Archived: Waterside Medical Centre

Updated 20 December 2016

Waterside Medical Centre is located in a purpose built two storey building located at Mumby Road, Gosport, Hampshire, PO12 1BA. Most patient services are provided on the ground floor; however, a lift and stairs provide access to the first floor consulting rooms. Disabled toilets are located on both the ground and first floor levels.

The practice has approximately 11,800 registered patients and provides services under an NHS Personal Medical Services Contract. It is part of Fareham and Gosport Clinical Commissioning Group (CCG). The practice is based in an area of relatively high deprivation compared to the national average for England and the practice told us they have a high number of children at risk or on the child protection register. A total of 48% of patients at the practice have a long-standing health condition which is lower than the CCG and national average of 54%. Approximately 1% of of the practice population describe themselves as being from an ethnic minority group; the majority of the population are White British.

The practice has two partners, one male and one female. The practice also employs three female salaried GPs. Together the GPs provide care equivalent to approximately 30 sessions per week or just under four whole time equivalent GPs. The GPs are supported by two advanced nurse practitioners, who are able to prescribe medicines, two practice nurses, a nurse training to be a practice nurse and two health care assistants. All the nursing team are female and together provide care equivalent to just over four whole time nurses. The clinical team are supported by a management team with secretarial and administrative staff. The practice is a training practice for foundation year two doctors, student nurses and medical students. At the time of our inspection the practice was supporting one doctor as part of their foundation training.

Waterside Medical Centre is open between 8am and 6.30pm Monday to Friday. Extended hours surgeries are available every Monday morning from 7.30am, Tuesday and Wednesday evenings until 7pm and one Saturday per month from 9am to 12pm. Patients are encouraged to use the NHS 111 service before 8am and after 6.30pm or the local minor injuries unit open from 8am to 9pm seven days a week.

We visited the Waterside Medical Centre as part of this inspection, which has not previously been inspected by the Care Quality Commission.

Updated 20 December 2016

Letter from the Chief Inspector of General Practice

We carried out an announced comprehensive inspection at Waterside Medical Centre on 18 October 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.

There were areas of practice where the provider should make improvements:

• Consider a process to review and analyse significant events and identify any trends or other learning.
• Review how all patient feedback is reveiwed and acted upon.
• Ensure that complainants are provided with information on how to escalate their complaint if required.
• Review the process of identifying patients who are also carers and offer support.
• Review arrangements for effective communication with those patients who had hearing loss and/or who use a hearing aid.

Professor Steve Field (CBE FRCP FFPH FRCGP) 

Chief Inspector of General Practice

Updated 20 December 2016

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

• Nursing staff had lead roles in chronic disease management and patients at risk of hospital admission were identified as a priority.
• Management plans were provided for patients with long term conditions, for example, for patients with diabetes to encourage better self-care.
• 77% of patients with diabetes had an acceptable blood pressure reading in 2014/2015 compared to the CCG and 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 20 December 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.
• 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.
• 86% of eligibile women received a cervical smear in the preceding five years, which is higher than the national average of 82%.
• Appointments were available outside of school hours and the premises were suitable for children and babies.
• We saw positive examples of joint working with midwives, health visitors and school nurses. For example, the practice offered a child health clinic for baby immunisations, health visitor checks, post natal checks and midwife support all on the same day.

Updated 20 December 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 patients in its population.
• The practice was responsive to the needs of older patients, and offered home visits and urgent appointments for those with enhanced needs. For example, nurses provided immunisations for housebound patients.
• There were bi-monthly multi-displinary meetings to discuss the care and treatment for patients at the end of their lives.
• The practice attempted to increase their ability at identifying patients who were also carers and asked a question as part of the ‘booking in’ system.
• The practice supported an older people’s mental health community psychiatric nurse to attend the practice on a weekly basis, so patients could be seen locally and in familiar surroundings.

Updated 20 December 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.

Updated 20 December 2016

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

• 90% of patients diagnosed with dementia had their care reviewed in a face to face meeting in the last 12 months, which is better than the CCG average of 85% and the national average of 84%.
• 97% of patients with schizophrenia, bipolar affective disorder and other psychoses had an agreed care plan recorded, which is better than the CCG average of 90% and the national average of 89%.
• 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 and offered a memory clinic within the practice.
• The practice was a pilot site in 2015 for the provision of Step 2 italk services. The practice now hosts a psychological wellbeing practitioner one day a week and can refer directly to the service. (italk is a free service for people suffering from depression and anxiety. It is part of an Improving Access to Psychological Therapies (IAPT) service offered in Hampshire).
• 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 a good understanding of how to support patients with mental health needs and those living with dementia.

Updated 20 December 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 homeless patients and those with a learning disability.
• The practice offered longer appointments for patients with a learning disability.
• There were 38 patients with a learning disability registered with the practice and 100% had received an annual health check in 2014-2015.
• 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.