment.

• Recruitment processes were in line with the requirements of the regulations and we found all necessary checks had been made and recorded prior to a member of staff commencing employment.

• Emergency equipment and medicines were suitable for use and regular checks were in place.

• The infection control processes were now in place, which included maintaining records and audits of cleaning regimes to ensure patients were protected from harm.

• Governance arrangements had been reviewed and systems and processes were in place for assessing and monitoring risk and the quality of the service provision. These included managing significant events and complaints; reviews of policies and procedures and proactive engagement with staff and patients on the running of the service.

• 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 which it acted on.

• The provider was aware of and complied with the requirements of the duty of candour.

The areas where the provider should make improvement are:

• Continue to make sure the signing in book is completed by all staff or make other arrangements to confirm who is in the building.

• Continue to review patients on an individual basis prior to excepting them, to improve exception reporting rates for the Quality and Outcomes framework and to demonstrate effective care is provided.

• Review the use of patients only lancets, which are used when taking blood for blood sugar levels, and replace with single use items to minimise risk of infection.

• Continue to provide opportunities for patients to provide feedback on service provision.

The full reports published on 5 May 2016 and September 2016 should be read in conjunction with this report.

I am taking this service out of special measures. This recognises the improvements made to the quality of care provided by this service. We will re-inspect the practice within one year.

Professor Steve Field CBE FRCP FFPH FRCGP

Chief Inspector of General Practice

Updated 16 February 2017

The practice is rated as requires improvement for the care of people with long-term conditions. The provider was rated as requires improvement for effective and well led. The issues identified as requiring improvement overall affected all patients including this population group. However, there are areas of good practice:

• 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 average blood sugar was acceptable in the preceding 12 months was 87% compared to the 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 16 February 2017

The practice is rated as requires improvement for the care of families, children and young people. The provider was rated as requires improvement for effective and well led. The issues identified as requiring improvement overall affected all patients including this population group. However, there are areas 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.

• The practice’s uptake for the cervical screening programme was 80%, which was comparable to the national average of 82%. The practice encouraged its patients to attend national screening programmes for bowel and breast cancer screening.

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

Updated 16 February 2017

The practice is rated as requires improvement for the care of older people. The provider was rated as requires improvement for effective and well led. The issues identified as requiring improvement overall affected all patients including this population group. However, there are areas of good practice:

• The practice offered proactive, personalised care to meet the needs of the older patients in its population.

• The practice worked with other health professionals to meet the needs of older patients, such as community nurses.

• The practice was responsive to the needs of older patients, and offered home visits and urgent appointments for those with enhanced needs.

Updated 16 February 2017

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 effective and well led. The issues identified as requiring improvement overall affected all patients including this population group. However, there are areas 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.

• Extended hours appointments were available on Thursday evenings until 8.15pm.

• The practice offered online services as well as a full range of health promotion and screening that reflects the needs for this age group.

Updated 16 February 2017

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 effective and well led. The issues identified as requiring improvement overall affected all patients including this population group. However, there are areas of good practice:

• 74% 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.

• Performance for mental health related indicators was better than the national average. For example the percentage of patients with Schizophrenia, Bipolar Affective Disorder and other psychoses who had a comprehensive agreed care plan documented in their records in the preceding 12 months was 94% compared to the 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 an understanding of how to support patients with mental health needs and those living with dementia.

Updated 16 February 2017

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 effective and well led. The issues identified as requiring improvement overall affected all patients including this population group. However, there are areas of good practice:

• The practice held a register of patients 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.