Ashdown Forest Health Centre

Updated 30 August 2016

Ashdown Forest Health Centre offers personal medical services to the population of Forest Row. There are approximately 9,700 registered patients. It is a dispensing practice.

Ashdown Forest Health Centre is run by four partner GPs, three male and one female partner. They are supported by three salaried GPs, two females and one male, two practice nurses, two healthcare assistants, a team of administrative staff, a practice manager and a patient services manager. The practice is recognised as a training practice for doctors in their final stages of training to become a GP. At the time of inspection the practice had two training GPs. There were some additional challenges presented to the practice through their patient list as they had a significant number of patients that embraced alternative medicine rather than conventional medicine.

Services are provided from one location:

Ashdown Forest Health Centre

Lewes Road,

Forest Row,

Sussex,

RH18 5AQ.

Opening hours are 8:30am to 6:30pm Monday to Friday. There is also an extended hour’s service operating on alternate Saturdays from 9:00am to 11:30am.

During the times that the practice was closed 6:30pm to 8:30am, the patients accessed healthcare via NHS 111.

The practice has a lower number of patients aged between 0-39 than the national and local clinical commissioning group average. The percentage of registered patients suffering deprivation (affecting both children and adults) is lower than the average for England.

Updated 30 August 2016

Letter from the Chief Inspector of General Practice

We carried out an announced comprehensive inspection of this practice on 15 December 2015. Breaches of Regulatory requirements were found during that inspection within the safe and effective domains. After the comprehensive inspection, the practice sent us an action plan detailing what they would do to meet the regulatory responsibilities in relation to the following:

• To ensure that all staff received appropriate training commensurate to their role and that an effective system was in place to monitor training needs and to take the appropriate actions to ensure training was up to date.

• To ensure that the practice had a robust system for securing and tracking the use of prescription forms used by the practice.

We undertook this focused inspection on 18 August 2016 to check that the provider had followed their action plan and to confirm that they now met regulatory requirements. This report only covers our findings in relation to those requirements. You can read the report from our last comprehensive inspection, by selecting the 'all reports' link for Ashdown Forest Health Centre on our website at www.cqc.org.uk.

This report should be read in conjunction with the last report published in February 2016. Our key findings across the areas we inspected were as follows:-

• We saw that there was a robust system in place to ensure all staff undertook required training and that there was an effective system in place to monitor this.

• We saw evidence that prescriptions forms were securely stored at all times and that there was an effective system in place that tracked these forms from entry into the practice to their subsequent use.

Professor Steve Field (CBE FRCP FFPH FRCGP) 

Chief Inspector of General Practice

Updated 30 August 2016

The practice is now rated as good for the care of people with long-term conditions. Our previous inspection in December 2015 rated this practice as requires improvement for the care of people with long term conditions, as the issues identified as requiring improvement for providing safe and effective services affected all patients including this population group. The practice has made significant improvement and is now rated as good for providing safe and effective services and overall.

• Nursing staff had lead roles in chronic disease management and patients at risk of hospital admission were identified as a priority.
• Longer appointments and home visits were available when needed.
• All these patients had a named GP and a structured annual review to check that their health and medicines needs were being met.
• For those people with the most complex needs, the named GP worked with relevant health and care professionals to deliver a multidisciplinary package of care.
• For patients with more complex diabetic needs there were appointments available as required with the practice nurse.
• The practice had identified that 5% of their patient list were carers.

Updated 30 August 2016

The practice is now rated as good for the care of families, children and young people. Our previous inspection in December 2015 rated this practice as requires improvement for the care of families, children and young people, as the issues identified as requiring improvement for providing safe and effective services affected all patients including this population group. The practice has made significant improvement and is now rated as good for providing safe and effective services and overall.

• 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 low for all standard childhood immunisations which was due to specific issues the practice faced with the patient demographic.
• 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.
• Appointments were available outside of school hours and the premises were suitable for children and babies.
• We saw good examples of joint working with midwives and health visitors.
• Practice staff had received safeguarding training relevant to their role and knew how to respond if they suspected abuse.
• Safeguarding policies and procedures were readily available to staff.
• The practice ensured that children needing emergency treatment would be seen on the day.

Updated 30 August 2016

The practice is now rated as good for the care of older people. Our previous inspection in December 2015 rated this practice as requires improvement for the care of older people, as the issues identified as requiring improvement for providing safe and effective services affected all patients including this population group. The practice has made significant improvement and is now rated as good for providing safe and effective services and overall.

• The practice offered proactive, personalised care to meet the needs of the older people in its population.
• It was responsive to the needs of older people, and offered home visits and urgent appointments for those with enhanced needs.
• The practice provided medical services for nursing homes without there being an additional private contract for this. The GPs conducted regular weekly doctor’s rounds for these homes.
• Elderly patients with complex care needs and those at risk of hospital admission all had personalised care plans that were shared with local organisations to facilitate the continuity of care.
• We saw evidence that the practice was working to the Gold Standards Framework for those patients with end of life care needs.
• The practice endeavoured to assist patients to remain in their preferred place of care for as long as possible.

Updated 30 August 2016

The practice is now rated as good for the care of working-age people (including those recently retired and students). Our previous inspection in December 2015 rated this practice as requires improvement for the care of working-age people (including those recently retired and students), as the issues identified as requiring improvement for providing safe and effective services affected all patients including this population group. The practice has made significant improvement and is now rated as good for providing safe and effective services and overall.

• 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.
• GPs offered advice by telephone each day for patients who had difficulty in attending the practice.
• Electronic prescribing was available which enabled patients to order their medicine on line and to collect it from a pharmacy of their choice.
• The practice offered NHS Health-checks and advice for diet and weight reduction.
• Patients could request routine travel immunisations including Yellow fever vaccinations.
• The practice offered routine appointments for patients on alternate Saturday mornings for patients who found it difficult to attend during the week.

Updated 30 August 2016

The practice is now rated as good for the care of people experiencing poor mental health (including people with dementia). Our previous inspection in December 2015 rated this practice as requires improvement for the care of people experiencing poor mental health (including people with dementia), as the issues identified as requiring improvement for providing safe and effective services affected all patients including this population group. The practice has made significant improvement and is now rated as good for providing safe and effective services and overall.

• 85% of people diagnosed with dementia had had their care reviewed in a face to face meeting in the last 12 months.
• The practice regularly worked with multi-disciplinary teams in the case management of people experiencing poor mental health, including those with dementia.
• It 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.
• It 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 people with mental health needs and dementia.
• The practice invited patients suffering from dementia and their carers for an annual review. Each patient had a comprehensive health check and a care plan agreed.

Updated 30 August 2016

The practice is now rated as good for the care of people whose circumstances may make them vulnerable. Our previous inspection in December 2015 rated this practice as requires improvement for the care of people whose circumstances may make them vulnerable, as the issues identified as requiring improvement for providing safe and effective services affected all patients including this population group. The practice has made significant improvement and is now rated as good for providing safe and effective services and overall.

• The practice held a register of patients living in vulnerable circumstances including homeless people, travellers and those with a learning disability.
• It offered longer appointments for people with a learning disability.
• There was a learning disability lead at the practice who oversaw the care provided to patients on the learning disability register.
• The practice regularly worked with multi-disciplinary teams in the case management of vulnerable people.
• It had told 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.
• Translation services were available for patients who did not use English as their first language.
• The practice could accommodate those patients with limited mobility or who used wheelchairs.
• Carers and those patients who had carers, were flagged on the practice computer system to alert staff. This included patients and carers of those receiving palliative care and possibly end of life treatment.