Archived: The Practice Hangleton Manor

Updated 29 September 2016

The Practice Hangleton Manor offers general medical services to people living and working in the Hangleton area of Brighton and Hove. It is a practice with one male lead locum GP providing six sessions a week and additional locums providing the other four sessions a week. In addition a lead locality male GP for The Practice Group/Chilvers and McCrea Ltd was available to support the practice and the locum GPs. The lead locality GP was employed for four sessions a week at one of the other Brighton based The Practice Group/Chilvers and McCrea and had an additional two sessions to provide support to the other four Brighton based members of the group. There are approximately 1800 registered patients.

The practice was run by The Practice Group/Chilvers and McCrea Ltd. The practice was supported by central management functions from the head office, including human resources, health and safety and clinical locality leads. The practice also had a practice nurse, a locum nurse, a healthcare assistant and a team of receptionists. Operational management was provided by the practice manager and assistant practice manager.

The practice runs a number of services for its patients including asthma clinics,child immunisation clinics, diabetes clinics, new patient checks, and weight management support.

Services are provided from:

The Practice Hangleton Manor

96 Northease Drive

Hove

BN3 8LH

The practice has opted out of providing Out of Hours services to their patients. There are arrangements for patients to access care from an Out of Hours provider (111).

The practice population has a marginally higher number of patients over the age of 75 and under the age of 18, compared with the England average. The practice population also has a slightly higher number of patients compared to the national average with a long standing health condition and with health related problems in daily life. The practice population has low levels of unemployment and similar numbers in terms of working status or education, compared to the national average.

Updated 29 September 2016

Letter from the Chief Inspector of General Practice

The Practice Hangleton Manor was inspected in September 2015 where they were rated inadequate in safe, effective, caring and well-led services. They were rated as good in responsive. As a result the practice was placed into special measures and a warning notice was issued. In February 2016 we carried out a focussed inspection of the areas covered by the warning notice and found that this had not been met. The warning notice was re-issued and was subject to written representations at the time of the announced comprehensive inspection at The Practice Hangleton Manor on 26 April 2016. Overall the practice is rated as inadequate.

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

• The practice was going through a period of uncertainty due to giving notice on their NHS England contract and this had resulted in some staff resigning from their posts at a time when the practice was experiencing difficulties with recruitment.
• There was no clear vision, strategy or business plan. However, The Practice Group/Chilvers and McCrea had developed an exit plan for the end of June following NHS England being given contractual notice. The practice were increasingly dependent on locum staff who were not given additional time to undertake activities such as care planning and attendance at practice meetings, despite taking a clinical lead on a day to day basis.
• The governance systems within the practice did not cover all aspects of clinical activity and not all risks had been properly evaluated and mitigated. For example, monitoring of blood results was undertaken remotely by the lead locum but there were no formal arrangements in place for this and there was no central system evident for how the practice should deal with national guidance and safety alerts.
• Staff understood and fulfilled their responsibilities to raise concerns, and to report incidents and near misses. However, locum staff did not have access to the reporting system and were not always involved in discussions and learning from incidents.
• Risks to patients were assessed and well managed, with the exception of those relating to medicines management.
• Published data showed patient outcomes were low compared to the national average, although we saw that the practice had worked to improve these for 2015/16.
• Patients with conditions such as dementia and those with a learning disability were not routinely receiving annual reviews..
• The practice had worked hard to set up multi-disciplinary meetings for patients at the end of life and those who were vulnerable. However, this had not yet happened and alternative ways to meet other than face to face had not been realised.
• Clinical audits had been carried out, including evidence of a full cycle audit being used to drive improvements to patient outcomes.
• The majority of patients said they were treated with compassion, dignity and respect. However, results from the GP patient survey were low in comparison to local and national figures. For example, in relation to explaining tests and treatments and involvement in care planning.
• The practice demonstrated some good work around the support they offered for carers and had carried out audits of this to ensure they were meeting carer’s needs.
• We saw evidence of improved processes around the handling of complaints and acting on feedback from patients. For example, by using audit as a tool to monitor and ensure improvements.
• The practice had significantly changed their appointment system to increase the number of face to face appointments. This had been a concern identified in previous inspections and through negative patient feedback around the previous telephone triage system.

The areas where the provider must make improvements are:

• Monitor and assess risks associated with the current staffing issues to ensure that increased risks are adequately mitigated regarding support for locum staff to ensure that safety is not compromised in relation to limited clinical leadership within the practice.
• Ensure that there is a central system for dissemination of national guidance and safety alerts that provides assurance that this guidance and alerts are being adhered to.
• Ensure that there is a formal system for monitoring of test results and clinical correspondence that is not dependant on an individual locum GP.
• Ensure that privacy and confidentiality are maintained in relation to the handling of telephone calls and patient information at the reception desk.
• Ensure that temperature monitoring of the vaccination fridge is carried out in line with national guidance and the practice policy, that patient group directions are signed by all locum nurses administering them and that competency has been assessed and that prescriptions are securely locked away and adequately tracked within the practice.
• Ensure that emergency medicines and oxygen with appropriate masks are easily accessible to all staff and that there is a system in place to monitor this during a time when the practice is dependent on locum staff.
• Ensure that all patients requiring regular reviews of their health have these available to them, that all patients on a chronic disease register have a care plan in place and that regular multi-disciplinary meetings are held for patients at the end of life and for those who are vulnerable.
• Ensure that information from the national GP patient survey is acted on and used to improve practice and that alongside improvements in care planning patients are involved in planning their care.
• Ensure that the risks associated with the uncertain future of the practice are fully identified, assessed and mitigated and that close monitoring and reporting to the appropriate external bodies is undertaken.

This service was placed in special measures in December 2015. Insufficient improvements have been made and there remains a rating of inadequate for all the population groups, two key questions and overall. Therefore, the practice continues to be in special measures. On 15 July 2016 this practice was closed by the provider.

Professor Steve Field CBE FRCP FFPH FRCGP

Chief Inspector of General Practice

Updated 29 September 2016

Due to issues identified within the practice the service is rated as inadequate for the care of people with long-term conditions.

• Diabetes performance had improved from the previous year (67.3%) at 78.4%. This was approximately 10% lower than local and national averages although the practice had demonstrated ongoing improvements in the 2015/16. However Unverified data from the practice showed an improvement for the 2015/16 with performance at 85%.
• Longer appointments and home visits were available when needed. However, not all these patients had a named GP, a personalised care plan or structured annual review to check that their health and care needs were being met.
• The practice had worked to develop services for carers, including undertaking audits of uptake of certain services such as health screening and vaccines. The practice had identified 0.7% of the practice list as carers.

Updated 29 September 2016

Due to issues identified within the practice the service is rated as inadequate for the care of families, children and young people.

• Unverified information from the practice showed that childhood immunisation rates for the vaccinations given were comparable to CCG/national averages at between 90% and 96%.

• The practice’s uptake for the cervical screening programme was 72% which was comparable to the CCG average of 72.4% and the national average of 82%.

Updated 29 September 2016

Due to the issues identified within the practice the service is rated as inadequate for the care of older people.

• The practice did not have a system in place for ensuring regular care plans were in place for patients, including for older people.

• Nationally reported data showed that outcomes for patients for conditions commonly found in older people were generally lower than average. For example, in heart failure performance. However, the practice was able to demonstrate improvements in all areas for the 2015/16 although this was unpublished data. For example, published data shows that heart failure performance at 65.5% is below national performance at 97.9%. However, practice data shows that current performance in this area is at 100%.

• The practice had increased the number of face to face to face appointments and offered telephone appointments and home visits to those unable to attend the practice.

Updated 29 September 2016

Due to issues identified within the practice the service is rated as inadequate for the care of working-age people (including those recently retired and students).

• The practice offered extended opening hours for appointments during weekday evenings and on Saturdays through a local project where appointments could be offered at a local practice.
• Patients were able to book appointments and request repeat prescriptions online.
• Telephone appointments were available.
• Health promotion advice was offered and there was health promotion material available in the practice.

Updated 29 September 2016

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

• Published data showed that performance in relation to mental health indicators was below local and national averages at 73.8% which was 15.7% below local performance and 19% below national performance. However, unverified data from the practice showed current performance at 94.6%.

• The practice did not have a system of multi-disciplinary team meetings in the case management of people experiencing poor mental health including those with dementia; however they were able to demonstrate good lines of communication with mental health specialist services and accessing support when needed.

• The percentage of patients with dementia whose care had been reviewed in a face-to-face review in the preceding 12 months was 50% lower than local and national averages.

Updated 29 September 2016

Due to issues identified within the practice the service is rated as inadequate for the care of people whose circumstances may make them vulnerable.

• The practice had not carried out annual health checks for people with a learning disability, although they had plans in place to carry out health checks and care planning clinics in the near future.

• 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.