3 March 2017
Harbour View Healthcare is situated in the town of Shoreham by Sea, in West Sussex. The practice came in to existence on 1 April 2016 as a result of a merger between Adur Medical Group and Church View Surgery. The practice still operates from two locations and serves approximately 15,000 patients living in the town and surrounding areas. It also provides a medical service to a local private school.
There are nine GP partners, one salaried GP and three GP registrars. Six of the GPs are male and seven are female. There are eight practice nurses and two health care assistants. There are two practice managers and a team of secretarial, administrative and reception staff. The practice is a training practice and provides placements for undergraduate medical students and trainee GPs.
Data available to the CQC shows the practice serves a higher than the local and national average number of patients over the age of 65. Income deprivation is relatively low for both children and older people; however there are small areas of significant deprivation within the practice’s boundaries. The ethnicity of the practice population is largely white British.
The practice is open at Shoreham Health Centre open on Mondays from 8am until 7.30pm, on Tuesdays from 8am until 8pm, on Wednesdays from 7am until 6.30pm and from 8am until 6.30pm on a Thursday and Friday. It is open every other Saturday from 8am until 10am. The practice is open at Downsway Surgery on Mondays, Tuesdays, Thursdays and Fridays from 8.20am until 6pm. It is closed for lunch from 12.30pm until 2pm. When the Downsway surgery is closed calls are taken by the reception team at Shoreham Health Centre. When Shoreham Health Centre is closed, patients are advised on how to access the out of hours service on the practice’s answerphone message or by referring to the practice website and practice leaflet. Out of hours calls are handled by an out of hours provider (Integrated Care 24). Appointments can be booked over the phone, on line or in person at the surgery.
The practice provides a wide range of NHS services and clinics for its patients including minor surgery, asthma, diabetes, cervical cytology, childhood immunisations, travel immunisations, family planning and smoking cessation.
When all the practice’s same day urgent appointments are fully booked patients also have access to the minor injury and minor illness (MIAMI) clinics located in other surgeries within the locality. These were open seven days a week up until 7.30pm which enables patients to be seen quickly during and after normal surgery hours for acute problems. The MIAMI clinics also provide a range of appointments including family planning, cytology, diabetes and asthma appointments over the weekends.
The practice provides services from the following locations:-
Shoreham Health Centre
Shoreham by Sea
The inspection took place at Shoreham Health Centre.
3 March 2017
Letter from the Chief Inspector of General Practice
We carried out an announced comprehensive inspection at Harbour View Healthcare on 10 January 2017. 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.
- The practice placed a strong emphasis on treating both patients and staff with compassion.
- The national GP survey highlighted that patients felt 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.
- The national GP survey highlighted that patients 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.
- The practice had a clear vision to create a sustainable and resilient practice for the future and improved patient care as a result of the merger of its two former entities Adur Medical Group and Church View Surgery.
- 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.
Professor Steve Field (CBE FRCP FFPH FRCGP)
Chief Inspector of General Practice
3 March 2017
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.
- The practice nurses were able to initiate and monitor insulin (a treatment for diabetes) for patients with diabetes and undertook spirometry for patients with chronic lung disease.
- Practice performance against indicators for the management of long term conditions was comparable the local and national averages. For example the percentage of patients on the diabetes register, in whom the last blood pressure reading (measured in the preceding 12 months) was 140/80 mmHg or less was 85% for Adur Medical Group (AMG) and 80%for Church View Surgery (CVS) compared to the clinical commissioning group (CCG) average of 80% and the national average of 76%.
- The percentage of patients with chronic obstructive pulmonary disease (COPD) who had had a review undertaken by a healthcare professional, including an assessment of breathlessness, in the preceding 12 months was 97% for AMG and 92% for CVS compared to the CCG average of 88% and the national average of 90%.
- Longer appointments and home visits were available when needed.
- As part of the diabetes ‘Year of Care’ the practice supported patients to self-manage their care and develop their own care plan. The practice had helped to train other practices in this approach.
- All these patients had a structured annual review to check their health and medicines needs were being met. For those patients with the most complex needs, the named practice worked with relevant health and care professionals to deliver a multidisciplinary package of care.
3 March 2017
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 accident and emergency attendances. The practice’s own data showed that immunisation rates were relatively high for all standard childhood immunisations, however this data was unverified.
- The practice provided a comprehensive family planning service. Two of the GPs were trained to fit intra-uterine contraceptive devices and implants.
- The number of women aged between 25 and 64 who attended cervical screening in 2015/2016 was 81% for Adur Medical Group and 82% for Church View Surgery compared to the clinical commissioning group (CCG) average of 82% and the national average of 81%.
- Four of the GPs were trained to undertake checks of six week old babies and the practice held four clinics a month for this. Additional clinics were provided if demand required.
- Appointments were available outside of school hours and the premises were suitable for children and babies.
- There were monthly meetings between the health visitors and the GPs to discuss children and families of concerns. All staff had up to date child safeguarding training relevant to their role.
3 March 2017
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 designated GPs to provide continuity of care to patients living in local care and nursing homes. They undertook regular visits to patients and reviewed their care. There was close liaison with care home managers and staff.
- As part of the clinical commissioning group’s (CCG) ‘proactive care’ initiative the practice identified and registered older patients at high risk of hospital admission. They worked with multi-disciplinary teams to develop care plans for these patients so that unnecessary and unplanned hospital admission was avoided.
- The practice held seasonal flu clinics on Saturday mornings to help ensure all patients eligible for the immunisation received it.
3 March 2017
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.
- There were early morning, evening and alternate Saturday morning surgeries for patients who could not attend during working hours.
- The practice was proactive in offering . It provided a full range of health promotion and screening that reflected the needs for this age group.
- The practice provided minor surgery, cryotherapy and cortisone injections for patient convenience.
- The practice provided a full range of travel immunisations and health advice.
3 March 2017
The practice is rated as good for the care of people experiencing poor mental health (including people with dementia).
- The practice regularly worked with multi-disciplinary teams in the case management of patients experiencing poor mental health, including those with dementia. Care plans were put in place and updated annually.
- Practice performance against indicators for the management of mental health was higher than or in line with the local and national averages. For example, 92
- 92% of AMG and 96% of CVS patients with severe and enduring mental health problems had a comprehensive, agreed care plan documented in the record, in the preceding 12 months compared to the CCG average of 80% and the national average of 89%.
- The practice told patients experiencing poor mental health about how to access various support groups and voluntary organisations.
- Staff had a good understanding of how to support patients with mental health needs and dementia
- The practice’s patient participation group had set up a singing group for patients with dementia.
- Patients had access to counselling services provided at both locations.
- The practice was able to refer patients with short and long term mental health problems to a local charity funded resource centre for a wide range of courses and group activities.
3 March 2017
The practice is rated as good for the care of people whose circumstances may make them vulnerable.
- The practice had enhanced its awareness in relation to making services accessible to vulnerable patients. For example staff had received deaf awareness training and training on mental health awareness was planned.
- The practice offered longer appointments for patients with a learning disability
- Home visits were undertaken for patients who were permanently housebound or temporarily incapacitated. This included flu immunisations for housebound patients.
- The practice regularly worked with other health care professionals in the case management of vulnerable patients.
- For patients who didn’t speak English the practice booked translators who attended the appointments in person or by phone.
- 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.