18 March 2019
Arch Healthcare is located at The School Clinic, Morley Street, Brighton, East Sussex, BN2 9DH.
Arch Healthcare Community Interest Company was developed in early 2017 to deliver an integrated homeless health contract within Brighton and Hove. The homeless primary care service operates as the hub within a hub and spoke model, with four spokes providing a collaborative service to the city. The model incorporates hospital in-reach services, non-clinical health engagement work, clinical outreach to hostels and temporary accommodation and city-wide leadership for the provision of integrated care for homeless people. The practice provided case management and clinical leadership to the services operating within the integrated model, coordination of weekly multi-agency homeless health meetings, supervision of the non-clinical health management service, training and citywide leadership and the management of contract performance.
The practice is registered with the CQC to carry out the following regulated activities - diagnostic and screening procedures, family planning, maternity and midwifery services and treatment of disease, disorder or injury.
The practice has a contract with the Brighton and Hove Clinical Commissioning Group (CCG) which is made up of 35 general practices. The practice provides Alternative Provider Medical Services (APMS) and offers locally commissioned services for homeless patients living in Brighton and Hove.
When the practice is closed, out of hours cover for emergencies is provided by NHS 111 services. The practice is part of any wider network of GP practices. At the time of our inspection there were approximately 1,400 patients on the practice list.
The practice has two male GPs, one female GP, one female practice nurse, a female advanced nurse practitioner, one female healthcare assistant, a chief executive officer, a practice manager, an assistant practice manager and an extensive administrative team. A second female practice nurse had recently been recruited to the practice and was due to commence in post in the coming weeks.
Arch Healthcare is in the most deprived area of Brighton and Hove. The practice scored one on the deprivation measurement scale; the deprivation scale goes from one to 10, with one being the most deprived. People living in more deprived areas tend to have greater need for health services. National General Practice Profile describes the practice ethnicity as being 85% white British, 6.1% Asian, 2.0% black, and 4.8% mixed and 2.0% other non-white ethnicities. The average age of death of patients registered at the practice was 49. Fifteen patients had died in 2018, a 30% reduction on the number of deaths in 2015. The general practice profile shows that 88% of patients registered at the practice have a long-standing health condition, compared to 52% locally and 52% nationally.
18 March 2019
We carried out an announced comprehensive inspection at Arch Healthcare on 28 January 2019 as part of our inspection programme. This was a first rated inspection for the service that was registered with CQC in February 2017.
We based our judgement of the quality of care at this service is on a combination of:
- what we found when we inspected
- information from our ongoing monitoring of data about services and
- information from the provider, patients, the public and other organisations.
We have rated this practice as outstanding overall.
We rated the practice as outstanding for providing safe services because:
- A proactive approach to anticipating and managing risks to people who use services is embedded and is recognised as the responsibility of all staff. A risk management model had been devised to identify which care pathway within the integrated service was most appropriate for each patient.
- There was evidence of learning from significant events that was shared outside of the practice to improve safety and reductions in harm.
We rated the practice as outstanding for providing effective services because:
- Multidisciplinary working was at the forefront of the model of care for the service. Collaborative working across the integrated service meant that patient outcomes had improved and there was evidence of reduced accident and emergency attendance, and a 32% reduction in unplanned admissions and a 42% reduction in re-admissions to hospital.
- There was a collaborative and holistic approach to transitioning patients to other GP practices when they were more stable and able to work.
We rated the practice as outstanding for providing caring services because:
- Feedback from patients was consistently positive and was higher than local and national averages in some areas.
- There is a strong, visible person-centred culture. Staff are highly motivated and inspired to offer care that is kind and promotes people’s dignity.
The practice coordinated an annual memorial service for patients, staff and the public to commemorate the lives of homeless patients who had died.
We rated the practice as outstanding for providing responsive services because:
- Services were tailored to meet the needs of individual patients. They were delivered in a flexible way that ensured choice and continuity of care, particularly for patients who were vulnerable and those with poor mental health.
- There were innovative approaches to providing integrated person-centred care that increased access to services for patients, including clinicians visiting patients in the community at hostels, drop-in centres and on the streets in order to meet their needs.
We rated the practice as outstanding for providing well-led services because:
- Strategies and plans are fully aligned with plans in the wider health economy, and there is a demonstrated commitment to system-wide collaboration and leadership.
- Leaders have an inspiring shared purpose, and strive to deliver and motivate staff to succeed. There is strong collaboration, team-working and support across all functions and a common focus on improving the quality and sustainability of care and people’s experiences.
- Governance arrangements are proactively reviewed and reflect best practice. A systematic approach is taken to working with other organisations to improve care outcomes.
These outstanding areas benefitted all population groups and so we rated all population groups as outstanding.
We saw several areas of outstanding practice including:
- A risk management framework was in use across the integrated service. This included clear referral criteria and case management responsibilities for patients based on the assessment of risk.
- The practice monitored key performance indicators and measured performance using a range of metrics. This included measuring the impact of interventions and care and treatment on a reduction in access to secondary care.
- Services were developed based on evidence based treatment and care and the practice participated in research to improve health outcomes, including the development of outreach services to treat patients with hepatitis C.
- GPs provided homelessness healthcare leadership across the city, including to other GP practices in supporting patients to transition from homelessness primary care services into mainstream primary care services.
- Clinicians provided education to increase the skills of other clinicians and frontline workers across the integrated care service and beyond, in order to improve treatment and care for homeless patients across the city.
Details of our findings and the evidence supporting our ratings are set out in the evidence tables.
Professor Steve Field CBE FRCP FFPH FRCGP
Chief Inspector of General Practice