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Lighthouse Group Practice Good

Inspection Summary


Overall summary & rating

Good

Updated 8 August 2017

Letter from the Chief Inspector of General Practice

We carried out an announced comprehensive inspection at Southsea Medical Centre on 1 September 2016. The practice was rated good for providing safe, caring, responsive and well-led services, and was rated requires improvement for providing effective services . The overall rating for the practice was good. The full comprehensive report on the September 2016 inspection can be found by selecting the ‘all reports’ link for Southsea Medical Centre on our website at www.cqc.org.uk.

This inspection was an announced focused inspection carried out on 12 July 2017 to confirm that the practice had carried out their plan to meet the legal requirements in relation to the breach in regulations that we identified in our previous inspection on 1 September 2016. This report covers our findings in relation to those requirements.

The practice is now rated as good for providing effective services.

Our key findings for 12 July 2017:

  • There was a comprehensive and organised training schedule for all staff and an updated policy on mandatory training requirements.
  • There was protected staff time for training and for practice meetings.
  • Practice management had a clear oversight of all staff training requirements.
  • There was a focus on communication within the practice with regards to all policy and safety updates. All staff had to sign each policy update once they had read it to ensure they were aware of the change.
  • The practice was working on increasing the number of carers on its register, including working alongside local care voluntary groups and the patient participation group. A member of staff was designated to increase carer support and the practice now offered longer appointments to this patients group.
  • The practice was now offering extended hours on a Saturday morning from 8am to 12pm for pre-bookable GP appointments.
  • Patients with long term conditions were now offered longer appointments.
  • Complaints were being dealt with comprehensively and in a timely fashion.

Professor Steve Field (CBE FRCP FFPH FRCGP) 

Chief Inspector of General Practice

Inspection areas

Safe

Good

Updated 18 January 2017

The practice is rated as good for providing safe services.

  • There was an effective system in place for reporting and recording significant events.

  • Lessons were shared to make sure action was taken to improve safety in the practice.

  • When things went wrong patients received reasonable support, truthful information, and a written apology. They were told about any actions to improve processes to prevent the same thing happening again.

  • The practice had clearly defined and embedded systems, processes and practices in place to keep patients safe and safeguarded from abuse. However not all staff had adult safeguarding training.

  • Risks to patients were assessed and well managed.

Effective

Good

Updated 8 August 2017

This practice is now rated as good for providing effective services.

  • Staff had the skills, knowledge and experience to deliver effective care and treatment.
  • The practice had identified which training was mandatory and how frequently staff needed to be updated in these areas. Mandatory training required annual staff updates and included health and safety, information governance and basic life support. Protected time for training was provided on a weekly basis.
  • All staff were evidenced to be up to date with all their training at the time of inspection.
  • There were improvements in the number of patients having reviews who had long term conditions, and an improvement in the uptake of health screening.

Caring

Good

Updated 18 January 2017

The practice is rated as good for providing caring services.

  • Data from the national GP patient survey showed patients rated the practice higher than others for several aspects of care.

  • Patients said they were treated with compassion, dignity and respect and they were involved in decisions about their care and treatment.

  • Information for patients about the services available was easy to understand and accessible.

  • We saw staff treated patients with kindness and respect, and maintained patient and information confidentiality.

  • However the practice needed to continue to review arrangements for identifying patients who are also carers.

Responsive

Good

Updated 18 January 2017

The practice is rated as good for providing responsive services.

  • Practice staff reviewed the needs of its local population and engaged with the NHS England Area Team and Clinical Commissioning Group to secure improvements to services where these were identified.

  • 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.

  • Information about how to complain was available and easy to understand and evidence showed the practice responded quickly to issues raised. Learning from complaints was shared with staff and other stakeholders. However arrangements for handling complaints did not include information on other agencies patients might approach if they were not satisfied with the practice response. Themes or trends identified were not acted on appropriately and in a timely manner.

Well-led

Good

Updated 18 January 2017

The practice is rated as good for being well-led.

  • The practice had a clear vision and strategy to deliver high quality care and promote good outcomes for patients. Staff were clear about the vision and their responsibilities in relation to it.

  • There was a clear leadership structure and staff felt supported by management. The practice had a number of policies and procedures to govern activity and held regular governance meetings.

  • There was an overarching governance framework which supported the delivery of the strategy and good quality care. This included arrangements to monitor and improve quality and identify risk.

  • The provider was aware of and complied with the requirements of the duty of candour. The partners encouraged a culture of openness and honesty.

    The practice had systems in place for notifiable safety incidents and ensured this information was shared with staff to ensure appropriate action was taken.

  • The practice proactively sought feedback from staff and patients, which it acted on. The patient participation group was active.

  • There was a focus on continuous learning and improvement at all levels.

  • However the practice needed to review arrangements for promoting ways in which patients were able to provide feedback and promote the patient participation group.

Checks on specific services

People with long term conditions

Good

Updated 18 January 2017

The practice is rated as requires improvement 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.

  • Quality Framework Outcomes for patients with diabetes were higher than clinical commissioning group (CCG) and national averages. For example, 100% of patients on the register had a flu vaccine, compared with the CCG average of 95% and the national average of 94%. However, we noted that exceptions reporting for diabetes was higher than the CCG and national averages. Exception reporting for this area was 23% compared with the CCG average of 18% and the national average of 18%.

  • 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.

Families, children and young people

Good

Updated 18 January 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 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.

  • The percentage of patients who had a cervical screening test was 70% which was lower than the CCG average of 81% and the national average of 82%. The practice had taken action to improve uptake of cervical screening and their latest unverified figures were 74%.

  • 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 and health visitors.

Older people

Good

Updated 18 January 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 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.

  • Each patient over the age of 75 had a named GP and were offered an annual health review.

Working age people (including those recently retired and students)

Good

Updated 18 January 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.

  • 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.

People experiencing poor mental health (including people with dementia)

Good

Updated 18 January 2017

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

  • A total of 92% of patients diagnosed with dementia had their care reviewed in a face to face meeting in the last 12 months, which was comparable to the national average.

  • Outcomes for patients with a mental health diagnoses were similar to the national average. For example, 91% of patients with schizophrenia, bipolar affective disorder and other psychoses had an agreed care plan in their records, compared with the national average of 88%.

  • 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.

  • 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.

People whose circumstances may make them vulnerable

Good

Updated 18 January 2017

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, travellers and those with a learning disability.

  • 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 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.