Archived: Holdenhurst Road Surgery

Updated 19 April 2016

Holdenhurst Road Surgery was inspected on Tuesday 5 April 2016. This was a comprehensive inspection.

The practice is located on the outskirts of Bournemouth town centre, close to the university and shopping centres. The practice serves a patient list of 10,300. Holdenhurst Road Surgery serves a population of high deprivation, high unemployment, higher than average drugs and alcohol problems and a high prevalence of mental health. The practice serve a lower than average population of patients over the age of 55.

The practice is a training practice for doctors who are training to become GPs and for medical students.

There is a team of three GP partners, one male and two female. Partners hold managerial and financial responsibility for running the business. The team are supported by an additional salaried GP, a practice manager and a team of three nursing staff, a health care assistant and additional administration and reception staff.

The practice is open between 8am and 6.30pm Monday to Friday and open until 8.15pm on alternate Tuesday and Wednesdays.

In addition to pre-bookable, urgent appointments are available for patients that need them. These are accessed through the telephone triage system although children under two are seen face to face as a matter of routine.

Patients using the practice also have access to community nurses, midwives and mental health teams. Health visitors were co-located at the practice.

Outside of opening times patients are directed to contact the out of hours service by using the NHS 111 number.

Updated 19 April 2016

Letter from the Chief Inspector of General Practice

We carried out an announced comprehensive inspection at Holdenhurst Road Surgery on Tuesday 5 April 2016. Overall the practice is rated as good.

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

• Data showed that Holdenhurst Road Surgery served a population with high deprivation, high unemployment, higher than average drugs and alcohol problems and a high prevalence of mental health. The practice serviced a lower than average number of patients above the age of 55.

• The practice was well managed and had a clear leadership structure and effective culture of team working.

• There was an open and transparent approach to safety and an effective system in place for reporting and recording significant events. Staff were supported through this process.

• Risks to patients were assessed and well managed.

• Staff assessed patients’ needs and delivered care in line with current evidence based guidance.

• There was a culture of learning and education at the practice. The practice supported medical students and trainee GPs. Staff had the skills, knowledge and experience to deliver effective care and treatment. There was an effective comprehensive induction programme at the practice.

• 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.

• Patients said they found it difficult to make a routine appointment with a named GP but said urgent appointments were available the same day by accessing the telephone triage system. However, patients said getting through on the telephone was frustrating.

• The practice had good facilities and was well equipped to treat patients and meet their needs.

• Communication was effective at the practice 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.

We saw one area of outstanding practice:

The practice had a track record of high achievements in Quality and Outcomes Framework (QOF) performance. For example, last years completed results showed that the practice achieved 557.62 of the 559 points available and this year the practice had achieved 538 of 545 points available. The practice were aware that they had missed points and explained this was down to the transient and non-compliant population groups they care for. The practice had achieved these results despite an experience of sustained increases in patient numbers (750 patients in three years), a 25% annual turnover of patients resulting in approximately 2000 new registrations each year and lower staffing numbers.

The areas where the provider should make improvements are:

• Continue to keep the telephone system under review to ensure patients can access appointments.

• Consider ways to increase the identification of carers within the practice population.

• Consider ways to improve patient satisfaction with access to the service.

Professor Steve Field (CBE FRCP FFPH FRCGP)

Chief Inspector of General Practice

Updated 19 April 2016

The practice is rated as good for the care of patients with long-term conditions.

• Due to the demographics of the practice, many patients had co-morbidities (multiple illnesses) and complex needs.
• There was a robust recall system to ensure that annual reviews were booked.
• Patients could book routine appointments in advance and on-the-day appointments where their needs were particularly complex. Longer appointments were available.
• Appointment slots were embargoed for GPs, so that they could always follow-up a patient in a timely manner as needed.
• Appointments could be booked online.
• The practice nurses had lead roles in chronic disease management.
• 77.94% of patients diagnosed with asthma, on the register, had an asthma review in the last 12 months which was better than the national average of 75.35%.
• There was an effective system in place for managing patients who regularly attended hospital. Practice nurses were given time to follow up these patients on discharge.
• Complex patients were discussed at the regular multi-disciplinary team (MDT) meetings.
• High numbers of patients at the practice had drug and alcohol problems. The practice had a system of managing their care and education into healthier living patterns. These patients were offered reviews and health checks opportunistically as well as in a clinic setting.
• The practice worked well with the local pharmacist to deliver vaccinations, manage patients with multiple prescriptions and provide medicine trays.
• Information was shared with out of hours services for palliative and end of life patients together with mental health or patients who frequently used secondary care or out-of-hours services.

Updated 19 April 2016

The practice is rated as good for the care of families, children and young patients.

• The practice had a higher than local and national average number of younger patients including young mothers, single parents, child protection, domestic violence and vulnerability.

• 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 patients who had a high number of A&E attendances.
• The health visiting team was accommodated within the practice which enabled effective working and communication to protect vulnerable families and children on the patient list.
• The practice held dedicated child immunisations clinics every week and offered opportunistic vaccines. There was a robust recall system in place to try and ensure a high percentage of children were vaccinated. The practice stated that a high turnover of patients made this challenging but they had tried hard to improve immunisations uptake/results by encouraging opportunistic immunisations.
• Patients told us that children and young patients were treated in an age-appropriate way and were recognised as individuals, and we saw evidence to confirm this.
• Midwife clinics were offered and GPs were involved in both ante and post-natal care.
• All staff within the practice were alert to safeguarding issues and had an effective communication network where there were concerns. A system on the clinical record highlighted where there were concerns with a child or family.
• Patients had access to a range of contraception services. The practice promoted healthy sex and offered referral to the genito urinary medicine (GUM) clinics specialising in sexual health. Patients also had access to The Junction (a sexual health service for the under 25s).
• There was a robust recall system for cervical smears. 82% of patient between 25 and 65 had had a smear test in the last 5-years.
• Appointments were offered outside school time hours as needed.
• The premises had been adapted to ensure a dedicated meeting room for the health visitor to see mothers and their babies. Baby changing facilities had also been added.
• A private room was available for breastfeeding and toys and books were available for children in waiting rooms.

Updated 19 April 2016

The practice is rated as good for the care of older patients.

• The practice offered proactive, personalised care to meet the needs of the older patients in its population.
• The practice had a smaller than national average number of older patients. For example only 1037 of the 10,200 patients were over 65.
• All patients had an allocated GP but could see any GP if required or necessary.
• Personalised care plans were in place for older patients.
• The GPs were involved in the anticipatory care team for admission avoidance in the over 75 year olds and had a dedicated GP to look after these patients. The GPs received referrals from outside agencies to this service.
• There were structured recall systems for flu, pneumococcal and shingles vaccinations and age-related conditions.
• Care and Nursing homes in the area had access to vaccinations. The GPs performed ‘ward-rounds’ as required.
• Home visits and on-the day appointments were offered as needed
• Patients were referred to local services such as dementia screening and falls assessments.
• The practice had a system for identifying vulnerable people with physical or mental health issues and used a template to undertake a complete health check reviews. This review included falls assessments, pressure sores, and chronic disease management.
• Longer appointments were offered to those with very complex needs or mental health difficulties.
• Care homes were given a bypass telephone number to ensure timely access to the GPs and practice.
• Effective multidisciplinary team meetings were held which included attendance from social care, voluntary sector and the mental health teams.

Updated 19 April 2016

The practice is rated as good for the care of working-age patients (including those recently retired and students).

• Holdenhurst Road had a larger than national average younger working-age population. The practice was in close proximity to the university of Bournemouth.
• 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 reflected the needs for this age group.
• Extended opening and online booking were available. Text reminders were used to prompt patients to attend or cancel their appointments.
• Flu clinics were offered at evenings and weekends to meet the needs of working people and screening and regular bloods tests were available during extended hours.
• GPs were sensitive to the needs of working people and helping them get back to work. Fit-notes were offered in a timely manner.
• Telephone access to the GP or Nurse was well-used and appreciated by working-age population.

Updated 19 April 2016

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

• Holdenhurst Road had higher than average number of patients in unemployment and social deprivation, and those with drug and alcohol related conditions. The practice also had a higher than average prevalence of mental health. For example, 1.8% compared to the national average of 0.8%.
• There was a nominated GP lead for mental health conditions who had additional expertise in mental health issues.
• The practice worked closely with other agencies to manage these patients in a multi-disciplinary way.
• The practice held special MDT meetings to include social services, mental health workers, support workers, voluntary services and sometimes the police where a patient was particularly difficult to manage due to their mental health.
• A system was in place for these patients who attend A&E or Out of Hours services to be followed up.
• 94.5% of mental health patients had a comprehensive care plans and received regular reviews.
• Reception staff had experience and expertise dealing with mental health patients.
• Medicine reviews were undertaken regularly and blood tests are carried out as needed.
• Extended appointments were offered to patients if needed to discuss their mental health issues.
• The practice proactively and opportunistically identified dementia patients. All staff had received a presentation given by GP specialists on dementia so that there was an increased awareness of this condition across the surgery.

• 80.85% of patients diagnosed with dementia who had had their care reviewed in a face to face meeting in the last 12 months, which is comparable to the national average of 84.01%.

Updated 19 April 2016

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

• The practice had a higher than local and national prevalence of patients living in vulnerable circumstances including drug dependency, alcohol abuse, homelessness, at risk of sexual or domestic violence, mental health, and learning disabilities.
• The practice held a register and had visual alerts on patient records to ensure these vulnerable patients were identified promptly.
• Immediate [same-day] and longer appointments were available to this group of patients with longer appointments offered as needed to patients with challenging circumstances or mental health problems.
• The practice ensured the community psychiatric nurses (CPN) and social services were able to attend the MDT meetings to discuss vulnerable patients.
• Staff knew how to recognise signs of abuse and neglect in this group.
• The ethos of the practice was non-judgemental of this vulnerable group.
• The practice worked closely with CPNs and mental health workers to ensure appropriate care was offered to these patients. For example, care plans, self-management techniques etc.
• Effective sign posting was in place to ensure these patients could access help from a variety of sources.
• Holdenhurst Road practice had a higher than average number of patients who did not speak English. Some of these patients had complex needs including mental health and abuse. The practice had GPs who could speak different languages which was helpful in managing the needs of this group. Practice staff also used interpreters and online translation services.
• There was a structured management of patients taking controlled drugs and medicines. Procedures were in place for issuing weekly prescriptions for those at risk of misusing their medicines. There was a cohesive and consistent approach to managing controlled drugs to ensure that patients with drug-seeking behaviour received a common approach irrespective of which GP they saw.

• The practice offered longer appointments for patients with a learning disability and had a system of reviewing these patients. For example, 57 of the 76 patients had received a review so far this year.