Archived: Silver Springs Medical Practice

Updated 12 October 2017

Silver Springs Medical Centre provides primary care services to its registered list of approximately 6760 patients. The practice has a General Medical Services (GMS) contract with NHS England. (GMS is one of the three contracting routes that have been available to enable commissioning of primary medical services). The practice is part of NHS Hastings and Rother Clinical Commissioning Group. It is situated at:

Beaufort Road, St Leonards-on-sea, East Sussex TN37 6PP

The practice had been through a period of instability over the previous two years having commenced collaboration with another local practice with a view to merging, which was not completed. An agreement was made with a larger organisation to provide administrative, senior management and GP support. Although this commenced on 1 July 2016, the support and changes only started from November 2016. The practice has already adopted the larger organisation’s procedures and policies and plans are in place for a merger with a local practice (which is already part of the supporting organisation) in 2018.

There are three GP partners (two female and one male), a further GP (male) who is named on the GP contract, carries out surgeries at the practice and is the CQC registered manager. There is a nurse practitioner, two practice nurses and two healthcare assistants. There is also a paramedic practitioner who, along with other staff, is shared with the local practice with whom Silver Springs Medical Practice plans to merge. The clinical staff are supported by a practice manager and administration and reception staff.

The practice is located on one floor, containing the reception area, waiting areas, consulting rooms, treatment rooms and disabled toilet facilities. There is step free access into the building and access for those in wheelchairs or with pushchairs.

The practice is open between 8.30am and 6.30pm each day, extended opening hours are provided on Wednesdays from 7.30am in the form of nurse led clinics and on Thursdays when GP appointments are available until 7.30pm. Patients phoning up requesting care and advice outside of these hours are directed to the out of hours service provider, IC24, via the 111 service.

The practice has a slightly higher than average number of patients over 65 years when compared to the national average. The practice also has a higher than average number of patients with long standing health conditions which could mean an increased demand for GP services. Deprivation amongst children and older people is higher than in the population nationally.

Updated 12 October 2017

Letter from the Chief Inspector of General Practice

We carried out an announced comprehensive inspection at Silver Springs Medical Practice on 15 December 2016. The overall rating for the practice was inadequate and it was placed in special measures for a period of six months. The practice was also issued with a Warning Notice and a further focused inspection was carried out on 12 April 2017 to ensure that the practice had complied with the legal requirements of the Warning Notice. The full comprehensive report on the 15 December 2016 and 12 April 2017 inspections can be found by selecting the ‘all reports’ link for Silver Springs Medical Practice on our website at www.cqc.org.uk.

After the inspection on 15 December 2016 the practice wrote to us with an action plan outlining how they would make the necessary improvements to comply with the regulations.

This inspection was an announced comprehensive inspection undertaken on 23 August 2017 following the period of special measures. Overall the practice is now rated as requires improvement.

Our key findings were as follows:

• The practice now had systems for receiving and actioning patient safety alerts.

• Significant events were now being recorded, discussed, actioned and learned from to help improve patient safety.

• Medicines were managed safely including repeat prescriptions and high risk medicines.

• All staff who acted as chaperones received a DBS (Disclosure and Barring Service) check.

• All staff were now receiving an annual appraisal.

• The practice was carrying out audits to drive quality improvements in services.

• Although improved compared to the last inspection, patient satisfaction with phone access and some aspects of care was still lower than national and local averages.

• We could not find evidence that a Legionella risk assessment had been carried out by someone with the qualifications, competence and experience to do so.

• The practice had a range of policies and procedures, but they were not always specific to the practice.

• We did not see evidence of a data sharing confidentiality agreement between the practice and the supporting organisation.

• The practice were seeking and acting on feedback from patients.

  There were areas of practice where the provider needs to make improvements.

  Importantly, the provider must:

• Ensure systems and processes are established and operated effectively to assess and monitor the service. This includes polices being specific to the practice, the detailed recording of significant events and verbal complaints and where indicated include a confidentiality sharing agreement between relevant parties.

• Ensure systems and processes are in place to identify and assess risks. This includes ensuring the training matrix is up to date and that records of the interview process and copies of staff induction forms are retained in staff files.

In addition the provider should:

• Assess and manage the risks to the health and safety of patients and staff by completing outstanding plumbing works and have a legionella risk assessment carried out by someone with the qualifications, competence and experience to do so. (Legionella is a term for a particular bacterium which can contaminate water systems in buildings).

• Review ways of increasing the percentage of patients with dementia receiving face to face interviews.

• Consider ways of improving blood pressure control in patients with raised blood pressure and in particular those with diabetes.

• Gain further feedback from patients with a view to reviewing and improving patient satisfaction.

  I am taking this service out of special measures. This recognises the significant improvements made to the quality of care provided by the service.

Professor Steve Field (CBE FRCP FFPH FRCGP) 

Chief Inspector of General Practice

Updated 12 October 2017

Our inspection on15 December 2016 identified issues which resulted in the practice being rated inadequate overall. This affected all patients including this population group and the practice was rated as inadequate for the care of people with long term conditions.

At the inspection in August 2017 we saw significant improvements and the practice is now rated as requires improvement overall, this affected all patients including this population group.

• The practice ran chronic lung disease, asthma, diabetic and coronary heart disease clinics.
• Patients with any of these conditions were offered a yearly review with the nurse and were encouraged to have their yearly flu vaccine.
• Patients with complex needs were, if necessary, discussed at the multi-disciplinary meetings.

The practice offered a 24 hour blood pressure and a seven day ECG (heart recording) service.

Updated 12 October 2017

Our inspection on 15 December 2016 identified issues which resulted in the practice being rated inadequate overall. This affected all patients including this population group and the practice was rated as inadequate for the care of families, children and young people.

At the inspection in August 2017 we saw significant improvements and the practice is now rated as requires improvement overall, this affected all patients including this population group.

• There were systems in place to identify and follow up children living in disadvantaged circumstances and who were at risk.

• The practice’s uptake for the cervical screening programme was 82%, which was comparable with the clinical commissioning group average of 84% and the national average of 81%.

• The surgery offered a full range of immunisations and vaccines and also positively encouraged young people to take part in chlamydia screening.

• Appointments were available outside of school hours and the premises were suitable for children and babies.

• Health visitors attend multi-disciplinary team meetings.

• The safeguarding lead worked with midwives and health visitors.

Updated 12 October 2017

Our inspection on 15 December 2016 identified issues which resulted in the practice being rated inadequate overall. This affected all patients including this population group and the practice was rated as inadequate for the care of older people.

At the inspection in August 2017 we saw significant improvements and the practice is now rated as requires improvement overall, this affected all patients including this population group.

• The practice assessed older patients using a frailty score.
• The practice collaborated with the frailty and crisis team to help prevent acute hospital admission.
• A paramedic practitioner helped co-ordinate care of the most vulnerable elderly patients.
• Patients considered to be vulnerable had a specifically designed care plan and medication reviews.
• Home visits were available to patients that required them and longer appointments were available if required.
• Multi-disciplinary meetings were held monthly at which patients with specific needs were, with their permission, discussed with health professionals from other agencies.

Updated 12 October 2017

Our inspection on 15 December 2016 identified issues which resulted in the practice being rated inadequate overall. This affected all patients including this population group and the practice was rated as inadequate for the care of working age people (including those recently retired and students).

At the inspection in August 2017 we saw significant improvements and the practice is now rated as requires improvement overall, this affected all patients including this population group.

• 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 offered a range of online services including an appointments service and repeat prescription ordering. Patients could also sign up to a text reminder service.
• They also offered a full range of health promotion and screening that reflected the needs for this age group including a self-testing blood pressure cuff in the waiting room.
• There were extended weekday surgery hours and Saturday morning surgeries available. Phone consultations were also offered.
• On site psychology services were available.

Updated 12 October 2017

Our inspection in December 2016 identified issues which resulted in the practice being rated inadequate overall. This affected all patients including this population group and the practice was rated as inadequate for the care of people experiencing poor mental health (including people with dementia).

At the inspection in August 2017 we saw significant improvements and the practice is now rated as requires improvement overall, this affected all patients including this population group.

• 73% 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 clinical commissioning group (CCG) 82% and national average of 84%.

• 91% of patients with severe and enduring mental health problems had a comprehensive care plan documented in their records within the last 12 months which was comparable to the CCG average of 87% and national average of 89%.

• 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.

• Carers were offered health checks and a flu vaccine.

• The practice had told patients experiencing poor mental health about how to access various support groups and voluntary organisations.

• The practice facilitated self-help and contact with counselling services for patients.

• 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.

• Same day appointments were available for those with acute mental health concerns.

• Patients diagnosed with mental health problems who were at risk of overusing medicines were prescribed medication accordingly; this was on a daily, weekly or monthly basis.

Updated 12 October 2017

Our inspection on 15 December 2016 identified issues which resulted in the practice being rated inadequate overall. This affected all patients including this population group and the practice was rated as inadequate for the care of people whose circumstances may make them vulnerable.

At the inspection in August 2017 we saw significant improvements and the practice is now rated as requires improvement overall, this affected all patients including this population group.

• The practice held a register of patients living in vulnerable circumstances including those with a learning disability. The practice offered longer appointments for patients who required them. Alerts on the clinical system identified vulnerable patients.

• The practice regularly worked with other health care professionals in the case management of vulnerable patients. The clinical system allowed data sharing of critical information (with consent).
• 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.
• There were noticeboards in the surgery displaying self-help material. A translation service was available.
• The practice worked with other health professionals to identify and address any special needs that individuals may have.
• Weekly prescriptions were available for patients at risk of overusing medicines.