Archived: Dr Nicholas James Lowe Also known as Highfield Health Surgery

Updated 21 October 2016

Dr Nicholas James Lowe is located at 31 University Road, Southampton, Southampton SO17 1BJ. The practice is locally known as Highfield Health.

It is situated in an urban area with a large student population. Southampton is ethnically diverse with many people from Poland, many overseas students from the Middle East and China and families of Pakistani and Indian heritage. The practice also oversee the care of a large 100 bed nursing home and have increasing number of elderly patients from the surrounding area. The list size has increased year on year over the last 4-5 years and it is currently 4581. The practice’s population’s score of deprivation is 7 on a scale of one to ten where ten is the least deprived decile. The practice provides its services under the General Medical Services (GMS) contract.

The practice is able to accommodate the needs of people with disabilities and there is a disabled parking space available. There is no general patient parking at the practice due to the practice is situated on the university campus therefore parking permit is required.

The current staff of the practice includes:

1 GP Partner (male, 1 whole time equivalent WTE)

1 Salaried GP (male 0.5 WTE)

1 Practice Nurse (0.5 WTE)

1 HCA (0.5 WTE)

1 Practice Manager (0.7 WTE)

5 Receptionist (3 WTE)

1 Secretary (0.4 WTE)

The practice is open from 8:30am to 6pm with duty clinician available on the telephone between 8 to 8:30am and 6 to 6:30pm. Extended hours service is offered from 6:30pm to 9pm on Thursday evenings. Out of hours services are accessible via NHS 111. Information about how patients can access these services is available on the practice’s website and at the practice’s entrance. In addition to pre-bookable appointments that could be booked up to two months in advance, routine, emergency same day appointments (6 per session), telephone and e-mail consultations were available.

Updated 21 October 2016

Letter from the Chief Inspector of General Practice

We carried out an announced comprehensive inspection at Dr Nicholas James Lowe on 14 September 2016. Overall the practice is rated as good.

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 well managed.
• 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.
• Patients said they found it easy to make an appointment with a named GP and there was continuity of care, with urgent appointments available the same day.
• 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 should make improvements are:

• The practice should ensure that all patient safety alerts are actioned, recorded and filed appropriately.

• The practice should ensure that clinical waste is labelled in line with its ‘Disposal of waste’ policy.

• The practice should ensure that they identify and support carers appropriately.

• The practice should continue to encourage women to have cervical screening.

Professor Steve Field (CBE FRCP FFPH FRCGP) 

Chief Inspector of General Practice

Updated 21 October 2016

The practice is rated as good for the care of people with long-term conditions (LTC).

• The practice nurse lead on chronic disease management and patients at risk of hospital admission were identified as a priority. Specific long term conditions clinics were offered such as diabetes, chronic obstructive pulmonary disease (COPD), ischemic heart disease and asthma.
• Performance for diabetes related indicators were similar or worse than the national average. We noted that the lower performance was due to low exception reporting, the younger demographic and more type 1 diabetics who can be 'harder to reach' for some of the interventions.
• 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. The practice had a recall system in place for all the LTCs and blood tests arranged prior to being seen for an annual assessment in the nurse led clinic. Problems were discussed with the GP on the day and alterations to treatment done at the same time. Regular medication reviews were undertaken, 99% of people on repeat prescriptions had been reviewed.

Updated 21 October 2016

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

• 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. Regular meetings with a Health Visitor to discuss any concerns and safeguarding issues.
• An immunisation clinic was held every other Wednesday morning, and the practice achieved a high immunisation rate. The practice received details from patients such as from those overseas on different immunisation programmes, the immunisation history was then scanned onto the practice computer system to ensure the patient records were up to date.
• The practice offered a vaccination catch up programme, contraception clinics, free condom scheme, implant clinics and provided access to the NHS’s “Let’s talk about it” website.
• Appointments were available outside of school hours and the premises were suitable for children and babies. The practice offered extended hours clinics on Thursday evening which often are used by working parents and their children.
• There was a system in place for 6-8 week post-natal and baby checks.

Updated 21 October 2016

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

• The practice offered proactive, personalised care to meet the needs of the older people in its population.
• The practice was responsive to the needs of older people, and offered home visits and urgent appointments for those with enhanced needs.
• The practice had been looking after the residents in a local nursing home and had worked with the home, residents, pharmacists, the Older People Mental Health team and palliative care team to provide a high quality service. Regular GP visits were made to the home twice every week to deal with prescription issues, arrange referrals and liaise with other services. The practice’s health care assistant also visited the home weekly to carry out domiciliary near patient INR blood tests. Large flu clinics were organised at the nursing home to vaccinate all residents and staff consenting in one clinic.
• The practice’s older patients were supported by an over 75’s nurse to do health checks and were involved in home assessments. The nurse also had close links with the community health team and social services.
• Palliative care plans were created for these patients and uploaded to the practice’s electronic records system so DNR (Do Not attempt Resuscitation) information and patient wishes were recorded and understood.

Updated 21 October 2016

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

• 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.
• The practice’s health care assistant (HCA) offered patients over 40 years of age health checks and there was a recall system in place. The HCA often offered the health checks for new patients when they were being seen for other issues.
• The practice offered a wide range of appointments including routine, emergency same day, telephone triage, extended hours and e-mail appointments.
• The practice accepted out of area patients who work nearby under the choice of GP scheme.
• The practice used an e-referral system extensively so patients were able to organise referrals around dates and times that suit them and their working lives.
• The practice also used text reminders for booked appointments and had a facility to cancel appointments if necessary.

Updated 21 October 2016

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

• 90% of patients diagnosed with schizophrenia, bipolar affective disorder and other psychoses had had their care reviewed in a face to face meeting in the last 12 months, which was comparable to the clinical commissioning group (CCG) average of 87% and the national average of 88%.
• 87% of patients diagnosed with dementia had had their care reviewed in a face to face meeting in the last 12 months, which was comparable to the CCG average of 86% and to the national average of 84%.
• The practice regularly worked with multi-disciplinary teams in the case management of patients experiencing poor mental health, including those with dementia.
• The practice carried out advance care planning for patients with dementia.
• The practice had told patients experiencing poor mental health about how to access various support groups and voluntary organisations. The practice actively encouraged self-help with a cognitive behaviour therapy, mindfulness guide and signposting to voluntary sector services as well as encouraging exercise and healthy living. People with mental health issues were referred in to the exercise on prescription service.
• Staff had a good understanding of how to support patients with mental health needs and dementia. Having a high dementia prevalence the practice had joined several innovative schemes including the Dementia Redesign Pathway and working closely with the Older People Mental Health team. Audits around antipsychotic prescribing and hospital admissions had also been undertaken.
• The practice had registers for mental health, dementia and learning disabilities to ensure these patients were reviewed appropriately and regularly.
• The practice worked closely with university counselling team who would often call and speak with the GP with concerns and the student services who offer more pastoral and practical support to students with mental health difficulties. The practice provided students struggling with studies or financial difficulties with medical reports and special considerations letters.
• The practice offered extra time in appointments for people struggling with severe mental health problems.
• The practice hosted a mental health practitioner in house once per week who offered convenience of access for registered patients and allowed closer working with the “steps to wellbeing team”.

Updated 21 October 2016

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

• The practice held a register of patients living in vulnerable circumstances including the elderly, students/young people and those with mental health needs or learning disabilities. The practice’s electronic record system alerted staff to vulnerable patients so that they could prioritise and support these patients.
• 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 held multi-disciplinary team meetings for vulnerable adults as and when the occasion arose with social services, safeguarding and other appropriate services.
• 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.
• The practice worked closely with the university, student services and university counselling service with regard to vulnerable students. The practice recognised that for students who have moved away from home to start a degree can be a difficult time for them. Students were often seen around exam times and provided medical reports for special considerations and extensions.
• Home visits for vulnerable house bound patients were provided and the over 75’s nurse were also visited to assess for social care packages at short notice.